Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
Neuroalgology Unit, Carlo Besta Institute, Milano, Italy.
Clin Exp Rheumatol. 2023 Jun;41(6):1216-1224. doi: 10.55563/clinexprheumatol/ld0lxn. Epub 2022 Jul 27.
Small fibre pathology is frequently described in fibromyalgia (FM), but its evolution and its role in clinical outcome of the disease are unclear. This longitudinal observational real-life study aimed to monitor the evolution of skin nerve fibre density in FM, in view of the clinical data.
Sixty-two FM patients were controlled by means of skin biopsy and clinical assessment after 18 months of follow-up.
At T0 intraepidermal nerve fibre density (IENFD) was normal in 10 patients, reduced at thigh-proximal-site in 46 cases and decreased at proximal and foot-distal-site in 6 patients. At follow up-T1-the IENFD was unchanged, while Brief Pain Inventory-BPI-pain sub score, DN4 and fatigue were improved. Reduced IENFD at proximal and distal sites, together with fatigue and BPI-motor and work sub scores were predictors of more severe disability measured with Fibromyalgia Impact Questionnaire (FIQ) at T1. Reduced IENFD influenced a minor effect of drugs-antiepileptics and/or antidepressants, and physical exercise on fatigue.
Small fibre impairment seems stable in medium term in FM. A possible influence of small fibre dysfunction on motor performance could have a role in FM evolution. The beneficial effect of physical exercise could be limited in patients with reduced IENFD.
小纤维病理学在纤维肌痛（FM）中经常被描述，但它在疾病的临床结果中的演变和作用尚不清楚。这项前瞻性观察性真实世界研究旨在监测 FM 中皮肤神经纤维密度的演变，同时观察临床数据。
62 名 FM 患者在 18 个月的随访后通过皮肤活检和临床评估进行控制。
在 T0 时，10 名患者的表皮内神经纤维密度（IENFD）正常，46 名患者大腿近端部位减少，6 名患者近端和足部远端部位减少。在随访-T1 时，IENFD 没有变化，而简明疼痛量表（BPI）疼痛子评分、DN4 和疲劳都有所改善。近端和远端部位的 IENFD 减少、疲劳以及 BPI-运动和工作子评分是 T1 时更严重残疾的预测因素，用纤维肌痛影响问卷（FIQ）进行评估。IENFD 减少影响抗癫痫药和/或抗抑郁药以及体育锻炼对疲劳的疗效。
小纤维损伤在 FM 中似乎在中期保持稳定。小纤维功能障碍对运动表现的可能影响可能在 FM 的演变中起作用。在 IENFD 减少的患者中，体育锻炼的有益作用可能受到限制。
