Frequency and the impact of fibromyalgia in the patients with chronic hepatitis B, chronic hepatitis C and liver cirrhosis independent of etiology

Fibromyalgia (FM) is a chronic condition of an unknown cause accompanying with chronic extensive pain, fatigue and impaired cognitive functions. FM has been associated with many chronic disorders including chronic liver diseases. Chronic liver diseases may cause many symptoms and signs that have no relation with liver, regardless of etiology. There is no comprehensive study on the frequency of FM in chronic hepatitis B (CHB), chronic hepatitis C (CHC) and liver cirrhosis patients in Turkish society. This study is aimed to investigate the frequency of FM in patients with liver cirrhosis, CHB, CHC and compare with control group and to investigate the effects of FM on the quality of life of these groups. Material and Method 74 patients with cirrhosis of any etiology, 55 CHB patients and 30 CHC patients without cirrhosis, 50 individuals who have been proven not to have chronic liver disease, who appealed for routine examination, has been involved in our study, among people who applied to Bolu Abant Izzet Baysal University Medical Faculty, Department of Gastroenterology outpatient clinic. Questionnaires arranged based on the literature were applied to the participants. Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) were applied in first, and the Fibromyalgia Impact Questionnaire (FIQ) were applied to those diagnosed with FM in the second level. The frequencies of fibromyalgia were compared between groups. FIQ scores were compared between groups with FM. Findings We found significant differences between median values among groups (cirrhosis, chronic hepatitis and control group) in WPI scores (p=0.001), SSS scores (p=0.006), Fibromyalgia Severity Scale (FSS) scores (p=0.002) and presence of FM (p=0.007). According to study; the median values of WPI, SSS, FSS scores and the presence of FM; were significantly higher in liver cirrhosis than chronic hepatitis. Median values of WPI, SSS, FSS scores and the presence of FM were similar when compared between CHB, CHC and the control groups (p>0.05 for each value). When compared to gender, the presence of FM was similar in each three groups of liver cirrhosis, chronic hepatitis and control group (respectively p=0.268, p=0.066 and p=0.683). On the other hand, when compared between men and women separately, the presence of FM was higher in women with liver cirrhosis (p=0.012) and similar in men (p=0.180), when compared between groups. Comparing according to gender, the presence of FM rates were similar in control, CHB and CHC groups (resp. p=0.066, p=0.077 and P=0.999). The similarity of FM ratios were also seen in men and women when compare them according to groups of control, CHB and CHC (resp. p = 0.840 and p = 0.059). The median FIQ scores were similar when compared between liver cirrhosis, chronic hepatitis and control groups with FM (p=0,181). The median FIQ scores were similar when compared between CHB, CHC and control groups with FM (p=0.926). Conclusion Our study showed that the presence of FM was higher in liver cirrhosis than chronic hepatitis group and the difference was statistically significant. It also showed that in women participants, FM presence was higher in liver cirrhosis group than chronic hepatitis and control group. According to these results, our study showed that the most important factor on the presence of FM is liver cirrhosis. It is found that the FIQ scores, which evaluated the functional status, were similar in the comparison of individuals with fibromyalgia according to groups. It showed that FM had similar effects on liver cirrhosis, chronic hepatitis and control group individuals with fibromyalgia, according to the FIQ assessment. It showed that, using FIQ score as survey tool, it obtained that individuals with FM were severely affected by this disease. In addition, our study showed that the presence of FM ratios were similar in CHB, CHC and control groups and it showed that the FIQ scores were similar in CHB, CHC and control groups with fibromyalgia. The frequency of FM in liver cirrhosis, CHB and CHC patients was higher than in general population. Therefore, in the presence of body pain, patients should be investigated for fibromiyalgia in follow-up period of these groups. Key words: chronic hepatitis B, chronic hepatitis C, fibromyalgia, liver cirrhosis