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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.
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.
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.’
22nd June 2023
The MHRA will consider whether further action is needed after a coroner warned doctors were unaware of a rare risk of suicide linked to the commonly used antibiotic ciprofloxacin.
A prevention of future deaths report said that a respected and experienced consultant cardiologist, who had recently retired, died by suicide 11 days after being prescribed a course of ciprofloxacin to relieve his symptoms of prostatitis ahead of investigations for prostate cancer.
The inquest into his death heard that Dr Robert Stevenson, who had worked at Huddersfield Royal Infirmary, had no previous history of depression or mental health problems.
On the day he died, he had left the house for his usual walk and his family had no indications that suggested they should be concerned, coroner Martin Fleming said. The 63-year-old messaged his wife to say that he had left a note under his pillow and was later found dead in a nearby wood.
In a report sent to medicines regulators, Mr Fleming said the urologist who had prescribed the antibiotic had referred him to published literature linking ciprofloxacin and quinoline antibiotics with a potential rare link to suicidal behaviour.
While it was unclear if he was suffering from this side effect, it remained possible, he said.
‘I heard evidence to suggest that the prescribing doctor did not reference this side effect at the time of issuing the prescription to Mr Stevenson, since it was not in accord with current advice,’ Mr Fleming wrote.
‘I also heard evidence to suggest that prescribing doctors may not be fully aware of this rare side effect, and that patient’s suffering from depression may be more vulnerable to it.’
In the report sent to the Medicines and Healthcare products Regulatory Agency (MHRA) he continued: ‘I am therefore concerned that this potential risk has not been given sufficient emphasis and I would ask you to consider the appropriateness of reviewing the current guidelines as to the dispensation of the drug to patients by clinicians and increasing the awareness of the side effect in order to monitor and mitigate the risks.’
Psychiatric side effects, including suicidal behaviours, have been reported following ciprofloxacin and the patient information leaflet warns of these risks, the MHRA said.
In response to the coroner’s report, Dr Janine Jolly, MHRA deputy director of benefit/risk evaluation, said: ‘We are very sorry to hear of Dr Stevenson’s death and would like to express our sympathies to his family.
‘As with any serious suspected side effects, reports of fatalities are evaluated by us including an assessment of post-mortem details if available. We will be reviewing the coroner’s verdict.
‘We will carefully consider the points raised by the coroner in the Regulation 28 Report to consider whether further regulatory action is required to minimise risks to patients and will provide a response upon completion of our investigation.’