Study finds patients with fibromyalgia may have heightened risk of death

18th July 2023

Patients with fibromyalgia may have a heightened risk of death as a result of vulnerability to accidents, infections and, especially, suicide, researchers have warned.

The results suggest ‘fibromyalgia should be taken seriously’ with a need for regular monitoring of patients’ physical and mental health to minimise these risks, they concluded.

Published in the journal RMD Open, the systematic review of eight studies covering more than 188,000 patients found a 27% increased risk of death from all causes for patients diagnosed with the condition under more modern criteria from 2010 onwards.

All the adults in the review had other co-existing conditions, the researchers said, and they also reported a 44% increased risk of infections, including pneumonia and septicaemia, and more than three times the risk for suicide. 

For accidents, the risk was 5% higher, but the risk of death from cancer was 12% lower than it was for the general population of the same age.

Whether the heightened risk is due to the fibromyalgia itself or the concomitant conditions is unclear, but it is an important finding that needs to be looked at in further research, the authors concluded.

Fibromyalgia prevalence increasing

It’s not clear what causes fibromyalgia, but its prevalence is increasing and there is growing recognition that the condition often coexists with other health problems, including rheumatic, gut, neurological and mental health disorders.

The higher risk of suicide could potentially be explained by the physical, and especially the psychiatric, comorbidities that are characteristic of fibromyalgia patients, the researchers said.

And increased mortality associated with accidents could stem from fatigue, unrefreshing sleep and the concentration difficulties linked to the condition.

When it comes to infection, increasing evidence supports immune system involvement and inflammation in the development of fibromyalgia, they added.

‘A serious public health problem’

The risks identified in their analysis ‘could represent a serious public health problem, given the high prevalence of the condition’, which clinicians don’t always take seriously, they wrote.

‘Studies have shown that medical staff are reluctant to accept fibromyalgia as a medical condition, and they face emotional and psychological difficulties interacting with these patients and coping with their disorder.

‘Our review provides further proof that fibromyalgia patients should be taken seriously, with particular focus on screening for suicidal ideation, prevention of accidents, and prevention and treatment of infections.’

A 2020 study by UK researchers found an increased risk of self-harm associated with some rheumatic conditions, particularly fibromyalgia where the incidence was found to be highest.

Author of this 2020 study, Carolyn Chew-Graham, a GP and professor of general practice research at Keele University, said: ‘In our research we concluded clinicians need to be aware of the potential for self-harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.’

No clear temperature threshold for infection screening in hypothermic infants

12th December 2022

There appears to be no clear temperature threshold which can be used to identify infections among hypothermic young.

It is difficult to identify a suitable temperature threshold to reliably allow emergency care clinicians to identify hypothermic young infants at risk of a serious bacterial infection according to a retrospective study by US researchers.

Fever in young children is a common emergency department (ED) presentation and there are recognised sequential approaches to young febrile infants on the basis of clinical and laboratory parameters, to identify those at risk of an invasive bacterial infection.

In contrast, hypothermia is also recognised as an important factor in very young children who subsequently develop a serious bacterial infection (SBI).

In fact, one study of children less than 60 days old, detected the presence of a SBI in 9% of evaluated infants, prompting the authors to concluded that hypothermia can be a presenting sign of SBI.

Another study found that neonates presenting with hypothermia had a substantial risk for SBI or other significant pathology.

Despite the growing recognition that hypothermia represents a risk factor for a SBI, what remains uncertain is the specific temperature threshold that should be used to identify at-risk young children.

In the present study, researchers undertook a retrospective cross-sectional study of infants less than 90 days old who presented at an ED and with a rectal temperature < 36.4^oC.

The team set the primary outcome as SBI defined as either a urinary tract infection, bacteraemia and/or bacterial meningitis and invasive bacterial infections (IBI) with the latter limited to bacteraemia and/or bacterial meningitis.

The team constructed receiver operating characteristic (ROC) curves for the two outcomes and calculated the area under the ROC curve (AUC) to evaluate an optimally derived cut-off point for the minimum ED temperature and the presence of SBI or IBI.

They defined accuracy using the AUC as poor where the AUC was < 70%, 70 – 80% as fair, 80 – 90% as good and > 90% as excellent.

Temperature threshold identification

The study included 3,376 infants with a median age of 22 days (53.1% male) with the overall median minimum temperature being 36.2^oC.

Overall, 1.8% of infants had an SBI and 0.5% an IBI and the most common infection identified was Escherichia coli UTI (74.2% of all SBIs).

Infants with both an SBI and IBI had lower median temperatures, 35.8°C and 35.4°C respectively, compared with those without corresponding infections and this difference was statistically significant (both p<0.05).

In their analysis, when evaluating the performance of temperature with an outcome of SBI, the AUC was 61% (95% CI 54.1 – 67.9%).

Using a cut-off of 36.2°C, the sensitivity was 59.7% and the specificity 59.2%. Similarly, for IBI, the AUC was 65.9% (95% CI 51.1 – 80.6%) and with a cut-off of 36.1°C, the sensitivity was 68.8% and the specificity 60.1%.

The authors concluded that although young infants with SBI and IBI presented with lower temperatures, there was no temperature threshold to reliably identify SBI or IBI.

Citation
Lo YHJ et al. Temperature threshold in the screening of bacterial infections in young infants with hypothermia. Emerg Med J 2022.