Do sex hormones play a role in fibromyalgia?

S. Akkus, N. Delibas1 and M. N. Tamer2

Süleyman Demirel University Medical School, Departments of Physical Medicine and Rehabilitation,
1 Biochemistry and
2 Endocrinology, Isparta, Turkey

SIR, Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread pain, exquisite tenderness at specific anatomical sites (i.e. tender points) and other clinical manifestations, such as fatigue, sleep disturbance and irritable bowel syndrome [1]. Despite increasing research efforts, considerable debate remains concerning the role of peripheral and central factors in the aetiopathogenesis of FM [2]. Nevertheless, there is no explanation for the higher frequency in women, which suggests that sex hormones may have a role in the expression of the disease.

Recent studies have demonstrated elevated levels of substance P (SP) in cerebrospinal fluid obtained from FM patients [3, 4]. SP is a peptide which has a role in the neurotransmission of pain from the periphery to the central nervous system [3]. The concentrations of SP in the brain appear to be modulated by ovarian steroids [5, 6]. Oestrogen also affects the contents of certain neuropeptides, including SP [6], in the hypothalamus. Furthermore, the number of SP-binding sites in the anterior pituitary varies during the oestrous cycle in rats [5].

The physiological functions of SP are influenced by serotonin [7], which is recognized as the chemical mediator of deep sleep and pain perception [8]. Investigators have recently observed serotonin deficiency in FM sera [9]. In addition, ovarian steroid hormones affect the function of the serotonin neural system [10]. A recent experimental study has also demonstrated that skeletal myoblasts contain oestrogen receptors [11]. Therefore, serum levels of oestradiol, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in patients with FM were determined in this study. To our knowledge, this is the first study investigating oestradiol, FSH and LH in FM.

The study population consisted of 87 female patients with FM (47 pre-menopausal and 40 post-menopausal women, mean age 44.4 ± 8 yr). All patients fulfilled the criteria of the American College of Rheumatology for FM. Fifty healthy adults (26 pre-menopausal and 24 post-menopausal women, mean age 42.7 ± 9 yr) served as controls. Oestradiol, FSH and LH were measured by chemiluminescence assay (ACS 180 Plus, Chiron Diagnostic, East Walpole, MA, USA). All studies were performed in the early follicular phase of the menstrual cycle (3rd day) in pre-menopausal subjects. The unpaired Student's t-test was used for comparison of oestradiol, FSH and LH concentrations between the patient group and the control group. Statistical significance was assigned to P values lower than 0.05.

A comparison of serum levels of oestradiol, FSH and LH in patients with FM and controls is presented in Table 1Go. As shown in the table, there were no significant differences in the measured values between the groups (P > 0.05).


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TABLE 1. Mean values of oestradiol, FSH and LH in patients with FM and control subjects

 
Several prospective studies have demonstrated a statistical correlation between sex hormones and some rheumatic diseases [1216]. Low oestradiol levels have been demonstrated in pre-menopausal and post-menopausal women with ankylosing spondylitis (AS) [12]. It has been reported that the administration of oestrogens has a demonstrable ameliorating effect in women with active AS and in rheumatoid arthritis [15, 16]. Furthermore, increased LH concentrations have been shown in patients with AS [14]. However, we have not found significant differences in oestradiol, FSH and LH serum levels in patients with FM. Further clinical and experimental studies are required to determine the role of sex hormones in the pathogenesis of this condition.

Notes

Correspondence to: S. Akkus, Hizirbey mah. 1523 Sok. Mutlu apt. No. 8/5 TR-32040, Isparta, Turkey. Back

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Accepted 30 March 2000





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