Prevalence of fibromyalgia syndrome in diabetics with chronic pain at the Kenyatta National Hospital

JIN U, GO O, CF O, M M, N N. "Prevalence of fibromyalgia syndrome in diabetics with chronic pain at the Kenyatta National Hospital." Afr J Rheumatol . 2017; Vol. 5(1): 54-57.


Background: Fibromyalgia Syndrome
(FMS), an increasingly recognized
disorder with heightened response to
pressure, characterized by Chronic
Widespread Pain (CWP), for which no
other cause can be identified. Diabetes
Mellitus (DM) is the most common
metabolic endocrinopathy. It is estimated
that more than 50% of diabetic patients
will suffer from chronic disability.
Musculoskeletal complications of
diabetes may be as a consequence of DM
complications or direct associations e.g.
Objectives: To determine the prevalence
of FMS in diabetics with chronic pain
and to determine the severity of FMS
related symptoms using the revised FMS
questionnaire (FIQR) tool.
Design: Descriptive cross-sectional study.
Setting: The Diabetic Out-patient Clinic
(DOPC), Kenyatta National Hospital
Subjects: Two hundred and nineteen
patients with chronic musculoskeletal
Results: The prevalence of fibromyalgia
in this group of patients was 61 (27.9%)
(95% CI 21.9-34.2). Mean age for patients
with FMS was 59.9 years, significantly
older than patients without FMS (55.6%)
(P=0.034). There was a higher female
preponderance at 49 (80%). Majority of
our study population were on followup
for Type 2 DM (94.1%). The mean
tender-point count for patients with FMS
was estimated at 13.7 (SD 2.1). The mean
FIQR score was 51.9 (SD 18.4) (moderate
disease). Patients with FMS had a higher
HBA1c value compared to those without
(9.6% vs. 9.3%) (P=0.565). Other
factors such as marital status, nature of
employment, activities of daily living and
type of medications used were not found
to be statistically significant. (P˃0.05).
Conclusion: FMS is a prevalent disease in
the diabetic population. There is increased
need of awareness by the clinicians of
this disease entity and a multidisciplinary
approach required to manage patients
presenting with CWP in DM.
FMS is a common disorder with cardinal
symptoms of diffuse chronic pain associated
with muscle stifness and tenderness of
specific points on examination. This
disease has strong biologic underpinnings
and the aetiopathogenesis is variable.
Trigger factors may be environmental
or psychosocial. This condition affects
mainly women, and its estimated
prevalence in various populations varies
between 0.2% and 4.4%. The American
College of Rheumatology Criteria (ACR)
1990 requires CWP for at least 3 months
and presence of ˃11/18 pre-specified
Tender Points (TP) on examination1
  A newer diagnostic criteria published
in 2010-2011, no longer requires
performing a tender point count to make
the diagnoses and instead entails asking
about the constellation of non-pain
somatic symptoms that are typically
present in addition to the widespread
. DM affects connective tissue in
multiple ways and this may be as a result
of micro or macrovascular complications,
a consequence of metabolic derangements
inherent to DM, and notable associations,
FMS being a key presentation3
. Over
the past few years, the most important
predictor that predisposed to development
of musculoskeletal complications is
blood glucose control. The HUNT
outlined the association between
DM and chronic musculoskeletal
complaints in 64,785 patients and noted
a high prevalence of FMS and a positive
correlation with HbA1c levels. Attar5
revealed that up to 17.9% of diabetics
suffer from chronic musculoskeletal
manifestations, fibromyalgia being one
of them. Yunus6
, in his review article, in
2011, noted that Central Sensitization
Syndromes (CSS) have an increased
prevalence in patients with diabetes
mellitus. Of particular interest, a study

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