Background & Aims

Fibromyalgia syndrome (FMS) is a chronic disease with the main symptoms chronic widespread pain, exhaustion and non-restorative sleep. Many patients also suffer from further symptoms, such as cognitive impairment, depression and anxiety. Chronic low-grade inflammation with increased levels of cytokines has been implicated in the pathophysiology of FMS. Periodontitis (PA) is a chronic inflammatory disease characterized by soft tissue and bone loss, which may lead to a loss of teeth. Patients suffer from a loss of function, aesthetics, phonetics and life quality. The pathogenesis of PA is based on a low-grade inflammation indicated by systemically elevated cytokines like interleukin (IL)-6, tumor necrosis factor-alpha (TNF-?), IL-17A and IL-18. Here we hypothesized that proinflammatory cytokine levels would be higher in FMS patients with additional PA.

Methods

In this study, 143 individuals were included divided into 24 FMS (FMS), 46 FMS and PA (FMS+PA), 44 PA (PA) patients and 29 healthy controls (HC). IL-10, IL-17A, IL-18, IL-6 and TNF-? were measured using the ELLATM device (ProteinSimple, CA, USA). Short-Form-Health-Survey-12 (SF-12) was used to determine health-related quality of life (QuL). The German version of the Center for Epidemiological Studies Depression Scale (ADS) was used to measure the severity of depression-related symptoms in the last week.

Results

The FMS+PA group had a higher analgesic use than the FMS group (FMS: 16,7%, FMS+PA: 30,4% (?2(6) = 34,820, p < 0,001, V = 0,349). The FMS and FMS+PA groups had higher median ADS sum scores than the PA group (p = 0.002) and HC (p < 0.001). In the physical sum scale of SF-12, the FMS and FMS+PA groups had lower median sum scores compared to PA and HC (p < 0.001). The PA but not the FMS group showed increased median TNF-? levels (11 pg/ml (7.41 - 18.9 pg/ml)) compared to HC (8.92 (6.26 - 16.0 pg/ml); p < 0.001). Median IL-6 levels were higher both in FMS+PA (2.62 pg/ml (0.61-19.5 pg/ml) (p < 0.001) and in PA (2.13 (0.85 - 51.7); p = 0.002) compared to HC (1.34 (0.58 - 9.13). None of the cytokines was higher in the FMS+PA group compared to FMS and PA alone.

Conclusions

The main hypothesis that the pro-inflammatory states of FMS and PA lead to additive cytokine levels in patient blood could be refuted. Blood cytokine levels were increased in both FMS+PA and PA, with high interindividual variability.

References

Eich, W., Bär, K. J., Bernateck, M., Burgmer, M., Dexl, C., Petzke, F., Sommer, C., Winkelmann, A., & Häuser, W. (2017). [Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. Schmerz, 31(3), 231-238. https://doi.org/10.1007/s00482-017-0200-7
Uçeyler, N., Häuser, W., & Sommer, C. (2011). Systematic review with meta-analysis: cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord, 12, 245. https://doi.org/10.1186/1471-2474-12-245
Pan, W., Wang, Q., & Chen, Q. (2019). The cytokine network involved in the host immune response to periodontitis. Int J Oral Sci, 11(3), 30. https://doi.org/10.1038/s41368-019-0064-z
Zhang, Y., Kuang, W., Li, D., Li, Y., Feng, Y., Lyu, X., Huang, G. B., Lian, J. Q., Yang, X. F., Hu, C., Xie, Y., Xue, S., & Tan, J. (2021). Natural Killer-Like B Cells Secreting Interleukin-18 Induces a Proinflammatory Response in Periodontitis. Front Immunol, 12, 641562. https://doi.org/10.3389/fimmu.2021.641562

Presenting Author

Nadine Cebulla

Poster Authors

Nadine Cebulla

OTHR

Department of Neurology University Hospital Würzburg

Lead Author

E-mail

Ariane Hillenbrand

Department of Neurology, University Hospital Würzburg

Lead Author

E-mail

Yvonne Jockel-Schneider Prof. Dr.

Department of Periodontology, University Hospital Würzburg

Lead Author

E-mail

Claudia Sommer

Prof. Dr. MD

Institute for neurology, university hospital Würzburg, Germany

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Fibromyalgia