Post-polio sendromu ile Fibromiyalji sendromunun birlikteliği ve ilişkisi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Post polio sendromu (PPS), akut paralitik poliomyelit enfeksiyonundan yıllar sonra ortaya çıkan yeni müsküloskeletal ve nöromüsküler semptomlarla karakterize bir sendromdur. Birçok mekanizma öne sürülmüş olmakla birlikte, PPS etiyopatogenezi henüz tam olarak anlaşılamamıştır. PPS'de en sık görülen semptomlar, klinik olarak etkilenmiş ve/veya etkilenmemiş kaslarda ortaya çıkan güçsüzlük, yorgunluk ve ağrı olup, yaşam kalitesinde belirgin bozulmaya yol açar. Klinik pratikte fibromiyalji sendromu (FMS) semptomları ile benzerliği dikkat çekicidir. İki sendrom arasındaki bu benzer özelliklere rağmen, PPS hastalarında FMS birlikteliğinin ne oranda olduğu ve bu birlikteliğin hangi hastalık özellikleri ile ilişkili olduğuna dair elimizde çok az veri bulunmaktadır. İki sendrom arasındaki benzer klinik özellikler ayrıca, ortak patogeneze sahip olabileceklerini akla getirmektedir. Bu çalışmamızın amacı, PPS'li hastalarda FMS görülme sıklığının ve santral sensitizasyon varlığının incelenmesidir. PPS etiyopatogenezinde santral sensitizasyonun olası rolünün ve FMS ile birlikteliğinin gösterilmesi, tedavi yaklaşımları için de yol gösterici olacaktır. Gereç ve yöntem: Çalışmaya PPS tanı kriterlerini karşılayan 41 katılımcı dahil edildi. Katılımcıların sosyodemografik ve klinik verileri alındıktan sonra polio ile ilişkili sorunlar ölçeği, Santral Sensitizasyon Envanteri(SSE), cetvel üzerinde ağrı ve yorgunluk düzeyi, Yorgunluk Etki Skalası, Nottingham Sağlık Profili hastalar tarafından işaretlenerek dolduruldu.PPS hastalarında FMS varlığı, American College of Rheumatology (ACR) 1990, ACR 2010, ACR2016 ve ACTTION-APS Ağrı Taksonomisi (AAPT) 2018tanı kriterleri kullanılarak değerlendirildi. Bulgular: Toplam 41 PPS hastasının 6'sı (%14.6) ACR 1990 kriterlerini karşılarken, 12'si (%29.3) ACR 2010, 14'ü (%34.1) ACR 2016, 5'i (%12.2) AAPT 2018 kriterlerini karşılıyordu. ACR 2016 kriterlerine göre FMS(+) olan PPS hastalarında, Polio ile ilişkili sorunlar ölçeği skorları, VAS ağrı skoru, VAS yorgunluk skoru, Yorgunluk Etki Skalası toplam skoru ve tüm alt skorları (kognitif, fiziksel, sosyal), Nottingham Sağlık Profili toplam skoru ve sosyal izolasyon hariç tüm alt skorları, FMS(-) olan gruba göre anlamlı olarak daha yüksek bulundu. ACR 2010 semptom şiddet skalası skoru ve ACR 1990 Hassas Nokta Sayısı FMS+ olan grupta, FMS- olan gruba göre anlamlı olarak daha yüksek saptandı. PPS'li 41 hastanın ortalama SSE skoru 37.8±18.6 olup, FMS+ olan grupta, FMS- olan gruba göre anlamlı olarak daha yüksek saptandı (p=0,00). 21 hastanın (%51.2) skoru 40 ve üzerinde idi. Bu hastaların 13'ü (%61,9) ACR 2016 kriterlerini karşılıyordu. SSE skoru 40'ın altında olan 20 hastanın sadece 1 tanesi (%5) ACR 2016 kriterlerini karşılıyordu. Santral sensitizasyon envanteri skoru ile polio ile ilişkili sorunlar envanteri, VAS ağrı ve yorgunluk skorları, Yorgunluk Etki Skalasının tüm alt grupları, Nottingham Sağlık Profili tüm alt grupları, ACR 2016 yaygın ağrı indeksi, somatik yakınmalar, jeneralize ağrı bölge sayısı, ACR 1990 hassas nokta sayısı arasında pozitif korelasyonlar saptandı. Sonuç: Bu çalışmada, PPS'li olgularda FMS prevalansının genel popülasyona göre daha yüksek olduğu, yarısından fazlasında santral sensitizasyonla ilişkili semptomların olduğu, santral sensitizasyon şiddeti arttıkça PPS ile ilişkili semptom ve sorunların arttığı ve yaşam kalitesinin bozulduğu gösterilmiştir. Bu bulgular, benzer semptomlara sahip olan her iki sendromun patogenezinde de ortak mekanizmaların rol oynayabileceğini düşündürmüştür. Çalışma sonuçları gerek PPS'nin etiyopatogenezine, gerekse tedavisine ışık tutacaktır. Ancak bu ince ve detaylı mekanizmaların aydınlatılabilmesi ve tedavideki rolünün gösterilebilmesi için daha fazla çalışmaya ihtiyaç vardır.
