FibromyalgiaHow does vitamin D work?

One way vitamin D reduces the risk of or symptoms of fibromyalgia is through reducing production of proinflammatory cytokines and chemokines, which likely cause much of the pain fibromyalgia patients’ experience.

RESULTS: Higher levels of IL-10, IL-8 and TNF-alpha were found in FM patients than in controls. Significant correlations between the biochemical parameters and clinical data were found.
CONCLUSION: The higher levels of cytokines found in FM patients suggest the presence of an inflammatory response system (IRS) and highlight a parallel between the clinical symptoms and biochemical data. They support the hypothesis that cytokines may play a role in the clinical features of fibromyalgia. In addition, the similar cytokine patterns found in FM patients with different psychiatric profiles suggests that IRS impairment may play a specific role in the disease1.

BACKGROUND: Fibromyalgia (FM) is characterized by chronic, widespread muscular pain and tenderness and is generally associated with other somatic and psychological symptoms. Further, circulatory levels of proinflammatory cytokines (IL-1beta, TNF-alpha, and IL-6) may be altered in FM patients, possibly in association with their symptoms. Recently, rises in BMI have been suggested to contribute to increased circulating levels of proinflammatory cytokines in FM patients. Our aim was to measure the circulatory levels of proinflammatory cytokines to determine the influence of BMI on these levels in FM patients and healthy volunteers (HVs). In Spanish FM patients (n = 64) and HVs (n = 25), we measured BMI and serum concentrations of proinflammatory cytokines by capture ELISA.
FINDINGS: There were significant differences in BMI levels between FM patients (26.40 +/- 4.46) and HVs (23.64 +/- 3.45) and significant increase in IL-6 in FM patients (16.28 +/- 8.13 vs 0.92 +/- 0.32 pg/ml) (P < 0.001). IL-1beta and TNF-alpha decreased in FM patients compared with HVs. By ANCOVA, there was no significant association between BMI and TNF-alpha (F = 0.098, p = 0.75) or IL-6 (F = 0.221, p = 0.63) levels in FM patients.
CONCLUSIONS: Our analysis in FM patients of BMI as a covariate of proinflammatory cytokines levels showed that serum TNF-alpha and IL-6 levels are independent of BMI. Further studies are necessary to dissect these findings and their implication in future therapeutic approaches for FM patients2.

However, a study from Germany disputes whether cytokines and chemokines are the cause of pain suffered by fibromyalgia patients:

RESULTS: On admission, serum levels of IL-8 (p < 0.001) and TNF-alpha (p < 0.001), but not IL-6, were elevated in patients with FM. No significant difference in IL-4 and IL-10 was found between FM patients and controls. High IL-8 levels remained consistent during the followup, but TNF-alpha was already reduced after 10 days and until 6 months after therapy. After 6 months’ treatment with multidisciplinary pain therapy, IL-8 and TNF-alpha levels were significantly lower than at the beginning (p < 0.05 for IL-8, p < 0.001 for TNF-alpha). IL-8 but not TNF-alpha serum levels were correlated with pain intensity (r = -0.782, p = 0.001) in FM patients after 6 months’ multidisciplinary pain therapy.
CONCLUSION: Our results suggest that proinflammatory cytokines TNF-alpha and IL-8 are involved in FM, but they do not apparently provoke the pain of FM directly. Multidisciplinary pain therapy modified the cytokine profile in patients with FM during the observation period3.

In studies unrelated to fibromyalgia, vitamin D reduces the production of the chemokine interleukin-8 (IL-8)4 and tumor necrosis factor (TNF)-alpha5. Whether it does the same for those with fibromyalgia remains to be determined.

Page last edited: 17 May 2011


  1. Bazzichi, L. Rossi, A. Massimetti, G. Giannaccini, G. Giuliano, T. De Feo, F. Ciapparelli, A. Dell’Osso, L. Bombardieri, S. Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007 Mar-Apr; 25 (2): 225-30.
  2. Hernandez, M.E. et al Proinflammatory cytokine levels in fibromyalgia patients are independent of body mass index. BMC Res Notes. 2010; 3 (1): 156.
  3. Wang, H. Moser, M. Schiltenwolf, M. Buchner, M. Circulating cytokine levels compared to pain in patients with fibromyalgia — a prospective longitudinal study over 6 months. J Rheumatol. 2008 Jul; 35 (7): 1366-70.
  4. Xue, M. L. Zhu, H. Thakur, A. Willcox, M. 1 alpha,25-Dihydroxyvitamin D3 inhibits pro-inflammatory cytokine and chemokine expression in human corneal epithelial cells colonized with Pseudomonas aeruginosa. Immunol Cell Biol. 2002 Aug; 80 (4): 340-5.
  5. Kuo, Y. T. Kuo, C. H. Lam, K. P. Chu, Y. T. Wang, W. L. Huang, C. H. Hung, C. H. Effects of vitamin D3 on expression of tumor necrosis factor-alpha and chemokines by monocytes. J Food Sci. 2010 Aug 1; 75 (6): H200-4.