Differentiation between Primary fibromyalgia and Middle East Pain syndrome regarding Serum IL-6 level and MRI changes in hands and knees joints

Ismail, Sahar Salah; Elbeialy, Adel Abbas; Abdelraheem, Sabah Ibrahim; Mohamed, Maha Salah Eldin

doi:https://doi.org/10.21608/aimj.2025.446556

Differentiation between Primary fibromyalgia and Middle East Pain syndrome regarding Serum IL-6 level and MRI changes in hands and knees joints

Document Type : Original Article

Authors

¹ Department of Rheumatology and Rehabilitation, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

² Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.

https://doi.org/10.21608/aimj.2025.446556

Abstract

Background: Fibromyalgia syndrome(FMS) is defined by the dysregulation of neuroendocrine function and/or nociceptive processing. Middle East Pain Syndrome(MEPS) is characterized by fibromyalgia that is accompanied by 2ry hyperparathyroidism and deficiency of vitamin D3.
Aim: To differentiate between primary fibromyalgia and MEPS in terms of serum IL-6 level and MRI changes in the joints of the hands and knees.
Patients and methods: This investigation involved forty cases diagnosed as MEPS and 40 patients with primary fibromyalgia. Full history taking, clinical examination, laboratory investigations involving vitamin D3, parathyroid hormone(PTH) and IL-6 serum levels, and MRI of both hand and knee joints.
Results: Vitamin D3 levels decreased in both groups, with a significant reduction in the MEPS group in comparison with the FMS group. IL-6 levels increased in both groups without significant differences, but correlated with clinical severity scores. PTH levels were significantly greater in the MEPS group (p-value less than 0.001). Hand MRI showed more spur excrescences and degenerative changes in the MEPS group(p-value less than 0.05). Knee MRI revealed higher chondrocalcinosis in the MEPS group, increasing with age and disease duration, while synovial hypertrophy showed no significant difference.
Conclusion: Vitamin D3 serum level decreased in both MEPS and FMS cases, significantly decreasing in the MEPS group compared to the FMS group, necessitating assessment and correction. IL-6 serum level increased in both groups with an insignificant difference; it positively correlates with clinical manifestations. MRI showed increased chondrocalcinosis and degenerative changes in MEPS patients.

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