Laborchemische, neurohormonelle und immunologische Befunde beim Fibromyalgie- und chronischen Müdigkeitssyndrom und ihre klinische Relevanz

  • R. Klein


Die Probleme in der Diagnose und Differentialdiagnose des Fibromyalgiesyndroms (FMS) und chronischen Müdigkeitssyndroms (CFS) sind bereits in den vorangehenden Kapiteln dargestellt worden. Da eindeutige diagnostische Kriterien fehlen, basiert ihre Erkennung auf dem Ausschluß anderer Erkrankungen [16, 22, 34, 64, 67, 86]. In diesem Kontext müssen auch die hier empfohlenen laborchemischen und immunologischen Untersuchungen gesehen werden.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alarcón-Segovia D, Cabral AR (1994) Antiphospholipid antibodies. Where do they come from? Where do they go to? J Rheumatol 21: 982–989PubMedGoogle Scholar
  2. 2.
    Aoki T, Usuda Y, Miyakoshi H et al. (1987) Low natural killer syndrome: clinical and immunologic features. Nat Immun 6:116–128Google Scholar
  3. 3.
    Asherson RA, Cervera R (1992) The antiphospholipid syndrome: a syndrome in evolution. Ann Rheum Dis 51:147–150PubMedCrossRefGoogle Scholar
  4. 4.
    Bates DW, Buchwald D, Lee J et al. (1995) Clinical laboratory test findings in patients with chronic fatigue syndrome. Arch Intern Med 155: 97–103PubMedCrossRefGoogle Scholar
  5. 5.
    Behan PO, Behan WMH, Bell EJ (1985) The postviral fatigue syndrome — an analysis of the findings in 50 cases: J Infect 10: 211–222PubMedCrossRefGoogle Scholar
  6. 6.
    Bengtsson A, Bengtsson M (1988) Regional sympathetic blockage in primary fibromyalgia. Pain 33:161–167PubMedCrossRefGoogle Scholar
  7. 7.
    Bennett RM, Clark SR, Campbell SM, Burckhardt CS (1992) Low levels of somatomedin C in patients with the fibromyalgia syndrome. Arthritis Rheum 35:1113–1116PubMedCrossRefGoogle Scholar
  8. 8.
    Berg PA, Klein R (1994) Fibromyalgie-Syndrom. Eine neuroendokrinologische Autoimmunerkrankung? Dtsch Med Wochenschr 119: 429–435PubMedCrossRefGoogle Scholar
  9. 9.
    Blalock JE (1994) The syntax of immune-neuroendocrine communication. Immunol Today 15:504–511PubMedCrossRefGoogle Scholar
  10. 10.
    Buchwald D, Wener MH, Pearlman T, Kith P (1997) Markers of inflammation and immune activation in chronic fatigue and chronic fatigue syndrome. J Rheumatol 24:372–376PubMedGoogle Scholar
  11. 11.
    Chao CC, Gallagher M, Phair J, Peterson PK (1990) Serum neopterin and interleukin-6 levels in chronic fatigue syndrome (letter). J Infect Dis 162:1412–1413PubMedCrossRefGoogle Scholar
  12. 12.
    Chao CC, Janoff EN, Hu S et al. (1991) Altered cytokine release in peripheral blood mononuclear cell cultures from patients with the chronic fatigue syndrome. Cytokine 3: 292–298PubMedCrossRefGoogle Scholar
  13. 13.
    Cheney PR, Dorman SE, Bell DS (1989) Interleukin-2 and the chronic fatigue syndrome (letter). Ann Intern Med 110:321PubMedGoogle Scholar
  14. 14.
    Cohen IR, Cooke A (1986) Natural autoantibodies might prevent autoimmune disease. Immunol Today 7: 363–364CrossRefGoogle Scholar
  15. 15.
    Coplan JD, Tamir H, Calaprice D et al. (1998) Plasma anti-serotonin and serotonin antiidiotypic antibodies are elevated in panic disorder. Neuropsychopharmacology (in press)Google Scholar
  16. 16.
    Csillag C (1992) Fibromyalgia. The Copenhagen declaration. Lancet 340: 663CrossRefGoogle Scholar
  17. 17.
