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A prospective study of tender points and fibromyalgia during and after an acute viral infection
Background:
Tender points (TPs) and fibromyalgia (FM) may be precipitated by infections, but the frequency, associated characteristics, and predictors of these outcomes are unknown.
Objectives:
To determine if acute infectious mononucleosis (AIM) is associated with the development of TPs or FM acutely or during the subsequent 6 months; if demographic, clinical, or psychosocial features predict TPs or FM; and if TPs or FM correlate with nonrecovery.
Methods:
A total of 150 subjects diagnosed as having AIM were assessed with physical examinations (including palpation of 18 TPs), laboratory tests, and measures of psychosocial and somatic functioning at enrollment and at 2 and 6 months. Subjects also completed a structured psychiatric interview at the initial evaluation.
Results:
At presentation and at 2 and 6 months, the mean TP counts were 7.5, 4.6, and 3.0, respectively; at these time points, 19%, 3%, and 1% of subjects also met modified criteria for FM. Tender points and degree of pain diminished over time following AIM. Acutely, TPs were associated only with higher temperature (P<.001). Baseline features that predicted more TPs at 2 and 6 months were female sex, older age, less family social support, and more TPs at presentation. Neither initial laboratory tests nor psychiatric disease or distress predicted TPs. Differences between those who had and had not recovered at 6 months were found for the mean number of TPs (P<.008), the proportion of subjects with 11 or more TPs (P<.002), and the degree of pain.
Conclusions:
Tender points are a common, transient finding associated with AIM, but FM is an unusual long-term outcome. Demographic, social, and physical examination features predicted TPs.
Insights
Tender points (TPs) are common after acute infectious mononucleosis (AIM) but usually resolve. Fibromyalgia (FM) is a rare long-term outcome, with TPs and pain decreasing over six months post-AIM.
Area of Science:
- Rheumatology
- Infectious Diseases
- Psychosomatic Medicine
Background:
- Infections may trigger tender points (TPs) and fibromyalgia (FM).
- The frequency, characteristics, and predictors of these conditions post-infection are not well understood.
Purpose of the Study:
- To investigate the association between acute infectious mononucleosis (AIM) and the development of TPs or FM.
- To identify demographic, clinical, or psychosocial predictors of TPs or FM.
- To determine if TPs or FM correlate with nonrecovery from AIM.
Main Methods:
- 150 subjects with AIM underwent physical examinations (including 18 TPs), lab tests, and psychosocial/somatic assessments at baseline, 2, and 6 months.
- A structured psychiatric interview was administered at the initial evaluation.
Main Results:
- Mean TP counts decreased from 7.5 at presentation to 3.0 at 6 months; 19% met FM criteria acutely, decreasing to 1% at 6 months.
- Higher temperature acutely predicted TPs. Female sex, older age, less social support, and baseline TPs predicted persistent TPs.
- TPs and pain diminished over time; differences in TPs and pain were noted between recovered and non-recovered subjects at 6 months.
Conclusions:
- TPs are a common, transient finding following AIM.
- FM is an uncommon long-term outcome after AIM.
- Demographic, social, and physical findings predict TPs post-AIM.