Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, USA.
Clin Rheumatol. 2012 Apr;31(4):677-85. doi: 10.1007/s10067-011-1912-1. Epub 2011 Dec 27.
The heterogeneity of patients meeting American College of Rheumatology (ACR) criteria for a diagnosis of fibromyalgia (FM) challenges our ability to understand the underlying pathogenesis and to optimize treatment of this enigmatic disorder. Our goal was to discern clinically relevant subgroups across multiple psychological and biomedical domains to better characterize the phenomenology of FM. Women meeting 1990 ACR criteria for FM (N = 107) underwent psychological (childhood trauma, mood, anxiety, and stress) and biomedical (neuroendocrine, immune, and metabolic) testing. Cluster analysis identified four distinct subgroups. Subgroups I, II, and III exhibited profiles that included high psychological distress. Subgroup I was further distinguished by a history of childhood maltreatment and hypocortisolism, and these women reported the most pain and disability. Subgroup II evinced more physiological dysregulation and also reported high levels of pain, fatigue, and disability. Subgroup III was characterized by normal biomarkers and reported intermediate pain severity with higher global functioning. Subgroup IV was distinguished by their psychological well-being, reporting less disability and pain. Our findings underscore the heterogeneity of both psychological and physiological features among FM patients presenting with nearly identical tender point counts. This subgroup categorization is compatible with hypothesized pathogenetic mechanisms of early trauma, stress system dysregulation, and pro-inflammatory bias, each prominent in some but not all FM patients. Appreciation of distinct FM subgroup features is invaluable for selecting the most appropriate treatment modalities.
纤维肌痛（FM）患者符合美国风湿病学会（ACR）诊断标准的异质性，这对我们理解其潜在发病机制和优化这种神秘疾病的治疗提出了挑战。我们的目标是在多个心理和生物医学领域辨别出具有临床意义的亚组，以更好地描述 FM 的表型。符合 1990 年 ACR FM 标准的女性（N=107）接受了心理（童年创伤、情绪、焦虑和压力）和生物医学（神经内分泌、免疫和代谢）测试。聚类分析确定了四个不同的亚组。亚组 I、II 和 III 表现出包括高度心理困扰的特征。亚组 I 进一步以童年期虐待和皮质醇功能减退为特征，这些女性报告的疼痛和残疾程度最高。亚组 II 表现出更多的生理失调，同时也报告了较高水平的疼痛、疲劳和残疾。亚组 III 的生物标志物正常，报告的疼痛严重程度中等，整体功能较高。亚组 IV 的特点是心理健康，报告的残疾和疼痛较少。我们的发现强调了在几乎具有相同压痛计数的 FM 患者中，心理和生理特征的异质性。这种亚组分类与早期创伤、应激系统失调和促炎倾向的假设发病机制相兼容，这些机制在某些但不是所有 FM 患者中都很突出。了解不同 FM 亚组的特征对于选择最合适的治疗方式非常重要。