    Demitrack M, Gold PW, Chrousos GP et al. (1991) Evidence for the impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J Clin Endocrinol Metab 73:1224–1234PubMedCrossRefGoogle Scholar
  18. 18.
    Dinerman H, Goldenberg DL, Felson DT (1986) A prospective evaluation of 118 patients with the fibromyalgia syndrome. Prevalence of Raynaud’s phenomenon, sicca symptoms, ANA, low complement and Ig deposition at the dermal-epidermal junction. J Rheumatol 13: 368–373PubMedGoogle Scholar
  19. 19.
    Ewig S (1993) Das Chronische Müdigkeitssyndrom. Dtsch Med Wochenschr 118: 1373–1380PubMedCrossRefGoogle Scholar
  20. 20.
    Ferraccioli G, Cavalieri F, Salaffi F et al. (1990) Neuroendocrinologic findings in primary fibromyalgia (soft tissue chronic pain syndrome) and in other chronic rheumatic conditions (rheumatoid arthritis, low back pain). J Rheumatol 17: 869–873PubMedGoogle Scholar
  21. 21.
    Ferraccioli G, Guerra P, Rizzi V et al. (1994) Somatomedin C (insulin-like growth factor 1) levels decrease during acute changes of stress related hormones. Relevance for fibromyalgia. J Rheumatol 21:1332–1334PubMedGoogle Scholar
  22. 22.
    Fukuda K, Straus SE, Hickie I et al. and The International Chronic Fatigue Syndrome Study Group (1995) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 123: 74–76Google Scholar
  23. 23.
    Gin W, Christiansen FT, Peter JB (1989) Immune function and the chronic fatigue syndrome. Med J Aust 151:117–118PubMedGoogle Scholar
  24. 24.
    Goldenberg DL (1989) Fibromyalgia and its relation to chronic fatigue syndrome, viral illness and immune abnormalities. J Rheumatol 16 (Suppl 19): 91–93Google Scholar
  25. 25.
    Goldenberg DL (1988) Fibromyalgia and other chronic fatigue syndromes: is there evidence for chronic viral disease? Semin Arthritis Rheum 18:111–120PubMedCrossRefGoogle Scholar
  26. 26.
    Goldstein JA (1994) Fibromyalgia syndrome: A pain modulation disorder related to altered limbic function? Baillière’s Clin Rheumatol 8: 839–856CrossRefGoogle Scholar
  27. 27.
    Griep EN, Boersma JW, de Kloet ER (1994) Pituitary release of growth hormone and prolactin in the primary fibromyalgia syndrome. J Rheumatol 21: 2125–2130PubMedGoogle Scholar
  28. 28.
    Griep EN, Boersma JW, de Kloet ER (1993) Altered reactivity of the hypothalamicpituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol 20: 469–474PubMedGoogle Scholar
  29. 29.
    Hader N, Rimon D, Kinarty A, Lahat N (1991) Altered interleukin-2 secretion in patients with primary fibromyalgia syndrome. Arthritis Rheum 34: 866–872PubMedCrossRefGoogle Scholar
  30. 30.
    Hamaty D, Valentine JL, Howard R et al. (1989) The plasma endorphin, prostaglandin and catecholamine profile of patients with fibrositis treated with cyclobenzaprine and placebo: a 5-month study. J Rheumatol 16 (Suppl 19): 164–168Google Scholar
  31. 31.
    Hernanz W, Valenzuela A, Quijaa J et al. (1994) Lymphocyte subpopulations in patients with primary fibromyalgia. J Rheumatol 21: 2122–2124PubMedGoogle Scholar
  32. 32.
    Ho-Yen DO, Carrington D, Armstrong AA (1988) Myalgic encephalomyelitis and alphainterferon. Lancet 1:125PubMedCrossRefGoogle Scholar
  33. 33.
    Holmberg D, Coutinho A (1985) Natural antibodies and autoimmunity. Immunol Today 6:356–357CrossRefGoogle Scholar
  34. 34.
    Holmes GP, Kaplan JE, Gantz NM et al. (1988) Chronic fatigue syndrome: a working case definition. Ann Intern Med 108: 387–389PubMedGoogle Scholar
  35. 35.
