Originally published August-September 1995 The Townsend Letter for Doctors

Fibromyalgia Rheumatoid Arthritis

Leslie N. Johnston, D.V.M.

Editor,

I read with interest the excellent article The Fibromyalgia Fiasco, Out of the Garbage Can in your April issue of the Townsend Letter by Sherry A. Rogers, M.D. I looked, in particular, for the mention of iron testing in the diagnosis of fibromyalgia/fibrositis patients, and found nothing about this. I feel that the patient who is diagnosed having the fibromyalgia/fibrositis syndrome without having an iron profile included in his blood workup, has not been properly examined. This can be said for nearly any examination, and that is to have iron studies included, both for iron deficiency, and more importantly for iron overload.

We find here and there, mention of fibromyalgia patients showing up at the rheumatologists door, so this makes us think, what is the connection? Fibromyalgia has to be at least a first cousin and maybe better described as a brother or sister to the arthritis/rheumatoid syndrome. Just knowing two people very well who were first diagnosed having fibromyalgia, and later, much too much later, to be diagnosed with full-blown hemochromatosis is enough to prove a connection to me.

In a rheumatology clinic in Australia, of 339 consecutive patients studied over a 12 month period of time, 23 patients had in their initial screening tests transferring saturation > 55%; ferritin > 500 micromilligrams/L. Repeat fasting transferrin saturation and ferritin concentrations were obtained in 20 of these patients; twelve of them had persistently elevated results consistent with genetic hemochromatosis (GH), and five of these were confirmed to have full-blown hemochromatosis by liver biopsy tissue hepatic iron indices. Thus, the prevalence of GH in this group was 1.5% which is five times that of the general population. Three of these patients presented with an arthropathy which was not characteristic of the disease. How fantastic! The increased prevalence of GH in this group of patients with peripheral arthropathy provides an excellent justification for the routine screening of patients with peripheral arthritis for the exclusion of iron overload.

These five patients in this study who were diagnosed as having full blown GH, left 7 or so with high transferrin saturation and ferritin readings consistent with the diagnosis of full blown GH.1 What are we supposed to do with the 4 or 5% of all the people in rheumatology clinics from all over the world, as occurred in this study, who have high iron readings? This says nothing of the probably very high percentage of this group who had iron readings between the normal and the readings for full-blown GH how many of these were there and how important are they? This group of people are the ones who should be steered in the direction of the blood bank to prevent full blown GH from ever developing. Are we to wait until the patient has his liver jammed plum full of iron before we make a diagnosis of iron overload? No, high iron readings are to be used to help prevent the full blown condition of GH from ever developing, if possible. Donating blood (phlebotomy) should be started early, and these people with high iron, being otherwise healthy, would make the very best blood donors to their good health. The insidious problems of iron overload start with transferrin saturations above 30% and ferritin readings above even 100 micromilligrams/L. Also, read the excellent E. Weinberg, Ph.D. papers,2,3 and Dr. Randy Lauffers book.4

How interesting it would be to know what percentage of fibromyalgia patients have high iron readings and even full blown GH, and compare these with the normal population. I bet it would make your eyes open wide with amazement. This would be so easy to find out just study say 100 to 500 patients of a fibromyalgia clinic. The cost should be nil in that the iron studies should be done anyway.

This fibromyalgia/arthritis syndrome is just one of the miserable aspects of GH and most of these disease processes can be avoided by an early diagnosis and proper management of GH; pituitary, thyroid, parathyroid, heart, skin, brain, gonad, adrenal, liver, pancreas, infection, gut, emotional or psychiatric, and cancer are a few more disease processes caused or aggravated by too much iron. Iron overload is not the cause of all our medical problems, though. Hemochromatosis is now being found in our animals also. Cattle5, horses6, monkeys (Lemurs)7, and mynah birds6. (Oh yes, this hemochromatosis mess is for the birds too).

I met a very good and brilliant 58 year-old OB/GYN/surgeon who was a fool to use himself for his doctor, and after going to 13 more doctors, he was finally diagnosed with GH, to die only one year later.

Doctors, include iron tests (serum iron, TIBC, and/or UIBC, and ferritin) in your examinations for all your patients and insist that this be done by your doctor for yourself as well.

1. Olynyk J, Hall P, Ahern M, Kwiatek R, Mackinnon M; Screening for Genetic Hemochromatosis in a Rheumatology Clinic; Aust N Z J Med 1994 Feb; 24(1):22-5.

2. Weinberg, Eugene D., Ph.D., Cellular Iron Metabolism in Health and Disease, Drug Metabolism Reviews, 22(5); 531-579 (1990). 3. Weinberg. Eugene D., Ph.D., Iron Withholding: A Defense Against Infection and Neoplasia, Physiological Reviews, Vol 64, No. 1, January 1984. 65-102. 4. Lauffer, Randall B., Iron Balance, New York: St. Martins Press, 1991. 5. House JK, Smith BP, Maas J, Lane VM, Anderson BC, Graham TW, Pino MV; Hemochromatosis in Salers Cattle; J Vet Intern Med, 1994, Mar-Apr; 8(2):105-11. 6. Pearson EG, Hedstrom OR, Poppenga RH; Hepatic Cirrhosis and Hemochromatosis in Three Horses; J Am Vet Med Assoc, 1994, Apr 1; 204970:1053-6. 7. Iancu TC, Shiloh H, Morphologic Observations in Iron Overload: an Update; Pediatric Research Unit, Carmel Hospital and B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, Abstracts of 4th International Conference on Hemochromatosis, Jerusalem, Israel, April 27-30, 1993.