Chronic musculoskeletal pain at Kenyatta National Hospital

Abstract

Background: Fibromyalgia is a rheumatic condition characterized by chronic widespread musculoskeletal pain with painful pressure points. Other associated symptoms include fatigue, sleep disturbance and depression. The cause of this condition is unknown however chronic viral infections eg Human Immunodeficiency Virus (HIV) have been associated with fibromyalgia. This study aimed to determine the prevalence of fibromyalgia in HIV positive patients. Methods: This was a cross-sectional descriptive study carried out at the Kenyatta National Hospital, Comprehensive Care Clinic (CCC) . The patients attending the clinic between the months of February 2013 and April 2013 were assessed for chronic musculoskeletal pain and subsequently fibromyalgia using the American College of Rheumatology criteria . Those found to have fibromyalgia were given the the revised Fibromyalgia Impact Questionnaire (FIQR) and those without were given the the revised Symptom Impact Questionnaire (SIQR) for comparison purposes. Clinical details eg WHO clinical stage, CD4 counts and Highly Active Anti Retroviral Therapy (HAART) regimen for those on HAART were also documented. Results: A total of 380 patients with chronic musculoskeletal pain were enrolled in the study. The prevalence of fibromyalgia in these patients was 17.9% (n=68). Their mean age was 42.2 years with a median of 42.5 years. There was a female preponderance of 88.2% (n=60). Fibromyalgia was associated with female gender, OR=3.0, unemployment status, OR=5.4 and retired status, OR=3.4. A majority of the patients were in WHO clinical stage 3 and the mean CD4 count was 276.2cells/ml. There was however no association between fibromyalgia and WHO clinical stage, CD4 count and use of HAART or the specific HAART regimens. The mean FIQR was 50.1 which was significantly higher than the mean SIQR score of 12.4 in those without fibromyalgia. Conclusion: Fibromyalgia is a prevalent rheumatologic condition among HIV positive patients with chronic musculoskeletal pain. It is also associated with a high FIQR score