الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The studies in which patients with fibromyalgia didn’t show improvements in their symptoms after vitamin D supplementation, their results may be explained by that some patients with fibromyalgia showed high scores of SSS, VAS, FIQ and HAD inspite of having normal vitamin D level and showed significant improvement in their scores despite receiving pregabalin and anti-depressant only without vitamin D supplementation as in group 2 in our study. Vitamin D replenishment represents a cheap, cost-effective method of symptom improvement in patients with FMS. The true benefit of vitamin D supplementation in FMS has not been fully ascertained and should be assessed by clinicians on an individual patient basis. Fibromyalgia is one of the most common diseases affecting the muscles manifested with pain, stiffness and tenderness of the muscles, tendons and joints. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain; patients with fibromyalgia do not develop tissue damage or deformity. The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back and the chest. The goals of fibromyalgia treatment are to alleviate pain, increase restorative sleep and improve physical function through a reduction in associated symptoms. The identification and treatment of all pain sources that may be present in addition to fibromyalgia such as peripheral inflammatory or neuropathic pain generators(e.g. Comorbid osteoarthritis or neuropathic pathologies) or visceral pain (e.g., comorbid irritable bowel syndrome) are central to the proper clinical management of fibromyalgia. Vitamin D is a pleiotropic hormone with a critical role in modulating several inflammatory and pain pathways in addition to calcium homeostasis. Observational studies suggest an association between vitamin D deficiency and chronic pain, most promisingly in fibromyalgia. Indeed, it has been hypothesized that vitamin D has anti-inflammatory properties that contribute to relieving pain. In vitro studies have found that the vitamin can reduce prostaglandin E2 (PGE2) synthesis to down-regulate proinflammatory pathways and its supplementation can improve musculoskeletal pain. The aim of this study is to assess serum vitamin D level in primary fibromyalgia patients and it’s correlation with clinical, functional and psychological status of primary fibromyalgia patients. Also to assess the effect of vitamin D therapy in this patients. This study was performed on 30 primary fibromyalgia patients diagnosed according to 2010 American College of Rheumatology revised diagnostic criteria of fibromyalgia (4). The patients will be divided into 2 groups according to serum vitamin D level. In addition to 15 healthy volunteers matched in age and sex were included as healthy controls. The patients were selected from the outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation department, Tanta University Hospitals. All patients are subjected to the following assessment before and after 2 months of treatment: I -Clinical assessment which include: 1-Complete history taking. 2-Clinical examination. 3-Assessment of symptom severity by the Symptom Severity scale(4). 4-The pain is assessed by using visual analogue scale(VAS)(212). II -Evaluation of the functional state of the patients of fibromyalgia using the Fibromyalgia Impact Questionnaire(FIQ)(213). III -The psychological state of the patient will also be assessed by Hospital Anxiety and Depression scale(HADS)(214). IV -Investigations to rule out other conditions include:CBC, ESR, RF, ACCP and Thyroid function tests. V -Serum vitamin D (25 Hydroxy vitamin D) level is measured by ELISA technique will be done to patients and control group. Patients received treatment as follows: Group1 (Vitamin D deficient fibromyalgia patients):Included 21 patients received the treatment of fibromyalgia (pregabalin and tricyclic antidepressants) plus vitamin D therapy ;50.000 iu per week for two months. group 2 (Vitamin D normal serum level fibromyalgia patients): Included 9 patients received only the treatment of fibromyalgia that include pregabalin and tricyclic antidepressants for two months. The result of this study could be summarized as follow: 1-The percentage of vitamin D deficiency in fibromyalgia patients was 70%. 2-There was significant difference between patients group1 and control group according to serum vitamin D level before treatment. 3-There was no significant difference between group 2 and control group according to serum vitamin D level before treatment. 4-There was significant difference between group1 and 2 before receiving treatment according to symptoms severity score, VAS score, FIQ score and HAD score. 5-There was significant difference between the two groups after receiving treatment according to VAS score and FIQ score. 6-There was no significant difference between the two groups after receiving treatment according to symptoms severity score, HAD-depression score and HAD-anxiety score . 7-There was significant difference between the two groups according to changes in symptoms severity score, VAS score, FIQ and HAD-depression score and HAD-anxiety score after receiving treatment. 8-There was significant correlation between serum level of vitamin D and VAS score and FIQ before and after receiving treatment in group1. 9-There was no significant correlation between serum level of vitamin D and SSS,VAS, FIQ and HAD in group 2 before and after receiving treatment.