    Hudson JI, Goldenberg DL, Pope HG et al. (1992) Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 92: 363–367PubMedCrossRefGoogle Scholar
  36. 36.
    Hudson JI, Hudson MS, Pliner LF et al. (1985) Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiatry 142: 441–446PubMedGoogle Scholar
  37. 37.
    Hudson JI, Pope HG (1994) The concept of affective spectrum disorder: relationship to fibromyalgia and other syndromes of chronic fatigue and chronic muscle pain. Baillière’s Clin Rheumatol 8: 839–856CrossRefGoogle Scholar
  38. 38.
    Katz RS, Kravitz HM (1996) Fibromyalgia, depression, and alcoholism: a family history study. J Rheumatol 23:149–154PubMedGoogle Scholar
  39. 39.
    Klein R, Berg PA (1994) A comparative study on antibodies to nucleoli and 5-hydroxytryptamine in patients with fibromyalgia syndrome and tryptophan-induced eosinophilia-myalgia syndrome. Clin Invest 72: 541–549CrossRefGoogle Scholar
  40. 40.
    Klein R, Berg PA (1995) High incidence of antibodies to 5-hydroxytryptamine, gangliosides and phospholipids in patients with chronic fatigue and fibromyalgia syndrome and their relatives: evidence for a clinical entity of both disorders. Eur J Med Res 1:21–26PubMedGoogle Scholar
  41. 41.
    Klimas NG, Salvato FR, Morgan R, Fletcher MA (1990) Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol 28:1403–1410PubMedGoogle Scholar
  42. 42.
    Konstantinov K, von Mikecz A, Buchwald D et al. (1996) Autoantibodies to nuclear envelope antigens in chronic fatigue syndrome. J Clin Invest 98:1888–1896PubMedCrossRefGoogle Scholar
  43. 43.
    Landay AL, Jessop C, Lennette ET, Levy JA (1991) Chronic fatigue syndrome: Clinical condition associated with immune activation. Lancet 338: 707–712PubMedCrossRefGoogle Scholar
  44. 44.
    Linde A, Andersson B, Svensson SB et al. (1992) Serum levels of lymphokines and soluble cellular receptors in primary Epstein-Barr virus infection and in patients with chronic fatigue syndrome. J Infect Dis 165: 994–1000PubMedCrossRefGoogle Scholar
  45. 45.
    Linde A, Hammerstrom L, Smith CIE (1988) IgG subclass deficiency and chronic fatigue syndrome. Lancet 1: 885–886PubMedCrossRefGoogle Scholar
  46. 46.
    Lloyd A, Abi Hanna D, Wakefield D (1988) Interferon and myalgic encephalomyelitis. Lancet 1: 471PubMedCrossRefGoogle Scholar
  47. 47.
    Lloyd A, Hickie I, Brockman A et al. (1991) Cytokine levels in serum and cerebrospinal fluid in patients with chronic fatigue syndrome (letter). J Infect Dis 164: 1023–1024PubMedCrossRefGoogle Scholar
  48. 48.
    Manu P, Matthews DA, Lane TJ (1993) Food intolerance in patients with chronic fatigue. Int J Eating Disorders 13: 203–209CrossRefGoogle Scholar
  49. 49.
    McDonald EM, Mann AH, Thomas HC (1987) Interferons as mediators of psychiatric morbidity. An investigation in a trial of recombinant alpha interferon in hepatitis B carriers. Lancet II: 1175–1179CrossRefGoogle Scholar
  50. 50.
    Moldofsky H (1989) Sleep and the fibrositis syndrome. Rheum Dis Clin North Am 15:91–103PubMedGoogle Scholar
  51. 51.
    Morrison LJA, Behan WMH, Behan PO (1991) Changes in natural killer cell phenotype in patients with post-viral fatigue syndrome. Clin Exp Immunol 83: 441–446PubMedCrossRefGoogle Scholar
  52. 52.
    Neeck G, Riedel W (1992) Thyroid function in patients with fibromyalgia syndrome. J Rheumatol 19:1120–1122PubMedGoogle Scholar
  53. 53.
