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Fibromyalgia Symptoms and Cirrhosis

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Abstract

Background

An association between fibromyalgia and hepatitis C virus (HCV) has been previously described. However, the relationship between nonalcoholic steatohepatitis (NASH) and fibromyalgia symptoms has not been assessed, though they share several risk factors.

Aim

We aimed to assess the factors associated with fibromyalgia symptoms across etiologies of liver disease.

Methods

Patients with cirrhosis due to HCV, NASH, or alcohol were recruited from an outpatient hepatology clinic and administered the Hospital Anxiety and Depression Score, Pittsburgh Sleep Quality Index, and the modified 2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia. Serum inflammatory markers were measured with standard luminex assays.

Results

Of 193 participants, 53 (27 %) met criteria for fibromyalgia. Fibromyalgia symptoms were significantly associated with etiology of liver disease (HCV: 35 %, NASH: 30 %, alcohol-related liver disease: 12 %, p < 0.01). Using logistic regression, mood symptoms (OR 1.14, 95 % CI 1.06, 1.22), sleep disturbance (OR 1.32, 95 % CI 1.16, 1.52), and etiology of liver disease (NASH vs. HCV not different, alcohol vs. HCV OR 0.19, 95 % CI 0.05, 0.63) were associated with fibromyalgia symptoms. If abdominal pain was included in the model, etiology became nonsignificant, indicating that it may be central sensitization due to abdominal pain in patients with chronic liver disease that explains fibromyalgia symptoms rather than the etiology of liver disease or inflammation.

Conclusions

Fibromyalgia symptoms were significantly associated with HCV and NASH cirrhosis and with psychiatric symptoms. Future work should focus on the underlying pathophysiology and management of widespread pain in patients with cirrhosis.

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Acknowledgments

We would like to thank Amy Schmotzer and Sharon Boggiano for their help with this project. This project was supported by the Starzl Transplantation Institute Young Investigator Award, NIH grant T32-DK063922.

Conflict of interest

We have no disclosures relevant to the manuscript, but Dr. Szigethy has received travel support from Merck.

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Authors and Affiliations

  1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA

    Shari S. Rogal

  2. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Shari S. Rogal

  3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA

    Klaus Bielefeldt

  4. Department of Anesthesia, University of Pittsburgh, Pittsburgh, PA, USA

    Ajay D. Wasan

  5. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    Eva Szigethy, Francis Lotrich & Andrea F. DiMartini

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  1. Shari S. Rogal
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Correspondence to Shari S. Rogal.

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Rogal, S.S., Bielefeldt, K., Wasan, A.D. et al. Fibromyalgia Symptoms and Cirrhosis. Dig Dis Sci 60, 1482–1489 (2015). https://doi.org/10.1007/s10620-014-3453-3

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