Fecal Calprotectin Levels in Patients with Fibromyalgia: A Cross-sectional Study

Overview

Journal Arch Rheumatol

Specialty Rheumatology

Date 2025 Mar 10

PMID 40060121

Authors

Ece Cinar

Meryem Burcu Turkoglu Aytar

Musa Baklaci

Simin Hepguler

Burcu Barutcuoglu

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aimed to evaluate levels of fecal calprotectin (FC), a biomarker that helps distinguish irritable bowel syndrome from inflammatory gut disorders, in patients with fibromyalgia syndrome (FMS) and compare them to healthy controls.

Patients And Methods: The cross-sectional study was carried out on patients diagnosed with FMS according to the ACR (American College of Rheumatology) 2016 classification and healthy controls between January 2021 and February 2022. FMS patients were grouped according to the absence (Group 1) or presence (Group 2) of gastrointestinal symptoms. A third group of healthy controls without gastrointestinal complaints (Group 3) was included. Demographic data, comorbidities, medications, symptom severity scale, and widespread pain index scores were recorded. All subjects were asked to provide stool samples for the measurement of FC levels.

Results: A total of 100 subjects were included in the study. There were 33 patients (4 males, 29 females, mean age: 46.9±10.6; range, 22 to 69 years) in Group 1, 32 patients (2 males, 30 females, mean age: 48.5±11.0; range, 22 to 73 years) in Group 2, and 35 patients (11 males, 24 females, mean age: 39.2±13.1; range, 22 to 67 years) in Group 3. Group 2 had significantly higher levels of FC compared to Group 3 (p <0.05). The number of patients with positive FC values was similar between the three groups. Symptom severity scale and widespread pain index scores were significantly worse in Group 2 compared to Group 1 (p <0.05).

Conclusion: Irritable bowel syndrome usually coexists in many patients with FMS, and this may cause a misdiagnosis or delay in the diagnosis of organic gastrointestinal conditions. The value of FC in screening and diagnosis of organic disease in FMS patients needs further evaluation.

References

Hor J, Lim S, Khor E, Chong K, Song S, Mohamed Ibrahim N . Fecal Calprotectin in Parkinson's Disease and Multiple System Atrophy. J Mov Disord. 2021; 15(2):106-114. PMC: 9171316. DOI: 10.14802/jmd.21085. View

Hauser W, Sarzi-Puttini P, Fitzcharles M . Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol. 2019; 37 Suppl 116(1):90-97. View

Kulshreshtha P, Deepak K . Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review. Clin Physiol Funct Imaging. 2013; 33(2):83-91. DOI: 10.1111/cpf.12000. View

Caviglia G, Ribaldone D, Rosso C, Saracco G, Astegiano M, Pellicano R . Fecal calprotectin: beyond intestinal organic diseases. Panminerva Med. 2018; 60(1):29-34. DOI: 10.23736/S0031-0808.18.03405-5. View

Kleykamp B, Ferguson M, McNicol E, Bixho I, Arnold L, Edwards R . The Prevalence of Psychiatric and Chronic Pain Comorbidities in Fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum. 2020; 51(1):166-174. DOI: 10.1016/j.semarthrit.2020.10.006. View

Smalley W, Falck-Ytter C, Carrasco-Labra A, Wani S, Lytvyn L, Falck-Ytter Y . AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology. 2019; 157(3):851-854. DOI: 10.1053/j.gastro.2019.07.004. View

Park S, Lee S, Kim W . Fecal Calprotectin Is Increased in Stroke. J Clin Med. 2022; 11(1). PMC: 8745495. DOI: 10.3390/jcm11010159. View

DAmico F, Rubin D, Kotze P, Magro F, Siegmund B, Kobayashi T . International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021; 9(4):451-460. PMC: 8259254. DOI: 10.1002/ueg2.12069. View

Sayuk G, Wolf R, Chang L . Comparison of Symptoms, Healthcare Utilization, and Treatment in Diagnosed and Undiagnosed Individuals With Diarrhea-Predominant Irritable Bowel Syndrome. Am J Gastroenterol. 2017; 112(6):892-899. PMC: 5465427. DOI: 10.1038/ajg.2016.574. View

10.

Guo J, Pei L, Chen L, Chen H, Gu D, Peng Y . Bidirectional association between irritable bowel syndrome and restless legs syndrome: a systematic review and meta-analysis. Sleep Med. 2020; 77:104-111. DOI: 10.1016/j.sleep.2020.12.002. View

11.

Ojetti V, Saviano A, Covino M, Acampora N, Troiani E, Franceschi F . COVID-19 and intestinal inflammation: Role of fecal calprotectin. Dig Liver Dis. 2020; 52(11):1231-1233. PMC: 7508507. DOI: 10.1016/j.dld.2020.09.015. View

12.

Gemignani F . Irritable bowel syndrome, restless legs syndrome, small fiber neuropathy, and fibromyalgia. Sleep Med. 2021; 83:4. DOI: 10.1016/j.sleep.2021.04.023. View

13.

Husebye E, Ton H, Johne B . Biological variability of fecal calprotectin in patients referred for colonoscopy without colonic inflammation or neoplasm. Am J Gastroenterol. 2001; 96(9):2683-7. DOI: 10.1111/j.1572-0241.2001.04126.x. View

14.

Ayling R, Kok K . Fecal Calprotectin. Adv Clin Chem. 2018; 87:161-190. DOI: 10.1016/bs.acc.2018.07.005. View

15.

Wolfe F, Clauw D, Fitzcharles M, Goldenberg D, Hauser W, Katz R . 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016; 46(3):319-329. DOI: 10.1016/j.semarthrit.2016.08.012. View

16.

Simioni J, Skare T, Campos A, Kotze L, Messias-Reason I, Ioshii S . Fecal Calprotectin, Gut Inflammation and Spondyloarthritis. Arch Med Res. 2019; 50(1):41-46. DOI: 10.1016/j.arcmed.2019.04.003. View

17.

Lacy B, Patel N . Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017; 6(11). PMC: 5704116. DOI: 10.3390/jcm6110099. View

18.

Erdrich S, Hawrelak J, Myers S, Harnett J . A systematic review of the association between fibromyalgia and functional gastrointestinal disorders. Therap Adv Gastroenterol. 2020; 13:1756284820977402. PMC: 7727037. DOI: 10.1177/1756284820977402. View