- Casos clínicos
martes, 7 de febrero de 2017
Effect of Vitamin D Replacement in Patients of Fibromyalgia
Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It is a chronic pain disorder that is difficult to treat. Recently Vitamin D has shown promising impact in the treatment of this disorder. Objective: To see the therapeutic role of vitamin D replacement in patients of fibromyalgia. Study design: Prospective study. Setting: Multicentre, Three private clinics. Material and Methods. Out of 223 patients presenting with body aches and pains over the course of six months (January to June 2008), 100 patients (96 females and 4 males) between 20 to 50 years of age fulfilled the American College of Rheumatology (ACR) criteria of fibromyalgia and were included in the study. Using standard proforma, frequency of complaints other than ACR criteria were also documented.All of them were on some form of pain medication by various general practitioners/ consultants for more than three months but their symptoms were persistent. After informed consent, their serum vitamin D3 (25OHD3) level was requested as the cost of investigation was to bear by patients themselves. Patients were then replaced with vitamin D with an expected target of > 50 ng/ml and followed for 6 months duration. Supplementation with calcium in a dose of 1000mg/day was also done. Results: In this study 83% of patients were having vitamin D between 11-20 ng/ml(mean =13 ±2), 11% between 5-10 ng/ml (mean=7 ±1) and 6% were below 5ng/ml (table-2). There were four male patients, all (100%) with age distribution of 41-50 year and all were deficient in vitamin D (<20ng/ml). Among 96 female patients 80(76.8%) were having level between 11-20 ng/ml, 10 (9.6%) between 5- 10ng/ml and 6 (5.7%) were below 5 ng/ml. After replacement with vitamin D achieving expected target serum levels >50ng/ml. Improvement in ACR criteria of fibromyalgia syndrome consisting of widespread musculoskeletal pains and 11 out 18 tender points was improved in more than 76 % of the patients. Improvement in the associated conditions was also observed e.g. restless legs in 91.3% chronic fatigue in 97.6%. Similarly 85% reported relief from muscle spasm and 65% from tingling. There was also improvement in neuropsychiatric conditions like depression 71%) and anxiety 46.8%. Moreover, improvement in cognitive function like concentration and forgetfulness was also reported by 69.8% and 67.7% respectively (Table-4). Keywords: Vitamin D, Fibromyalgia, Generalized body aches, Fatigue, Tenderness.