    Neeck G, Riedel W (1994) Neuromediators and hormonal abnormalities in fibromyalgia syndrome — results of chronic stress? Baillière’s Clin Rheumatol 8: 764–775Google Scholar
  54. 54.
    Olin R, Klein R, Berg PA (1998) A randomised double-blind 16-week study of Ritanserin in fibromyalgia syndrome: clinical outcome and analysis of autoantibodies to serotonin, gangliosides and phospholipids. Clin Rheumatol 17: 89–94PubMedCrossRefGoogle Scholar
  55. 55.
    Pellegrino MJ, Waylonis GW, Sommer A (1989) Familial occurrence of primary fibromyalgia. Arch Phys Med Rehabil 70: 61–63PubMedGoogle Scholar
  56. 56.
    Prieto J, Subira ML, Castilla A, Serrano M (1989) Naloxone-reversible monocyte dysfunction in patients with chronic fatigue syndrome. Scand J Immunol 30:13–20PubMedCrossRefGoogle Scholar
  57. 57.
    Qiao ZG, Vaeroy H, Morkrid L (1991) Electrodermal and microcirculatory activity in patients with fibromyalgia during baseline, acoustic stimulation and cold pressor tests. J Rheumatol 18:1383–1389PubMedGoogle Scholar
  58. 58.
    Read R, Spickett G, Harvey J et al. (1988) IgGI subclass deficiency in patients with chronic fatigue syndrome. Lancet 1: 241–242PubMedCrossRefGoogle Scholar
  59. 59.
    Renfro L, Feder HM Jr, Lane TJ et al. (1989) Yeast connection among 100 patients with chronic fatigue. Am J Med 86:165–168PubMedCrossRefGoogle Scholar
  60. 60.
    Riederer J (1991) Fibromyalgiesyndrom mit IgA- und IgG-Subklassenmangel. Med Klin 86: 547–549Google Scholar
  61. 61.
    Russell IJ (1989) Neurohormonal aspects of fibromyalgia syndrome. Rheum Dis Clin North Am 15:149–168PubMedGoogle Scholar
  62. 62.
    Russell IJ, Michalek JE, Vipraio GA et al. (1992) Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol 19:104–109PubMedGoogle Scholar
  63. 63.
    Russell IJ, Orr MD, Littman B et al. (1994) Elevated cerebrospinal fluid levels of substance P in patients with fibromyalgia syndrome. Arthritis Rheum 11:1593–1601CrossRefGoogle Scholar
  64. 64.
    Salit IE and The Vancouver Chronic Fatigue Syndrome Consensus Group (1996) The chronic fatigue syndrome: a position paper. J Rheumatol 23: 540–544PubMedGoogle Scholar
  65. 65.
    Shafran SD (1991) The chronic fatigue syndrome. Am J Med 90: 730–739PubMedGoogle Scholar
  66. 66.
    Sharma HS, Nyberg F, Olsson Y (1992) Dynorphin A content in the rat brain and spinal cord after a localized trauma to the spinal cord and its modification with p-chlorophenylalanine. Neurosci Res 14:195–203PubMedCrossRefGoogle Scholar
  67. 67.
    Sharpe MC, Archard LC, Banatvala JE et al. (1991) A report — chronic fatigue syndrome: guidelines for research. J R Soc Med 84:118–121PubMedGoogle Scholar
  68. 68.
    Silberring J, Castello ME, Nyberg F (1992) Characterization of dynorphin A-converting enzyme in human spinal cord. J Biol Chem 267: 21324–21328PubMedGoogle Scholar
  69. 69.
    Stefano GB, Salzet B, Fricchione GL (1998) Enkelytin and opioid peptide association in invertebrates and vertebrates: immune activation and pain. Immunol Today 19: 265–268PubMedCrossRefGoogle Scholar
  70. 70.
    Sternberg EM (1993) Hyperimmune fatigue syndromes: diseases of the stress response? J Rheumatol 20: 418–421PubMedGoogle Scholar
  71. 71.
    Straus SE, Dale JK, Peter JB, Dinarello CA (1989) Circulating lymphokine levels in the chronic fatigue syndrome (letter). J Infect Dis 160:1085–1086PubMedCrossRefGoogle Scholar
  72. 72.
