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Musculoskeletal Manifestations and Rheumatic Symptoms in Patients with Cystic Fibrosis (CF) —
No Observations of CF-specific Arthropathy
ANN-KRISTIN KOCH, SABINE BRÖMME, BETTINA WOLLSCHLÄGER, GERD HORNEFF, and GERNOT KEYSZER
ABSTRACT. Methods. Rheumatic symptoms and signs of 70 patients with CF (age 6 to 61 yrs) were determined by interview and clinical assessment. Age and sex-matched healthy volunteers served as a control group. In CF patients, laboratory measures and bone mineral density (BMD) were investigated. The data were correlated with the CF phenotype [Shwachman Score (ShS), Chrispin-Norman Score (ChNS), and pulmonary function tests (PFT)]. Results. The prevalence of joint pain in the CF patients was 12.9%, with a mean duration of 7 days. Swollen joints were found in 4 patients. None fulfilled the criteria for rheumatoid arthritis or connective tissue disease. Adult CF patients complained more often about noninflammatory back pain and myalgia, and demonstrated reduced spine mobility and impaired everyday life functions compared with the controls. Symptomatic CF patients had elevated erythrocyte sedimentation rate and C-reactive protein levels and performed worse on the ShS, ChNS, and PFT than asymptomatic patients. Antibodies against exotoxin A of Pseudomonas aeruginosa and recombinant Aspergillus fumigatus allergen f4 were found more frequently in CF patients with arthralgia. BMD was decreased in adult patients with more severe CF. Conclusion. In CF patients, the prevalence of rheumatic symptoms increases with age and CF severity. Our data suggest an association of infections with P. aeruginosa and A. fumigatus with the occurrence of rheumatic symptoms. However, no association of CF with definite inflammatory joint or connective tissue diseases was observed, and no CF-specific pattern of musculoskeletal symptoms was seen. (First Release Aug 1 2008; J Rheumatol 2008;35:1882-91) Key Indexing Terms:
CYSTIC FIBROSIS
From the Department of Internal Medicine I, Department of Paediatrics, Department of Internal Medicine II, University Hospital of Martin-Luther University Halle-Wittenberg, Halle Saale; and Department of Paediatrics, Asklepios Hospital St. Augustin, Bonn, Germany. A-K. Koch, MD, Department of Internal Medicine I; S. Brömme, MD, Department of Paediatrics; B. Wollschläger, MD, Department of Internal Medicine II, University Hospital of Martin-Luther University Halle-Wittenberg; G. Horneff, MD, Professor of Medicine, Department of Paediatrics, Asklepios Hospital St. Augustin; G. Keyszer, MD, Professor of Medicine, Department of Internal Medicine I, University Hospital of Martin-Luther University Halle-Wittenberg. Address reprint requests to A-K. Koch, University Hospital Halle, Martin Luther University, Halle-Wittenberg, Department of Internal Medicine I, Ernst-Grube-Str. 40, Halle/Saale, 06120 Germany. E-mail: ann-kristin.koch@medizin.uni-halle.de Accepted for publication May 5, 2008. |
