Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
GH-IGF1 Axis in Severe Fibromyalgia Patients: Screening Data From the CT27560 Trial
Alegre1, C., Cuatrecasas2, G., Cabrera3, J., Joaquim Sr.4, Fernandez-Sola
Fibromyalgia syndrome (FM), defined by tender points and weakness is becoming widespread. Some studies have shown disturbances in the GH axis in global FM (1), although not clear subgroup stratification according to GH secretion or resistance had been done. Two intervention studies have been published so far (2,3). CT27560 compares GH +triple therapy (2 antidepressive + opioid analgesia) vs triple therapy alone, in a low IGF-1 but normal ITT and GT responders, in a selective cohort of severe FM. We present screening data of the pre-selected patients for the trial.
All patients (n=164 women) had>16 tender points and FIQ scale>75. Mean age was 50± 9,4 years and mean BMI was 27,2±4,1 Kg/m2. They had 2 basal GH and IGF-1 determinations (IGF-1<150 uU/ml corresponded to-2SD and <250 uU/ml to-1 SD according to control population), insulin-tolerance test (ITT) or glucagon test for the GH secretion analysis,(cut-off 5 ng/ml) and a modified generation test (GT) for the insensitivity analysis (cut-off >50% IGF-1 response). IGF1 was measured by chimioluminiscensce or RIA depending on the center.
19/164 (12,75%) had IGF-1>150 ug/l and 4/164 had IGF-1>250 ug/l (2,68%). 7/95p had an ITT<3ng/ml (7,36% of the total),15/95 had an ITT<5 ng/ml (15,7%), criteria for AGHD. 5 patients were retested, previous withdrawal of the antidepressant drug, 1 normalized its response (glucagon test). 9/95 had basal GH>5 ng/ml (9,4%), 8/95 had a GT<50% IGF-1 response (8,4%), criteria for GH insensitivity. No correlation was found between basal GH or IGF-1 and GT response. No statistical differences were seen between the centers when analyzing IGF-1, % of itt non-responders and % of GT non-responders (Student t test).
Severe fibromyalgic syndromes have a high prevalence of GH axis disfunction. Some patients show classic biochemical patterns of AGHD and might be candidates for substitution treatment. The majority stands with normal-low IGF-1 but correct secretion test, suggesting certain GH insensitivity in this disease. This seems to be confirmed by the % of non responders to the GT
To cite this abstract, please use the following information:
Alegre, C., Cuatrecasas, G., Cabrera, J., Joaquim Sr., Fernandez-Sola; GH-IGF1 Axis in Severe Fibromyalgia Patients: Screening Data From the CT27560 Trial [abstract]. Arthritis Rheum 2009;60 Suppl 10 :82