Increased Rates of Infectious Diseases in Fibromyalgia Patients: A Population-Based Case-Control Study, 2024, Vinker-Shuster et al

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Increased Rates of Infectious Diseases in Fibromyalgia Patients: A Population-Based Case-Control Study

Michal Vinker-Shuster, Eli Magen, Ilan Green, Eugene Merzon, Avivit Golan-Cohen, Ariel Israel

Introduction: Fibromyalgia (FM) patients are known to have medical comorbidities. This study characterized the rates of infectious diseases in FM patients compared to the general population.

Methods: A nationwide population-based case-control study was conducted, including all patients diagnosed with FM by a rheumatologist compared to a matched 5:1 control group within a large health maintenance organization in Israel (January 2002 to December 2023). Demographic, anthropometric, and health habit data were extracted from medical records as well as the ICD-9 codes of diagnoses related to infectious diseases in 9232 FM patients and 46,160 controls. Infection rates in the FM patients were compared to the controls over a mean follow-up of 6.7 years.

Results: The FM patients had a significantly higher incidence of viral, bacterial, fungal, and parasitic diseases compared to the controls. The FM patients had significantly higher odds ratios (ORs) for respiratory/sinopulmonary infections, including upper respiratory tract infections (OR = 1.49), influenza (OR = 1.80), tonsillitis (OR = 1.40), sinusitis (OR = 1.98), otitis media (OR = 1.84), otitis externa (OR = 1.48), and pneumonia (OR = 1.60), all p < 0.01.

They also experienced more gastrointestinal infections, including gastroenteritis (OR = 1.40), Helicobacter pylori (OR = 2.05), candidal esophagitis (OR = 7.88), and giardiasis (OR = 3.41), all p < 0.01.

They had a higher prevalence of genitourinary infections, including urinary tract infections (OR = 1.79) and pelvic inflammatory disease (OR = 3.17), p < 0.01 as well as skin infections such as abscess (OR = 1.74) and cellulitis (OR = 1.64) and systemic infections such as symptomatic COVID-19 (OR = 1.76) and Cytomegalovirus (CMV) (OR = 1.85), all p < 0.01.

Conclusions: The FM patients had a significantly higher incidence of infectious diseases than the general population. Further research is needed to better understand the underlying mechanisms and develop targeted interventions to address infection risks in FM patients.

Link | PDF (Biomedicines) [Open Access]
 
One notable thing about this study is that it gives an indication of CFS prevalence in Israel. The control group in this study was taken from large-scale healthcare data (n=46160), and 58/46160 (0.13%) had the ICD-9 code of 780.71 (chronic fatigue syndrome). Among the fibromyalgia patients 121/9232 (1.31%) also had the ICD-9 diagnostic code for CFS.
 
Hard to know how much the results were because of FM patients' higher BMI and much higher rates of smoking and being more sedentary, in addition to the detection bias and the limitation of one institution's record vs an immunologic causation.

Still, interesting.
 
shak8 said:
Hard to know how much the results were because of FM patients' higher BMI and much higher rates of smoking and being more sedentary, in addition to the detection bias and the limitation of one institution's record vs an immunologic causation.
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Yes. Although the differences in BMI, smoking and activity levels between the fibromyalgia and sex and age matched controls aren't massive. And the differences in the incidences of infections are surprisingly large. I agree, it is an interesting report.
 
Yann04 said:
What could be a possible cause for that?
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It could be an artefact of the other causes of death. If the average age at death of someone with fibromyalgia is lower than the average age of the population that made up the normative data, it could mean that they simply did not live long enough for so many to develop cancer.

Certainly otherwise wouldn’t you expect a higher incidence of cancer, as with ME, than the general population.
 
Peter Trewhitt said:
It could be an artefact of the other causes of death. If the average age at death of someone with fibromyalgia is lower than the average age of the population that made up the normative data, it could mean that they simply did not live long enough for so many to develop cancer.
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I think they controlled for age, so it should be cancer deaths compared to a same age reference population.
The effect measures (HR, SMR, OR) extracted from the eligible studies were adjusted for age and sex, but not for other potential confounding factors, such as the Charlson score or concomitant psychiatric conditions, since the main aim of the review was to assess whether there is an increased mortality risk in fibromyalgia patients, and not whether fibromyalgia per se, in fully adjusted effect measures, leads to increased mortality.
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