Objectives:Post polio syndrome (PPS) is a syndrome characterized by new musculoskeletal and neuromuscular symptoms appearing years after acute paralytic poliomyelitis infection. Although many mechanisms have been suggested, the etiopathogenesis of PPS is not yet fully understood. The most common symptoms in PPS are weakness, fatigue, and pain in clinically affected and/or unaffected muscles, leading to significant deterioration in quality of life. Its similarity with fibromyalgia syndrome (FMS) symptoms in clinical practice is remarkable. Despite these similar features between the two syndromes, we have little data on the rate of FMS association in PPS patients and which disease characteristics this association is associated with. Similar clinical features between the two syndromes also suggest that they may have a common pathogenesis. The aim of this study is to examine the frequency of FMS and the presence of central sensitization in patients with PPS. Demonstrating the possible role of central sensitization in the etiopathogenesis of PPS and its association with FMS will also guide treatment approaches. Materials and methods:The study included 41 participants who met the diagnostic criteria for PPS. After obtaining the sociodemographic and clinical data of the participants, the polio-related problems scale, Central Sensitization Inventory (SSI), pain and fatigue level on the Visual Analog Scale (VAS), Fatigue Impact Scale (FIS), Nottingham Health Profile (NHP) were performed by the patients. The presence of FMS in PPS patients was evaluated using the diagnostic criteria of the American College of Rheumatology (ACR) 1990, ACR 2010, ACR2016 and ACTTION-APS Pain Taxonomy (AAPT) 2018. Results: Of the 41 PPS patients, 6 (14.6%) met the criteria for ACR 1990, while 12 (29.3%) met the criteria for ACR 2010, 14 (34.1%) for ACR 2016, and 5 (12.2%) for AAPT 2018. According to ACR 2016 criteria, in PPS patients with FMS, Polio-related problems scale scores, VAS pain score, VAS fatigue score, Fatigue Ġmpact Scale total score and all sub-scores (cognitive, physical, social), Nottingham Health Profile total score and Except for social isolation, all sub-scores were found to be significantly higher than the group without FMS. ACR 2010 symptom severity scale score and ACR 1990 Tender Point Count were found to be significantly higher in the FMS(+) group than in the FMS(-) group. The mean SSI score of 41 patients with PPS was 37.8±18.6, and it was found to be significantly higher in the FMS(+) group than in the FMS(-) group (p=0.00). The score of 21 patients (51.2%) was 40 and above. Thirteen of these patients (61.9%) met the criteria for ACR 2016. Only 1 (5%) of 20 patients with an SSE score below 40 met the ACR 2016 criteria. Central sensitization inventory score showed positive correlation with polio-related problems inventory, VAS pain and fatigue scores, all subgroups of Fatigue Ġmpact Scale, Nottingham Health Profile all subgroups, ACR 2016 common pain index, somatic complaints, number of generalized pain zones, ACR 1990 number of tender points. Conclusion:In this study, it was shown that the prevalence of FMS is higher in cases with PPS than in the general population, more than half of them have symptoms related to central sensitization, and as the severity of central sensitization increases, PPS-related symptoms and problems increase and quality of life deteriorates. These findings suggested that common mechanisms may play a role in the pathogenesis of both syndromes with similar symptoms. The results of the study will shed light on both the etiopathogenesis of PPS and its treatment. However, more studies are needed to elucidate these fine and detailed mechanisms and to show their role in treatment.
