الفهرس 
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Abstract
Fibromyalgia syndrome (FMS) is a complex clinical syndrome that primarily affects middle-age women (Redondo et al., 2004). It is believed to arise from the abnormal central sensory processing of pain signals, involving the interaction between neurotransmitters, external stressors, behavioural constructs, hormones and the sympathetic nervous system. FM is characterized by pain (Sokka,2005), associated with sleep disturbances (non-refreshing sleep, hypersomnolence) (Carette et al.,1995); (Sarzi-Puttini et al., 2002) the presence of specific painful sites (tender points) (Martinez-Lavin,2001), and is often accompanied by fatigue and depression (Torpy et al.,2000).
Its etiology is not known, and several aspects of its pathogenesis are being investigated (Fitzcharles and Boulos, 2003).
Brain derived neurotrophic factor (BDNF), a member of neurotrophines, is the most prevalent growth factor in the central nervous system(CNS).It is essential for the development of the CNS and for neuronal plasticity. Because BDNF plays a crucial role in development and plasticity of the brain, it is widely implicated in psychiatric diseases ( Binder and Scharfman , 2004).
The aim of this study was to evaluate serum level of brain-derived neurotrophic factor in fibromyalgia patients and its relation to depression.
Thirty patients with primary fibromyalgia syndrome (FMS) who fulfilled the recent preliminary diagnostic Criteria for diagnosis of fibromyalgia syndrome (Wolf et al.2010) were enrolled in the study together with twenty age and sex matched apparently healthy volunteers were enrolled as a control group.
These patients were selected randomly from the in-patients’ and the out-patients’ clinic of the Rheumatology and Rehabilitation Department of Benha University Hospitals between May 2014 and September 2014 .
All patients and subjects provided an informed consent prior to participation
Criteria for Exclusion of fibromyalgia patients:
- History of psychological disorders prior to diagnosis of FM.
- Family history of psychological disorders.
- Presence of autoimmune disease.
- Sever chronic disabling conditions like sever complicated diabetes mellitus (DM) or hypertension (HTN).
- Known malignancy.
All patients included in this study were subjected to full history taking, general and local examination:
(1) History taking
(2) Examination
(3) Assessment of pain using VAS (Revill et al., 1976).
(4) Assessment of disability and current health status using fibromyalgia impact questionnaire( FIQ) (Burckhardt et al., 1991).
(5)Assessment of depression using Hamilton depression rating scale (HDR-S) (Hamilton, 1960).
(6) Laboratory investigations include:
Complete blood count (CBC).
Erythrocyte sedimentation rate(ESR).
Serum CRP (c-Reactive protein).
Renal function tests. S.creatinine,S. urea
liver function tests: SGPT, SGOT , s.albumin. s.bilirubin, PT.
Fasting blood sugar & 2 hours post brandial.
Hepatitis C virus antibody.
Anti-nuclear antibodies(ANAs Anti-nuclear antibodies) by indirect immuno fluorescence technique
Rheumatiod factor by latex agglutination test
serum brain derived neurotrophic factor[BDNF]: by ElISA( for both patients and healthy controls).
(7)-plain x-ray on both hands and both knees .
The result of our study were calculated , tabulated and statistically analyzed.
The findings of this study were as follow:
The mean value of FMS age were 34.71 1.29 years, disease duration was 4.88 4.19 years.
In our study the most reported symptoms in FM patients were : fatigue was about (86.67% ), paresthesia (70%), sleep disturbance (63,33%),IBS was (33.33%) ,joint pain (93.33%),post exertional pain and diffuse pain (100%) ,memory disorder (51.25%), migraine headache(56.67) ,soft tissue swelling(53.33),weight loss (46.67)and loss of appetite(60%).
Least reported symptoms were ,joint swelling (10%), Raynauds phenomena(16,67%), confusion (26.67)and morning stiffness (16.67%).
Psychological disturbances were prominent in our PFM patients. Significantly higher frequencies of depression (90%) and anxiety (76.67%) were observed in our patients compared to HCs.
Our results using Hamelton depression rating scale (HDR-S) showed that only 10 % of FM patients reported no depression, while FM patients with depression were 90% subdivided into 66.67% have mild depression, 20% have moderate depression and 3.33% have severe depression.
Mean BDNF levels were higher in FM patients group than HCs and in PFM patients with depression higher than PFM patients without depression .
Mean serum BDNF levels were elevated with increasing grade of depression.
There was( negative) inverse correlation between mean serum levels of BDNF and age of HCs while there was non-significant correlation between BDNF and age of PFM patients.
Mean score of VAS measuring average pain intensity was higher in PFM than HCs.
FIQ score was (59.03±5.5) and the highest mean FIQ subscale scores were observed in fatigue and depression.
Conclusion:
This study showed that mean serum levels of BDNF was age-dependent in HCs. FMS patients had higher level of serum BDNF as compared to HCs. Additionally, serum level of BDNF showed correlation with depression, but not with other disease manifestations . Mean serum level of BDNF increased with higher values of depression score in FMS.
Taken together, BDNF is involved in the pathophysiology of FMS. Additionally, it seems to be correlated with intensity of depressive symptoms in FMS.