2013 myresearch Science Internship Program

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3 2013 myresearch Science Internship Program

4 Ryan Palko Science Internship Program

5 Association and Frequency of Antithyroid Antibodies in Fibromyalgia Cohort at the Cleveland Clinic Ryan Palko Mehrnaz Hojjati MD; Carmen Gota MD

6 Background: Disease Fibromyalgia (FM) is a disorder categorized by general, widespread musculoskeletal pain and fatigue present throughout the body. Symptoms: severe muscle and joint pain, and fatigue Diagnosis is based on ACR criteria 3. Cause of disease is not yet well understood.

7 Problem/Purpose Aim 1 Frequency of microsomal antibodies in patients with diagnosis of FM meeting the 2010 ACR criteria compared to patients with fibromyalgia not meeting this criteria. Aim 2 Association of microsomal antibodies and Fibromyalgia disease severity and depression scores

8 Abstract Evidence exists that thyroid antibodies are found in a higher percentage of FM patients. However, whether the presence of thyroid antibodies can affect the Fibromyalgia severity is not yet clear. The objective is to investigate the frequency of thyroid antibodies in a cohort of patients with Fibromyalgia.

9 Hypothesis The aim of this study is to assess the frequency and association of anti-thyroid antibodies in patients with established diagnosis of fibromyalgia (FM) based on the ACR 2010 criteria, and whether the presence of these antibodies affects the severity of fibromyalgia symptoms

10 ACR 2010 Criteria for Diagnostic of Fibromyalgia Figure 1: ACR FM diagnostic criteria 3

11 Methodology FM patients identified using the FM cohort at CCF main campus - Dr Carmen Gota. Fibromyalgia diagnosis was confirmed using the ACR 2010 criteria. Retrospective chart review of 200 patients with diagnosis of FM.

12 Data Demographics: 173 Females (86%) to 27 males (14%) Mean Age: years old Median Age: 44 years old Range of the Age: 57 years 146 Met FM 2010 ACR Criteria (85%) to 25 did not meet ACR Criteria (15%)

13 Data Average depression and Fatigue scores in group of patients who met the 2010 ACR criteria for fibromyalgia Average PHQ = Average FVAS = Depression: Frequency, Microsomal, Hypothyroid 11 patients positive for depression and antibody 23 patients positive for depression and hypothyroid

14 Data Microsomal Antibody 81 patients tested for microsomal antibody 18 Tested positive, 63 negative 14 patients positive for both hypothyroid and microsomal (autoimmune thyroiditis)

15 Results Frequency of microsomal antibody's positive patients in CCF Fibromyalgia Cohort n=81 78% 22% Patients Positive for Microsomal Antibody Patients Negative for Microsomal Antibody Figure 3: The frequency of the microsomal antibody in the cohort.

16 Negative Negative Negative Negative Results WPI score to the frequency of microsomal antibody SS score to the frequency of microsomal antibody Positive R 2 = Positive R 2 = FVAS score to frequency of microsomal antibody PHQ score to the frequency of microsomal antibody Positive R 2 = Positive R 2 = Figures 4, 5, 6, 7: Show the relationship between questionnaires and microsomal antibody

17 Results Depression and frequency of microsomal antibody 38% Positive Microsomal 62% Positive for both Depression and Microsomal Antibody Figure 8: Describes the relationship between depression and the microsomal antibody

18 Conclusions More than 1/3 of patients with depression also tested positive for anti-microsomal antibodies The majority of patients tested positive for microsomal antibodies were diagnosed with autoimmune thyroid disease at some point( n=14/18) Presence of anti microsomal antibodies does not appear to significantly affect the disease activity scores (WPI, SS, FVAS, PHQ)

19 Recommendations Incorporate more subjects to have a larger population. Whether the titer of thyroid antibodies or presence of autoimmune thyroid disease is associated with more severe disease in Fibromyalgia patients Whether the presence of thyroid antibodies can predict onset/development of Fibromyalgia Acquire healthy participants to use as a control group.

20 References 1. Pamuk, O. N., & Cakir, N. (2007). The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms. Clinical Rheumatology, 26(1), doi: /s y. Retrieved from 2. Suk, J. H., Lee, J. H., & Kim, J. M. (2012). Association between thyroid autoimmunity and fibromyalgia. Experimental and Clinical Endocrinology & Diabetes, 120(7), doi: /s Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, et al. (2010). The american college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research, 62(5), doi: /acr Retrieved from: ssification_criteria_for_other_diseases/

21 Special Thanks Cleveland Clinic Office of Civic Education Initiatives Mehrnaz Hojjati, MD Carmen Gota, MD

22 Copyright 2013 Cleveland Clinic Foundation

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