title: Fibromyalgia symptoms and cirrhosis.
abstract: BACKGROUND
  An association between fibromyalgia and hepatitis C virus (HCV) has been previously described. However, the relationship between nonalcoholic steatohepatitis (NASH) and fibromyalgia symptoms has not been assessed, though they share several risk factors.
  
  
  OBJECTIVE
  We aimed to assess the factors associated with fibromyalgia symptoms across etiologies of liver disease.
  
  
  METHODS
  Patients with cirrhosis due to HCV, NASH, or alcohol were recruited from an outpatient hepatology clinic and administered the Hospital Anxiety and Depression Score, Pittsburgh Sleep Quality Index, and the modified 2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia. Serum inflammatory markers were measured with standard luminex assays.
  
  
  RESULTS
  Of 193 participants, 53 (27 %) met criteria for fibromyalgia. Fibromyalgia symptoms were significantly associated with etiology of liver disease (HCV: 35 %, NASH: 30 %, alcohol-related liver disease: 12 %, p < 0.01). Using logistic regression, mood symptoms (OR 1.14, 95 % CI 1.06, 1.22), sleep disturbance (OR 1.32, 95 % CI 1.16, 1.52), and etiology of liver disease (NASH vs. HCV not different, alcohol vs. HCV OR 0.19, 95 % CI 0.05, 0.63) were associated with fibromyalgia symptoms. If abdominal pain was included in the model, etiology became nonsignificant, indicating that it may be central sensitization due to abdominal pain in patients with chronic liver disease that explains fibromyalgia symptoms rather than the etiology of liver disease or inflammation.
  
  
  CONCLUSIONS
  Fibromyalgia symptoms were significantly associated with HCV and NASH cirrhosis and with psychiatric symptoms. Future work should focus on the underlying pathophysiology and management of widespread pain in patients with cirrhosis.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA, rogalss@upmc.edu.
authors.forename: Shari S
authors.initials: SS
authors.lastname: Rogal
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.forename: Eva
authors.initials: E
authors.lastname: Szigethy
authors.forename: Francis
authors.initials: F
authors.lastname: Lotrich
authors.forename: Andrea F
authors.initials: AF
authors.lastname: DiMartini
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000523:psychology; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004644:Emotions; D005260:Female; D005356:Fibromyalgia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology; D016017:Odds Ratio; D010147:Pain Measurement; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators