Middle east pain syndrome is a pollution-induced new disease mimicking rheumatoid arthritis

Abstract

Musculoskeletal pains are sometimes misdiagnosed in some diseases, like rheumatoid and psoriatic arthritis, erosive OA, etc. Secondary hyperparathyroidism was not considered a differential diagnosis for RA, despite the fact that it can cause arthralgia or arthritis. Also, fibromyalgia is a psychosomatic condition marked by widespread pain and tenderness. This study included 400 patients attended certain outpatient clinics of Rheumatology in Egypt and Saudi Arabia, who were not fulfilling criteria for RA diagnosis. Criteria for classification of fibromyalgia syndrome were applied to all patients. We did lab tests and radiological imaging modalities for diagnosis or exclusion of suspected diseases were applied. All patients were fulfilling both old and new criteria of fibromyalgia syndrome, and not fulfilling any RA criteria, and had vitamin D3 deficiency or insufficiency. 75% of patients had abnormally high levels of PTH, without parathyroid gland pathology. Radiology showed subperiosteal and subchondral resorption of mainly thumbs, subchondral osteopenia of proximal and middle phalanges, mild subperiosteal resorption along the radial aspect of the middle phalanx and mild tuft erosions, besides changes in the carpus closely resembling those of rheumatoid arthritis, of ulnar styloid resorption, radiocarpal and scapho-trapezoid joint arthritis. Of special interest, the presence of tuft spur-like excrescences.

Middle East pain syndrome as a mixture of various chronic diseases

“…The authors who are in charge of this syndrome found the patients did not achieve any criteria for RA diagnosis as well. More detail of this study showed abnormal serum parathormone in 75% of cases, without parathyroid gland morphology, along with sub-chondral and sub-periosteal desorption of mostly thumbs, with sub-chondral osteopenia of sub-chondral area of proximal and middle phalanges (1). Moreover, mild sub-periosteal resorption across the radial part of the middle phalanx is in association with mild tuft erosions.…”

“…Possible cadmium contamination should also be considered. Notably, symptoms of this syndrome improved by fibromyalgia therapy consisting of muscle relaxants and vitamin D3 supplementation, and other related drugs (1). Therefore, we suggest more attention to this syndrome, in patients with various complaints as mentioned above.…”

“…ecently, several cases of bilateral hand and wrist arthritis accompanied by fibromyalgia and lowserum vitamin D3 were described (1). This condition is associated with elevated serum concentrations of parathormone in some cases.…”

“…The etiology of secondary hyperparathyroidism is interpreted as a result of low-serum vitamin D3 concentration, which is not related to kidney disease, or other causing factors. They also regarded that chronic vitamin D3 insufficiency or deficiency might be due to unhealthy food habits and pollutants, like exposure to various heavy metals like lead or cadmium, which are present in some fizzy waters, mineral waters, fried snacks, or tobacco smoke (1).…”

Diagnosis and Treatment of Calcium Pyrophosphate Deposition (CPPD) Disease: A Review

“…Middle Eastern Pain Syndrome, a newly discovered disease characterised by vitamin D deficiency, secondary hyperparathyroidism and fibromyalgia, may also predispose to chondrocalcinosis due to the occurrence of secondary hyperparathyroidism in these patients. 29 Bartter’s and Gitelman’s syndromes may also be associated, likely due to the associated chronic hypomagnesaemia. In a recent study by Chotard et al, 79% of patients with Gitelman’s Syndrome had evidence of chondrocalcinosis at least at one site, with the highest prevalence at the cervical spine (81.8%) followed by the knee (52.6%) and the wrist (50.9%).…”