title: Impaired lung transfer factor in fibromyalgia syndrome.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether pulmonary diffusing capacity is impaired in patients with fibromyalgia (FM) as it is in those with other diseases characterised by autonomic nerve system (ANS) dysfunction such as type 1 diabetes.
  
  
  METHODS
  Forty-five consecutive anti-nuclear antibody (ANA)-negative female Caucasian patients aged 50.1± 5.6 years with FM and compared with 45 healthy female control volunteers matched in terms of age and body mass index (BMI). The autonomic function has been evaluated by means of standard electrocardiography (ECG), finger blood pressure respiration, and muscle sympathetic nerve activity (MSNA) at rest and during a stepwise tilt test up to 75°. Their autonomic profiles were drawn up on the basis of MSNA, plasma catecholamine levels, and spectral indices of cardiac sympathetic and vagal modulation, and sympathetic vasomotor control computed by means of the spectrum analysis of RR and systolic arterial pressure (SAP) variability. Lung volumes and dynamic spirometry parameters were assessed by means of plethysmography. All of the patients were clinically evaluated and completed the FQI and COMPASS questionnaire.
  
  
  RESULTS
  There was no difference in lung volumes between the FM patients and healthy controls, but DLCO (83±4 vs. 96±5; p<0.001), Kco (84±5 vs 98±5; p<0.001), DM (12.7±2.4 vs 13.6±1.8; p<0.05) and Vc (48±3.9 vs 65±7; p<0.001) were significantly reduced in the patients. The COMPASS-31, RCS and pain VAS scores significantly correlated with DLCO, Kco and Vc with the correlation being particularly close in the case of Vc. Furthermore, univariate Cox proportional hazard analysis showed that the three scores were all significantly associated with an increased risk of impaired DLCO (respectively, χ(2) 16.21, p<0.0005; χ(2) 7.09, p<0.005; χ(2) 6.37, p<0.01).
  
  
  CONCLUSIONS
  FM impairs DLCO mainly as a result of a reduction in Vc, and that this defect is inversely proportional to the severity of the dysfunction suggesting a relationship between impaired DLCO and autonomic nerve dysfunction.
authors.affiliation: Pulmonary Department, University Hospital L. Sacco, Milan, Italy. rizzi.maurizio@hsacco.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: IRCCS Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Atzeni
authors.affiliation: Pulmonary Department, University Hospital L. Sacco, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Airoldi
authors.affiliation: Orthopedic Unit, Santissima Trinità Hospital, Cagliari, Italy.
authors.forename: Ignazio Francesco
authors.initials: IF
authors.lastname: Masala
authors.affiliation: Pulmonary Department, University Hospital L. Sacco, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Frassanito
authors.affiliation: Department of Rheumatology, University of Ancona, Jesi, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.affiliation: Pulmonary Department, University Hospital L. Sacco, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Macaluso
authors.affiliation: Rheumatology Unit, University Hospital L. Sacco, Milan, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Sarzi-Puttini
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000097:blood; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005356:Fibromyalgia / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008176:Lung Volume Measurements / Q000379:methods*; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000503:physiopathology
chemical_list: D002395:Catecholamines