    Straus SE, Dale JK, Wright R, Metcalfe DD (1988) Allergy and the chronic fatigue syndrome. J Allergy Clin Immunol 82: 791–795CrossRefGoogle Scholar
  73. 73.
    Straus SE, Fritz S, Dale JK et al. (1993) Lymphocyte phenotype and function in the chronic fatigue syndrome. J Clin Immunol 13:30–40PubMedCrossRefGoogle Scholar
  74. 74.
    Straus SE, Tosato G, Armstrong G et al. (1985) Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Ann Intern Med 102: 7–16PubMedGoogle Scholar
  75. 75.
    Suhadolnik RJ, Peterson DL, O’Brien K et al. (1997) Biochemical evidence for a novel low molecular weight 2–5A-dependent RNAse L in chronic fatigue syndrome. J Interferon Cytokine Res 17:377–385PubMedCrossRefGoogle Scholar
  76. 76.
    Suhadolnik RJ, Reichenbach NL, Hitzges P et al. (1994) Upregulation of the 2–5A synthetase/RNAse L antiviral defense pathway associated with chronic fatigue syndrome. Clin Infect Dis 18: S96–S104PubMedCrossRefGoogle Scholar
  77. 77.
    Tariot PN, Yocum D, Kalin NH (1986) Psychiatric disorders in fibromyalgia (letter). Am J Psychiatry 143: 812–813PubMedGoogle Scholar
  78. 78.
    Vaeroy H (1996) A contribution to the understanding of pain in fibromyalgia based on cerebrospinal fluid investigations. Pain Res Manag 1:45–49Google Scholar
  79. 79.
    Vaeroy H, Helle R, Forre O et al. (1988) Elevated CFS levels of substance P and high incidence of Raynaud’s phenomenon in patients with fibromyalgia: new features for diagnosis. Pain 32:21–26PubMedCrossRefGoogle Scholar
  80. 80.
    Vaeroy H, Helle R, Forre O, Kass E, Terenius L (1989) Cerebrospinal fluid levels of betaendorphin in patients with fibromyalgia. J Rheumatol 15:1804–1806Google Scholar
  81. 81.
    Vaeroy H, Nyberg F, Terenius L (1991) No evidence for endorphin deficiency in fibromyalgia following investigation of cerebrospinal fluid (CSF) dynorphin A and Met-enkephaline-Arg6-Phe7. Pain 46:139–143PubMedCrossRefGoogle Scholar
  82. 82.
    Vaeroy H, Qiao ZG, Morkrid L, Forre O (1989) Altered sympathetic nervous response in patients with fibromyalgia (fibrositis syndrome). J Rheumatol 16:1460–1465PubMedGoogle Scholar
  83. 83.
    Wakefield D, Lloyd A, Brockman A (1990) Immunoglobulin subclass abnormalities in patients with chronic fatigue syndrome. Pediatr Infect Dis J 9: S50–S53PubMedGoogle Scholar
  84. 84.
    Wallace DJ, Bowman RL, Wormsley SB, Peter JB (1989) Cytokines and immune regulation in patients with fibrositis (letter). Arthritis Rheum 32:1334–1335PubMedCrossRefGoogle Scholar
  85. 85.
    Wallace DJ, Margolin K (1988) Acute-onset fibromyalgia as a complication of interleukin-2 therapy. Arthrits Rheum 31 (Suppl 4): S24Google Scholar
  86. 86.
    Wolfe F, Smythe HA, Yunus MB et al. (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172PubMedCrossRefGoogle Scholar
  87. 87.
    Yunus MB (1994) Psychological aspects of fibromyalgia syndrome: a component of the dysfunctional spectrum syndrome. Baillière’s Clin Rheumatol 8: 811–837CrossRefGoogle Scholar
  88. 88.
    Yunus MB, Dailey JW, Aldag JC et al. (1992) Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. J Rheumatol 19: 90–94PubMedGoogle Scholar
  89. 89.
    Yunus MB, Denko CV, Masi AT (1986) Serum beta-endorphin in primary fibromyalgia syndrome: a controlled study. J Rheumatol 13:183–186PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1999

Authors and Affiliations

  • R. Klein

There are no affiliations available

Personalised recommendations