Elhamamy Mona H, Elbeialy Adel A, Mohamed Maha S, Abdelraheem Sabah E, Elzomor Hala M
Rheumatology Department, Al-Azhar University Faculty of Medicine for Girls, 74 Ali Amin St, Nasr City, PO 11727, Cairo, Egypt.
Clinical Pathology Department, Al-Azhar University Faculty of Medicine for Girls, Cairo, Egypt.
BMC Rheumatol. 2025 Jan 8;9(1):3. doi: 10.1186/s41927-024-00428-0.
Fibromyalgia Syndrome (FMS) is a chronic disabling musculoskeletal condition of unknown aetiology characterized by generalized musculoskeletal pain, extreme fatigue, mood disturbance, impaired cognition, and lack of refreshing sleep. Middle East pain syndrome (MEPS) is a newly described pollution-induced syndrome of hyperparathyroidism and fibromyalgia mimicking rheumatoid arthritis, characterized by the radiological presence of spur-like excrescences in terminal phalanges. This study aimed to explore the inflammatory nature of Middle East pain and Fibromyalgia syndromes.
Eighty primary fibromyalgia patients were included in this study. They were divided into two groups, group [1] 1 of 40 FMS patients with low vitamin D levels and secondary hyperparathyroidism, which were diagnosed as MEPS, and group [2] of 40 primary FMS patients. They were subjected to full medical history taking, clinical examination and laboratory assessment including serum IL-17 by enzyme-linked immunosorbent assay technique, as well as assessment of Madrid Sonographic Enthesitis Index (MASEI) using musculoskeletal ultrasound and nailfold capillaroscopic pattern assessment. Plain X-ray films for hands were done on all patients.
There was a statistically significant elevation of serum IL17 in the MEPS group (median = 58.3 ng/L) compared to the FMS group (median = 45.7 ng/L) as the p-value is < 0.05. Capillaroscopic examination revealed a statistically significant difference between MEPS and FMS groups regarding angiogenesis as the p-value is < 0.05. The ultrasonographic examination also showed a statistically significant difference between MEPS and FMS groups as regards MASEI score as the p-value is < 0.05. Hands X-rays evidenced the exclusive existence of tuft spur-like excrescences in MEPS patients only.
Elevated IL-17 levels, non-scleroderma pattern capillaroscopic and enthesopathy findings in both MEPS and FMS patients are strongly supportive that inflammatory mechanisms participate in the pathogenesis of both diseases. The significant increase of these findings in MEPS than FMS patients as well as the presence of hand tufts spur-like excrescences, confirm that the newly discovered MEPS is a different disease although it involves fibromyalgia symptoms and signs.
纤维肌痛综合征（FMS）是一种病因不明的慢性致残性肌肉骨骼疾病，其特征为全身性肌肉骨骼疼痛、极度疲劳、情绪障碍、认知受损以及睡眠不佳。中东疼痛综合征（MEPS）是一种新描述的由污染引起的综合征，表现为甲状旁腺功能亢进和类似类风湿关节炎的纤维肌痛，其特征是在末节指骨出现刺状赘生物的影像学表现。本研究旨在探讨中东疼痛综合征和纤维肌痛综合征的炎症性质。
本研究纳入了80例原发性纤维肌痛患者。他们被分为两组，第1组为40例维生素D水平低且继发甲状旁腺功能亢进的纤维肌痛患者，被诊断为中东疼痛综合征；第2组为40例原发性纤维肌痛患者。对他们进行了全面的病史采集、临床检查和实验室评估，包括采用酶联免疫吸附测定技术检测血清白细胞介素-17（IL-17），以及使用肌肉骨骼超声和甲襞毛细血管镜模式评估马德里超声附着点炎指数（MASEI）。对所有患者进行了手部X线平片检查。
与纤维肌痛综合征组（中位数 = 45.7 ng/L）相比，中东疼痛综合征组血清IL-17水平有统计学显著升高（中位数 = 58.3 ng/L），p值 < 0.05。毛细血管镜检查显示，中东疼痛综合征组和纤维肌痛综合征组在血管生成方面存在统计学显著差异，p值 < 0.05。超声检查还显示，中东疼痛综合征组和纤维肌痛综合征组在马德里超声附着点炎指数评分方面存在统计学显著差异，p值 < 0.05。手部X线片仅在中东疼痛综合征患者中显示有簇状刺状赘生物的存在。
中东疼痛综合征和纤维肌痛综合征患者中IL-17水平升高、非硬皮病模式的毛细血管镜检查结果和附着点病表现，有力地支持了炎症机制参与这两种疾病的发病过程。与纤维肌痛综合征患者相比，这些表现中东疼痛综合征患者显著增加，以及手部簇状刺状赘生物的存在，证实新发现的中东疼痛综合征是一种不同的疾病，尽管它涉及纤维肌痛的症状和体征。
