The relationship between vitamin 25(OH)D level and hematological parameters in newly diagnosed women with fibromyalgia syndrome
Keywords:fibromyalgia, inflammation, platelet activation, Platelet Distribution Width, vitamin D
Background/Aim: Chronic inflammation may play a role in the pathogenesis of fibromyalgia syndrome (FMS). Several hematological markers are prothrombotic, and markers of systemic inflammation. Vitamin D (VitD) level can affect FMS and has an anti-inflammatory effect. The aim of this study is to investigate the relationship between hematological parameters and VitD in FMS and its effect on disease severity. Methods: The prospective case-control study included 90 newly diagnosed female patients with FMS (group 1) and 90 healthy volunteers (group 2). Pain and fatigue were evaluated by visual analogue scale (VAS). Disease severity was evaluated by FMS Impact Questionnaire (FIQ) in FMS. Neutrophils, lymphocytes, platelets, platelet distribution width (PDW) and mean platelet volume (MPV) were obtained from complete blood count results in both groups. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were calculated. 25(OH)D concentration was measured. Patients were divided into 3 groups according to vitamin D levels (VitD < 10 ng/ml, 10-30 ng/ml and >30 ng/ml.) Results: The mean MPV and vitamin D levels were significantly higher in group 2 (P=0.001, P<0.001 for both), whereas median PDW was significantly higher in group 1 (P<0.001). Among FMS patients grouped according to VitD levels, only PLR level was significantly different (P=0.049). In subgroup analysis, PLR was significantly higher in the group with VitD < 10 ng/ml compared to the group with vitD levels between 10-30 ng/dl (P=0.024). There was no significant relationship between VitD levels and clinical and laboratory parameters (P>0.05). There was a significant inverse relationship between FIQ and PLR (P=0.022). Conclusion: VitD deficiency may be a risk factor for FMS (cut-off is<14.6 ng/ml). In FMS, high PDW and high PLR in patients with VitD<10 ng/ml are indicative of a prothrombotic condition which can be aggravated by inflammation. We think that complete blood count and VitD levels can support the diagnosis and predict cardiovascular risk in FMS.
Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55.
Bennett RM, Russell J, Cappelleri JC, Bushmakin AG, Zlateva G, Sadosky A. Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis. BMC Musculoskelet Disord. 2010 Jun 28; 11:134.
Berssaneti AA, Matsutani LA, Yuan SLK, et al. Prevalence of fibromyalgia: literature review update. Rev Bras Reumatol Engl Ed. 2017 57(4):356-363.
Coskun Benlidayi. Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int. 2019;39(5):781-91.
Akturk S, Buyukavci R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017;36(8):1885–9.
Al-Nimer MSM, Mohammad TAM. Correlation of hematological indices and ratios derived from them with FIQR scores in fibromyalgia. Pak J Med Sci. 2018;34(5):1219–24.
Çintesun E, Akar S, Gul A, Çintesun FNI, Sahin G, Ezveci H, et al. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study. J Lab Physicians. 2019;11(2):149-53.
Çetin MS, Özcan Çetin EH, Akdı A, Aras D, Topaloğlu S, Temizhan A, et al. Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients. Kardiol Pol. 2017;75(10):1005-12.
Haliloğlu S, Carlioglu A, Sahiner E, Karaaslan Y, Kosar A. Mean platelet volume in patients with fibromyalgia. Z Rheumatol. 2014;73(8):742-5.
Molina F, Del Moral ML, La Rubia M, Blanco S, Carmona R, Rus A. Are patients with fibromyalgia in a prothrombotic state? Biol Res Nurs. 2019;21(2):224-30.
Baeke F, Gysemans C, Korf H, Mathieu C. Vitamin D insufficiency: implications for the immune system. Pediatr Nephrol. 2010;25:1597-606.
Çidem M, Karacan İ, Beytemur O, Kara S. Prevalence and risk factors for vitamin D deficiency in patients with widespread musculoskeletal pain. Turk J Med Sci. 2017 12;47(3):728-31.
