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Relationship Among Fibromyalgia and Rhinitis

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Relationship Among Fibromyalgia and Rhinitis
Marianne Frieri1, Antigone Argyriou2
1. Medicine, Nassau Univ. Medical Ctr., East Meadow, NY, United States.  2. Physical Medicine & Rehabilitation, Montefiore Medical Center , Bronx, NY, United States.

­Purpose of Study: Fibromyalgia(FM),a common chronic pain disorder characterized by diffuse musculoskeletal pain  has several unrelated symptoms, a broad variety of complaints and lack of tests to accurately identify the disease. FM has significant overlap with several other systemic diseases including those of sensory hypersensitivity, autonomic deregulation, rhinitis and neurological dysfunction.A relationship among chronic rhinitis and the pathogenesis related to aberrant pain processing, immunoregulatory abnormalities may occur in autoimmune disorders with increases in immunological signalling molecules such as cytokines, NGF, TNFa, L-selectin.

­Methods Used:  A case report and review of the literature. A 45 year old woman was diagnosed with FM at age 25 with compliants of fatique, myalgias, migraine, sinusitis, and asthma. An ANA had a speckled pattern but rheumatologic evaluation was negative for SLE, Physical examination revealed non-tender sinuses, boggy nasal turbinates, clear lungs. Skin tests were consistent with non-allergic rhinitis. Family history was significant for Hashimoto thyroiditis, migraine and asthma. 

Summary of Results: The pathophysiology is an inflammatory response, cytokine activation through viral neurotropism and  glial activation as a possible mechanism. By better understanding the pathophysiology of FM, physicians may be able to more accurately diagnose and treat debilitated and often stigmatized patients, the complexity of the disease by a multidisciplinary approach of this multifaceted syndrome. Baraniuk has discussed an overlap with systemic hyperalgesia, autonomic dysfunction, irritable bowel syndrome, migraine headaches, sensory hypersensitivity, dyspnea, congestion, rhinorrhea (Baraniuk JN, Allergy Asthma Proc 31:169 -178, 2010.)Neurological dysfunction may account for the overlap of CFS with idiopathic nonallergic rhinopathy and sinusitis. 

Conclusions: The overlap between fibromyalgia and several other diseases of immunological dysfunction and rhinitis suggest a link between the immune system and the body's pain response. The inflammatory molecules used as chemical signals throughout the nervous system have provided much insight into altered levels of pain sensation.

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