Objectives:Post polio syndrome (PPS) is a syndrome characterized by new musculoskeletal and neuromuscular symptoms appearing years after acute paralytic poliomyelitis infection. Although many mechanisms have been suggested, the etiopathogenesis of PPS is not yet fully understood. The most common symptoms in PPS are weakness, fatigue, and pain in clinically affected and/or unaffected muscles, leading to significant deterioration in quality of life. Its similarity with fibromyalgia syndrome (FMS) symptoms in clinical practice is remarkable. Despite these similar features between the two syndromes, we have little data on the rate of FMS association in PPS patients and which disease characteristics this association is associated with. Similar clinical features between the two syndromes also suggest that they may have a common pathogenesis. The aim of this study is to examine the frequency of FMS and the presence of central sensitization in patients with PPS. Demonstrating the possible role of central sensitization in the etiopathogenesis of PPS and its association with FMS will also guide treatment approaches. Materials and methods:The study included 41 participants who met the diagnostic criteria for PPS. After obtaining the sociodemographic and clinical data of the participants, the polio-related problems scale, Central Sensitization Inventory (SSI), pain and fatigue level on the Visual Analog Scale (VAS), Fatigue Impact Scale (FIS), Nottingham Health Profile (NHP) were performed by the patients. The presence of FMS in PPS patients was evaluated using the diagnostic criteria of the American College of Rheumatology (ACR) 1990, ACR 2010, ACR2016 and ACTTION-APS Pain Taxonomy (AAPT) 2018. Results: Of the 41 PPS patients, 6 (14.6%) met the criteria for ACR 1990, while 12 (29.3%) met the criteria for ACR 2010, 14 (34.1%) for ACR 2016, and 5 (12.2%) for AAPT 2018. According to ACR 2016 criteria, in PPS patients with FMS, Polio-related problems scale scores, VAS pain score, VAS fatigue score, Fatigue Ġmpact Scale total score and all sub-scores (cognitive, physical, social), Nottingham Health Profile total score and Except for social isolation, all sub-scores were found to be significantly higher than the group without FMS. ACR 2010 symptom severity scale score and ACR 1990 Tender Point Count were found to be significantly higher in the FMS(+) group than in the FMS(-) group. The mean SSI score of 41 patients with PPS was 37.8±18.6, and it was found to be significantly higher in the FMS(+) group than in the FMS(-) group (p=0.00). The score of 21 patients (51.2%) was 40 and above. Thirteen of these patients (61.9%) met the criteria for ACR 2016. Only 1 (5%) of 20 patients with an SSE score below 40 met the ACR 2016 criteria. Central sensitization inventory score showed positive correlation with polio-related problems inventory, VAS pain and fatigue scores, all subgroups of Fatigue Ġmpact Scale, Nottingham Health Profile all subgroups, ACR 2016 common pain index, somatic complaints, number of generalized pain zones, ACR 1990 number of tender points. Conclusion:In this study, it was shown that the prevalence of FMS is higher in cases with PPS than in the general population, more than half of them have symptoms related to central sensitization, and as the severity of central sensitization increases, PPS-related symptoms and problems increase and quality of life deteriorates. These findings suggested that common mechanisms may play a role in the pathogenesis of both syndromes with similar symptoms. The results of the study will shed light on both the etiopathogenesis of PPS and its treatment. However, more studies are needed to elucidate these fine and detailed mechanisms and to show their role in treatment.
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