Friday, March 8, 2013

Biological marker for fibromyalgia is challenged- No surprise

A unique immunological pattern has been found in fibromyalgia in a study done by Behm, et al, 2012. Full article in pdf here.

"The cytokine responses to mitogenic activators of PBMC isolated from patients with FM were significantly lower than those of healthy individuals, implying that cell-mediated immunity is impaired in FM patients. This novel cytokine assay reveals unique and valuable immunologic traits, which, when combined with clinical patterns, can offer a diagnostic methodology in FM."
Bruce Gillis, MD, and member of the clinical faculty at the University of Illinois, Chicago College of Medicine, has taken the results of this study of which he was a part, to another level. He has developed a blood analysis, the FM/a® Test, which is capable of diagnosing FM. (Dr Gillis is the founder of the Epic Genetics, where the blood test is conducted.) 

As I read the study and the following publications, I braced for what I knew would follow.

Questions arise over new diagnostic test for fibromyalgia

As with all good science comes challenge, as it should. I agree with Dr Daniel Clauw that replicated studies are necessary.  Dr. Gillis may or may not have jumped the gun on objective blood test, but the evidence is significant.  Though this is the first study of its kind, it certainly is not the first study suggesting that diminished cytokine response has been implicated in fibromyalgia. Consistent cytokine abnormalities, though none as significant as seen in this study, suggest an immunological factor. This would explain why fibromyalgia clusters with other neuro-endocrine-immunologic disorders.  

As I have written, yet to be published, this is the beginning of some very interesting research.  Investigations that will move us down the right path.  It does not negate the involvement of the HPA axis in FM.  My opinion is that neuroimmunologic science suggests it is part of it.  When the hypothalamus-pituitary axis is dysfunctional, as seen in repeated studies of FM, it affects the neuro-endocrine and immunologic responses, and involvement of the autonomic nervous system.  We know the central nervous system is bombarded with chronic pain impulses from the periphery (from conditions such as  myofascial pain syndrome, known muscle abnormalities, or from cervical nerve root impingement another pain impulse aggravator suggested in FM). The fibromyalgia brain does not respond the same way when compared to other chronic pain disorders.  Many people with chronic pain share centralization, which is amplification of pain, but do not have any of the comorbid disorders associated with fibromyalgia. That is where the difference lies, that is the defining factor of HPA dysfunction resulting in neuro-endocrine and immunologic responses. 

Dr Frederick Wolfe suggests that these same results might be found in other illnesses.  This bears mentioning and I agree.  We need more research.  However, this study does suggest that fibromyalgia patients do have an immune dysfunction, whether it shares the same immune dysfunction with other illnesses is up for debate. I believe we need to focus on this, it proves that fibromyalgia is a biological disorder." Dr. Clauw and Dr. Robert Bennett, Dr. Roland Staud, and many others who have studied fibromyalgia diligently for many years all agree that fibromyalgia is NOT a psychological disorder.

Dr. Dan Wallace, a clinical professor of medicine at the David Geffen School of Medicine at UCLA based at Cedars-Sinai Medical Center,  says,

“The elegantly designed study by Dr. Gillis and his co-investigators represents a milestone on the path our group charted 25 years ago when we first hypothesized that cytokines play a role in fibromyalgia. It is hoped that this and future work sponsored by EpicGenetics will lead to a greater understanding of how the immune system, fatigue, sleep disorders, chronic stress and pain interact in patients with fibromyalgia and related disorders.”
Here is the hope in this message.   I feel optimistic that this biological marker will prove itsself because of the significant results between the FM and the healthy control group in the study. Fibromyalgia can no longer be seen as a psychosomatic disorder.  We will not have to be concerned about an ICD classification, or how fibromyalgia could be interpreted by the APA (American Psychiatric Association) Diagnostic and Statistical Manual of Mental Disorders, DSM-5. (See Who is the WHO, and Why does it Matter to You?).   Why is this important? Because these classifications are used to track data, ultimately determine treatment/referrals, and insurance reimbursement.

Fibromyalgia is now recognized in the Social Security Administration Blue Book, “Listing of Impairments,” and having a biological marker, whether specific to fibromyalgia or not, is a really big deal for the lives of many fibromyalgia patients whose symptoms are so severe they are no longer able to work. 

Yes, a glorious storm is brewing.  I am jubilant, even giddy, because, without adversity there is no opportunity.” Questions such as those proposed and those yet to come deserve merit, it means we will see more target rich research.  We will continue on in our current treatment plan, just as those with other syndromes, such as rheumatoid arthritis, systemic lupus erythematosus, and many others for which we have no cure.  The test may be cost prohibitive and maybe we should exercise patience until replicated and larger studies are implemented. If it bears out, then insurance companies should not deny reimbursement. But until then, this research and the test developed by Dr. Gillis is a really BIG deal, researchers have been working on a biological marker, have felt it was around the corner and the corridor of light could be staring us straight in the face, there is hope.

In healing and hope, Celeste

For more information on the test

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  For more information about the author see


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Fibromyalgia and Chronic Pain Life, Cover article, Mar/April 2013

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JQ said...

Yes, it is a really big deal, Celeste. But one more in hype than hope. Failure of researchers to have disclosed their conflict of interest, as happened with the paper from Gillis et al., is inexcusable. Yes, Fred Wolfe was spot on when he penned "Junk Science - Junk Ethics".

JQ said...

Dear Celeste, are you you still jubilant about the "test"? Sounds very fishy to me, but I am not an expert, just a very skeptical rheumatologist. By the way, are you intending to respond to Professor Wolfe in the light of his response to you on his blog, Fibromyalgia Syndrome.

JQ said...

Sorry, I meant Fibromyalgia Perplex.

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