Differentiating primary fibromyalgia cases and its subset that had deficient vitamin D3 using serum TNF-alpha and ultrasound of hands and knees

Mousa, Samar A.; Elbeialy, Adel A.; Abd El Rahim, Sabah I.; Ibrahim, Amira S.

doi:10.21608/jram.2025.305094.1258

Differentiating primary fibromyalgia cases and its subset that had deficient vitamin D3 using serum TNF-alpha and ultrasound of hands and knees

Document Type : Original Article

Authors

¹ Rheumatology and Rehabilitation Department, Faculty of Medicine for Girls, Cairo, Al-Azhar University, Egypt.

² Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt.

10.21608/jram.2025.305094.1258

Abstract

ABSTRACT
Background: Fibromyalgia syndrome (FMS) is characterized by ongoing musculoskeletal pain, muscle tightness, insomnia, malaise, mood disturbances, cognitive impairments, depression, general sensitivity, and challenges in carrying out daily activities. Lately, there have been numerous cases of bilateral hand and wrist arthritis that are combined with fibromyalgia and low serum vitamin D3, potentially linked to elevated serum parathormone hormone levels in certain cases.
Objective: To differentiate between primary FMS cases and its subset that had deficient vitamin D3 level and to determine ultrasound (US) changes in hands and knee joints.
Methodology: A cross-sectional comparative study was conducted on eighty patients with FMS. They were recruited from rheumatology and rehabilitation department, Al-Zahraa university hospital. Patients were divided into two groups; Group A: included 40 FMS patients with vitamin D3 deficiency, and Group B: included 40 patients with primary FMS. Both groups underwent tender point count, symptom severity scale assessment, measurement of serum tumor necrosis -α (TNF -α), widespread pain index assessment, and US for hands and knees.
Results: There was a statistically significant higher percentage of chondrocalcinosis of knee in group A than group B, and a statistically significant higher percentage of synovial hypertrophy was found in group B than group A. Also, a significant positive correlation was detected between TNF-α level and tender point count (from 11 up to 18), in both groups.
Conclusions: The degenerative changes are more in group A patient. This may be due to their association with secondary hyperparathyroidism (SHPT) and vitamin D3 deficiency which in turn accelerates the degenerative complications in joints.

Keywords