Ramírez Manuel, Guerra-Juárez Arturo, Miyake Daniel-Yoshiro, Sebastian-Arellano Christian, Estrada-Mata Aranza-Guadalupe, González-Moyotl Nadia-Janet, Rodríguez-Aguayo Allan-Miguel, Martínez-Lavin Manuel, Martínez-Martínez Laura-Aline
From the Servicio de Cornea del Hospital Sánchez Bulnes de la Asociación para Evitar la Ceguera en México.
Departamento de Reumatología del Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
J Clin Rheumatol. 2021 Dec 1;27(8):e606-e608. doi: 10.1097/RHU.0000000000001592.
A consistent line of investigation proposes fibromyalgia as a dysautonomia-associated neuropathic pain syndrome. Comorbid anxiety or depression amplifies fibromyalgia symptoms. The recent recognition of small fiber neuropathy in fibromyalgia patients supports the neuropathic nature of the illness. Corneal confocal microscopy accurately identifies small nerve fiber pathology. The newly developed Small-Fiber Symptom Survey captures the spectrum of small fiber neuropathy symptoms. We aimed to correlate corneal nerve density with different fibromyalgia disease severity questionnaires including the Small-Fiber Symptom Survey. We defined the possible confounding role of comorbid anxiety or depression severity in the clinical-pathological association.
This is a case series of 28 women with fibromyalgia. A single ophthalmologist quantified corneal subbasal plexus nerve density. Corneal innervation was correlated (Spearman ρ) with the following clinical questionnaires scores: Small-Fiber Symptom Survey, Revised Fibromyalgia Impact Questionnaire, and COMPASS-31 (Composite Autonomic Symptom Survey 31-Item Score). Validated inquiry forms assessed the comorbid anxiety and/or depression severity.
There were no clinical-pathological correlations in the group as a whole. In the subgroup of fibromyalgia women without severe anxiety or depression (n = 13), there was a strong negative correlation between corneal nerve density with the Small-Fiber Symptom Survey score (ρ = -0.771, p = 0.002) and COMPASS-31 score (ρ = -0.648, p = 0.017). Patients with profound anxiety or depression (n = 15) had more intense symptoms but had not clinical-pathological correlations.
Small fiber neuropathy and dysautonomia symptoms correlate with corneal denervation in women with fibromyalgia without severe anxiety or depression. This clinical-pathological association reinforces fibromyalgia as a dysautonomia-related neuropathic pain syndrome. Severe anxiety or depression distorts fibromyalgia symptoms.
Corneal confocal microscopy may become a useful procedure to study fibromyalgia patients.
一系列连贯的调查研究表明纤维肌痛是一种与自主神经功能障碍相关的神经性疼痛综合征。合并焦虑或抑郁会加重纤维肌痛症状。最近在纤维肌痛患者中发现的小纤维神经病变支持了该病的神经性本质。角膜共焦显微镜能够准确识别小神经纤维病变。新开发的小纤维症状调查问卷涵盖了小纤维神经病变症状的范围。我们旨在将角膜神经密度与包括小纤维症状调查问卷在内的不同纤维肌痛疾病严重程度问卷进行关联。我们确定了合并焦虑或抑郁严重程度在临床病理关联中可能起到的混杂作用。
这是一项包含28名纤维肌痛女性患者的病例系列研究。由一名眼科医生对角膜基底丛下神经密度进行量化。角膜神经支配与以下临床问卷得分进行相关性分析（Spearman ρ）：小纤维症状调查问卷、修订版纤维肌痛影响问卷以及COMPASS - 31（31项复合自主神经症状调查问卷得分）。通过经过验证的询问表评估合并焦虑和/或抑郁的严重程度。
在整个研究组中未发现临床病理相关性。在无严重焦虑或抑郁的纤维肌痛女性亚组（n = 13）中，角膜神经密度与小纤维症状调查问卷得分（ρ = -0.771，p = 0.002）以及COMPASS - 31得分（ρ = -0.648，p = 0.017）之间存在强烈的负相关。存在严重焦虑或抑郁的患者（n = 15）症状更严重，但不存在临床病理相关性。
在无严重焦虑或抑郁的纤维肌痛女性患者中，小纤维神经病变和自主神经功能障碍症状与角膜去神经支配相关。这种临床病理关联强化了纤维肌痛作为一种与自主神经功能障碍相关的神经性疼痛综合征的地位。严重焦虑或抑郁会使纤维肌痛症状失真。
角膜共焦显微镜检查可能会成为研究纤维肌痛患者的一种有用方法。
