Association between chronic widespread musculoskeletal complaints and thyroid autoimmunity. Results from a community survey.

OBJECTIVE: To test a hypothesis derived from observations in general practice that thyroid antibodies were associated with chronic widespread musculoskeletal complaints. DESIGN: Cross-sectional study of 40-42 year old men and women based on a self-administered questionnaire and on results of blood tests. SETTING: Sarpsborg municipality, Norway. PARTICIPANTS: 737 men and 771 women who attended the National Health Screening Service's mobile unit in 1989 and answered the questionnaire. MAIN OUTCOME MEASURES: Prevalence of detectable microsomal thyroid antibodies in persons with and without chronic widespread musculoskeletal complaints. RESULTS: The prevalence of thyroid microsomal antibodies was significantly higher in persons with than without chronic widespread musculoskeletal complaints (16.0% versus 7.3%, p < 0.01). The increase was restricted to women (20.4% versus 11.6%, p = 0.02). Thyroid function tests did not differ significantly between the two groups. CONCLUSION: The association between chronic widespread musculoskeletal pain complaints and thyroid antibodies in women may reflect a subgroup of patients in which thyroid autoimmunity, rather than thyroid function, is important. A possible relationship to fibromyalgia is discussed as well as a hypothetical role for thyrotropin releasing hormone.

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

Chronic musculoskeletal complaints and subgroups with special reference to uric acid.

In a previous article from a cross-sectional study of 737 men and 771 women (40-42 years old) in Norway, we found a higher mean serum uric acid in persons with than without chronic musculoskeletal complaints. Furthermore, the odds ratio for chronic complaints increased by increasing uric acid level. Persons with chronic complaints are heterogenous. The scope of the present study was to inquire whether a further breakdown of the material would shed more light upon our previous findings, and thereby contribute to the understanding of the pathogenesis of chronic complaints. Among persons with such complaints, we wished to characterize the ones with the highest serum uric acid. As possible explanatory factors we used the former fibromyalgia minor criteria and modulating factors, and the presence or absence of widespread complaints judged from the Nordic form body map. Persons with chronic widespread weather-dependent complaints had the highest values. The odds ratios for this subgroup increased by increasing uric acid level to a greater extent than reported in our previous article. Some hypotheses about possible action mecanism are put forward, and the relation to fibromyalgia are briefly discussed. Uric acid needs attention in future studies on chronic widespread musculoskeletal complaints.

Uric acid and chronic musculoskeletal complaints.

The relation between chronic musculoskeletal complaints and serum uric acid was examined in 737 men and 771 women (40-42 years old). The study is cross-sectional and part of the National Health Screening Service county studies in Norway. Both men and women with chronic musculoskeletal complaints had significantly higher s-urate means than persons without such complaints. Moreover, the prevalence of chronic musculoskeletal complaints (gout excluded) changed significantly across increasing s-urate levels also within the normal distribution of s-urate. Multivariate logistic regression analysis showed that the s-urate odds ratio for chronic complaints rose in a linear manner across these s-urate levels (adjusted for 12 other independent variables that may interfere with uric acid). Such a relation has not to our knowledge been previously described.