Kiani A, Mohamadi-Nori E, Vaisi-Raygani A, Tanhapour M, Elahi-Rad S, et al. Vitamin D-binding protein, and vitamin D receptor genotypes and 25-hydroxyvitamin D levels are associated with development of aortic and mitral valve calcification and coronary artery diseases. Mol Biol Rep. 2019;29.
Verdoia M, Pergolini P, Nardin M, Rolla R, Negro F, Kedhi E. Vitamin D levels and platelet reactivity in diabetic patients receiving dual antiplatelet therapy. Vascul Pharmacol. 2019;7:106564.
Bennett RM, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, et al. Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. Arthritis Care Res (Hoboken). 2014;66(9):1364-73.
Bennett RM, Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. Minimal clinically important difference in the fibromyalgia impact questionnaire. J Rheumatol. 2009;36:1304-11.
Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000;20:9-12.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30.
Xiao Y, Haynes WL, Michalek JE, Russell IJ. Elevated serum high-sensitivity C-reactive protein levels in fibromyalgia syndrome patients correlate with body mass index, interleukin-6, interleukin-8, erythrocyte sedimentation rate. Rheumatol Int. 2013;33(5):1259–64.
Uslu AU, Deveci K, Korkmaz S, Aydın B, Senel S, Sancakdar E, et al. Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? Biomed Res Int 2013:185317.
Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291–4.
Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597–601.
Al-Nimer MSM, Mohammad TAM, Alsakeni RA. Serum levels of serotonin as a biomarker of newly diagnosed fibromyalgia in women: Its relation to the platelet indices. J Res Med Sci. 2018;23:71.
Vagdatli E, Gounari E, Lazaridou et al. Platelet distribution width: a simple, practical, and specific marker of activation of coagulation. Hippokratia 2010; 14:28–32
Kosus N, Kosus A, Turhan NO. Relationship of ovarian volume with mean platelet volume and lipid profile in patients with polycystic ovary syndrome. Exp Ther Med. 2011;2:1141–4.
Santhakumar AB, Bulmer AC, Singh I. A review of the mechanisms and effectiveness of dietary polyphenols in reducing oxidative stress and thrombotic risk. Journal of Human Nutrition and Dietetics. 2014;27:1–21.
La Rubia M, Rus A, Molina F, Del Moral ML. Is fibromyalgia-related oxidative stress implicated in the decline of physical and mental health status? Clinical and Experimental Rheumatology. 2013;31:S121–7.
Yildirim T, Solmaz D, Akgol G, Ersoy Y. Relationship between mean platelet volume and vitamin D deficiency in fibromyalgia. Biomedical Research. 2016;27(4):1265-70.
Nsengiyumva V, Fernando ME, Moxon JV, Krishna SM, et al. The association of circulating 25- hydroxyvitamin D concentration with peripheral arterial disease: A meta-analysis of observational studies. Atherosclerosis. 2015;243:645-51.
Kunadian V, Ford GA, Bawamia B, Qiu W, Manson JE. Vitamin D deficiency and coronary artery disease: a review of the evidence. Am. Heart J. 2014;167:283-391.
Correia LC, Sodré F, Garcia G, Sabino M, Brito M, Kalil F, et al. Relation of severe deficiency of vitamin D to cardiovascular mortality during acute coronary syndromes. Am J Cardiol. 2013;111:324-7.
Okyay R, Kocyigit BF, Gursoy S. Vitamin D levels in women with fibromyalgia and relationship between pain, tender point count and disease activity. Acta Medica Mediterranea. 2016;32(1):243–7.
Olama SM, Senna MK, Elarman MM, Elhawary G. Serum vitamin D level and bone mineral density in premenopausal Egyptian women with fibromyalgia. Rheumatol Int. 2013;33(1):185–92.
Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain 2014;155(2):261–8.
Mateos F, Valero C, Olmos JM, Casanueva B, Castillo J, Martinez J, et al. Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia. Osteoporosis Int. 2014;25(2):525–33.
Ellis SD, Kelly ST, Shurlock JH, Hepburn ALN. The role of vitamin D testing and replacement in fibromyalgia: a systematic literatüre review BMC Rheumatol. 2018;2:28.
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