Diagnostics


Fibromyalgia: Neurological or autoimmune?


Fibromyalgia is a condition that baffl es medical minds and evades categorisation. Characterised by chronic musculoskeletal pain, as well as defi cits in energy, sleep and memory, the disease is considered to have a peripheral neuropathy basis – but some researchers believe it could have an autoimmune cause. Peter Littlejohns explores the arguments for each by speaking to a selection of researchers.


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obody wants to be handed a problem they cannot solve, much less one they do not fully understand. Yet, this has been the reality for doctors dealing with fibromyalgia patients for decades. Of course, there are many diseases for which treatments remain scarce or ineffective – but fibromyalgia, much like its close relative chronic fatigue syndrome (CFS), has taken on an almost cult- like status due to the mystery surrounding it. It is this mystery that has led to fibromyalgia being treated like a hot potato that no clinical department wants to catch. Dr Camilla Svensson, professor in cellular and molecular pain physiology at Karolinska Institutet, was part of a team who broke new ground in fibromyalgia research by implicating the role of human


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immunoglobulin G (IgG) antibodies in perpetuating the disease by transferring it to mice and observing many of the same symptoms seen in sapiens. It is too early to say whether the findings are enough to set the broader research community on a new path searching for an autoimmune cause. But the implication of specialised peripheral sensory neurons, known as nociceptors, was enough for the rheumatologists at a recent meeting she attended to explain the findings, to question once again whether fibromyalgia patients belonged in their care. “They said great. We sometimes feel like these patients do not belong with us. Now we can send them to the neurologists.” Despite the peripheral nervous system involvement, Svensson says the neurologists


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