Diagnosing Fibromyalgia
There are no biomarkers available for the diagnosis of fibromyalgia, which may lead to significant management challenges. Clinicians currently rely on diagnosis through patient-reported information and physical evaluation of a patient's pain.
In a new study,1 Kevin Hackshaw, MD, associate professor in the division of rheumatology and immunology at The Ohio State University Wexner Medical Center, and colleagues used vibrational spectroscopy on blood spot samples to develop a rapid biomarker-based method for diagnosing fibromyalgia. Through this technique, the researchers were able to differentiate patients with fibromyalgia from patients with rheumatoid arthritis, osteoarthritis, and systemic lupus erythematosus.
Consultant360 caught up with Dr Hackshaw about the research.
Consultant360: What prompted you to conduct this study?
Dr Hackshaw: The study evolved from our prior animal studies that showed spectroscopy could differentiate various aspects of feline interstitial cystitis from normal cats via blood spot samples. Since there are many parallels between interstitial cystitis and fibromyalgia, we sought to do the same type of analysis in patients with fibromyalgia.
C360: What is the significance of having a biomarker to identify fibromyalgia?
Dr Hackshaw: A large portion of this population is inappropriately treated with narcotic analgesics. Identification of fibromyalgia would redirect the prescribing physician to treat with more appropriate nerve-based agents. In addition, an early diagnosis may reduce the significant health care costs that result from patients with fibromyalgia.
C360: Treatment options are limited, with patients often prescribed opioids for their pain. What overall impact does opioid use have on this patient population?
Dr Hackshaw: In chronic pain clinics, 40% of treated individuals meet clinical criteria for fibromyalgia. These numbers strongly suggest that a number of chronic pain patients are inappropriately treated with opioids rather than neuropathic agents. Generally speaking, opioids have no role in the treatment of neuropathic pain. Instead, emphasis should be on use of exercise, tricyclic agents, voltage-gated calcium blockers, muscle relaxants, sodium channel modulators, and other neuropathic agents.
C360: A new blood test biomarker could influence the use of targeted treatments in fibromyalgia. How do you think targeted treatment could change the management of patients?
Dr Hackshaw: In our study, we were able to identify certain chemical groups that were more predominantly seen in varying subsets of fibromyalgia. If we were to find that individuals with fibromyalgia and severe depression displayed a unique biochemical profile compared to individuals with fibromyalgia and sleep disturbance or fibromyalgia without depression, then this type of clinical phenotype might be matched with a specific treatment paradigm, if identified, by our molecular studies. This would result in a form of personalized medicine which should be highly efficacious.
Reference:
- Hackshaw KV, Aykas DP, Sigurdson GT, et al. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J Biol Chem. 2019;294(7):2555-2568. doi:10.1074/jbc.RA118.005816