“…While the pathways with increased gene products include glucocorticoid signaling and B-cell development, there has been no obvious pathologic dysfunction of these pathways noted in FMS. Rather than being an immunologic failing, the atypical B-cell findings appear to be another aspect of the organism-wide alterations in physiology noted in FMS, such as the reported alterations in pain processing, autonomic and neuroendocrine function, neurotransmitter concentrations, and small-fiber nerve density (Balkarli, Sengul, Tepeli, Balkarli, & Cobankara, 2014; Oaklander, Herzog, Downs, & Klein, 2013; Serra et al, 2014). Understanding the significance of these B-cell differences requires knowing whether such differences precede and predispose people to future symptom development, are causal in creating symptoms, or are just an epiphenomenon that accompanies or instantiates the experience of symptoms.…”