Delineating psychological and biomedical profiles in a heterogeneous
fibromyalgia population using cluster analysis.
Loevinger BL, Shirtcliff EA, Muller D, Alonso C, Coe CL.
Department of Psychiatry, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA, bloevinger@gmail.com.
Abstract
The heterogeneity of patients meeting American College of Rheumatology
(ACR) criteria for a diagnosis of fibromyalgia (FM) challenges our
ability to understand the underlying pathogenesis and to optimize
treatment of this enigmatic disorder. Our goal was to discern
clinically relevant subgroups across multiple psychological and
biomedical domains to better characterize the phenomenology of FM.
Women meeting 1990 ACR criteria for FM (N=E2=80=89=3D=E2=80=89107) underwen=
t
psychological (childhood trauma, mood, anxiety, and stress) and
biomedical (neuroendocrine, immune, and metabolic) testing. Cluster
analysis identified four distinct subgroups.
Subgroups I, II, and III exhibited profiles that included high
psychological distress.
Subgroup I was further distinguished by a history of childhood
maltreatment and hypocortisolism, and these women reported the most
pain and disability.
Subgroup II evinced more physiological dysregulation and also reported
high levels of pain, fatigue, and disability. Subgroup III was
characterized by normal biomarkers and reported intermediate pain
severity with higher global functioning.
Subgroup IV was distinguished by their psychological well-being,
reporting less disability and pain.
Our findings underscore the heterogeneity of both psychological and
physiological features among FM patients presenting with nearly
identical tender point counts.
This subgroup categorization is compatible with hypothesized
pathogenetic mechanisms of early trauma, stress system dysregulation,
and pro-inflammatory bias, each prominent in some but not all FM
patients.
Appreciation of distinct FM subgroup features is invaluable for
selecting the most appropriate treatment modalities.
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