Differentiating primary Fibromyalgia cases and its subset that had deficient vitaminD3 using Serum TNF-alpha and ultrasound of hands and knees .

Background: Fibromyalgia Syndrome (FMS) is characterized by ongoing musculoskeletal pain, muscle tightness, insomnia, malaise, mood disturbances, cognitive impairments, depression, general sensitivity, and challenges in carrying out daily activities. Lately, there have been numerous cases of bilateral hand and wrist arthritis that are combined with fibromyalgia and low serum vitamin D3, potentially linked to elevated serum parathormone levels in certain cases. Objective: To differentiate between primary (FMS) cases and its subset that had deficient vitamin D3 regarding Serum Tumor necrosis factor alpha (TNF-α) level and to determine ultrasound (US) changes in hands and knee joints. Methods: A cross-sectional comparative study was conducted on eighty patients with (FMS) . They were recruited from Al Zahraa University Hospital's Rheumatology and Rehabilitation department. Patients were divided into Group A (40 FMS cases with vitamin D3 deficiency) and Group B (40 FMS cases). Both groups underwent tender point count, symptom severity scale, serum TNF alpha level, widespread pain index, and US for hands and knees. Results: It was revealed a statistically significant higher percentage of Chondrocalcinosis of knee in group A versus group B. While a statistically significant higher percentage of synovial hypertrophy was found in group B compared to group A. Also, a significant positive correlation was detected between TNF-α level and tender point count (from 11 up to 18), in both groups. Conclusions: The degenerative changes are more in group A patients. This may be due to their association with secondary hyperparathyroidism (SHPT) and vit D3 deficiency which in turn accelerate the degenerative complications in joints.