Chronic Obstructive Pulmonary Disease <-> Fibromyalgia

Comorbidity UNKNOWN CANDIDATE

Cross-system comorbidity: fibromyalgia is over-represented in COPD. Surfaced as a strong positive both-in-dismech ICEES EHR signal (UNC PCD cohort, chi-square=52.3, p=4.7e-13) and corroborated by a cross-sectional study reporting higher fibromyalgia prevalence in COPD than controls. Directionality is UNKNOWN (cross-sectional evidence); the proposed mechanism is central sensitization driven by chronic pain, systemic inflammation, poor sleep, and depression in COPD.

Disease A

Chronic Obstructive Pulmonary Disease

Slug:Chronic_Obstructive_Pulmonary_Disease

Disease B

Fibromyalgia

Slug:Fibromyalgia

Causal Mechanism Graphs

Chronic Obstructive Pulmonary Disease

graph LR
    Alveolar_Destruction["Alveolar Destruction"]
    Progressive_Respiratory_Impairment["Progressive Respiratory Impairment"]
    Exercise_Intolerance["Exercise Intolerance"]
    Respiratory_Failure["Respiratory Failure"]
    Hypoxemia["Hypoxemia"]
    Oxidative_Stress_and_Mitochondrial_Dysfunction["Oxidative Stress and Mitochondrial Dysfunction"]
    Hypercapnia["Hypercapnia"]
    Airflow_Limitation["Airflow Limitation"]
    NFE2L2["NFE2L2"]
    Forced_Expiratory_Volume_in_1_Second_FEV1["Forced Expiratory Volume in 1 Second (FEV1)"]
    SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation["SIRT1-Mediated NAD+ Signaling and Protective Deacetylation"]
    Chronic_Inflammation["Chronic Inflammation"]
    Cellular_Senescence["Cellular Senescence"]
    Dyspnea["Dyspnea"]

    Airflow_Limitation -.-> Progressive_Respiratory_Impairment
    SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation --> Chronic_Inflammation
    SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation --> Cellular_Senescence
    SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation --> Alveolar_Destruction
    SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation --> Oxidative_Stress_and_Mitochondrial_Dysfunction
    Dyspnea --> Exercise_Intolerance
    Respiratory_Failure --> Hypoxemia
    Respiratory_Failure --> Hypercapnia
    Airflow_Limitation -.-> Forced_Expiratory_Volume_in_1_Second_FEV1
    NFE2L2 --> SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation

    style Alveolar_Destruction fill:#dbeafe
    style Progressive_Respiratory_Impairment fill:#fee2e2,stroke:#dc2626,stroke-dasharray: 5 5
    style Exercise_Intolerance fill:#fef3c7
    style Respiratory_Failure fill:#fef3c7
    style Hypoxemia fill:#fef3c7
    style Oxidative_Stress_and_Mitochondrial_Dysfunction fill:#dbeafe
    style Hypercapnia fill:#fef3c7
    style Airflow_Limitation fill:#dbeafe
    style NFE2L2 fill:#f3e8ff
    style Forced_Expiratory_Volume_in_1_Second_FEV1 fill:#e0e7ff
    style SIRT1_Mediated_NAD+_Signaling_and_Protective_Deacetylation fill:#dbeafe
    style Chronic_Inflammation fill:#dbeafe
    style Cellular_Senescence fill:#dbeafe
    style Dyspnea fill:#fef3c7

Fibromyalgia

graph LR
    Small_Fiber_Pathology["Small Fiber Pathology"]
    Neuroinflammation["Neuroinflammation"]
    Central_Sensitization["Central Sensitization"]

    Neuroinflammation --> Central_Sensitization
    Small_Fiber_Pathology --> Central_Sensitization

    style Small_Fiber_Pathology fill:#dbeafe
    style Neuroinflammation fill:#dbeafe
    style Central_Sensitization fill:#dbeafe

Association Signals

Signal 1

Population:ICEES KG 8-20-2024, UNC Health primary-ciliary-dyskinesia (PCD) cohort (condition-specific base population), patient-level chi-square contingency.

Signal IDs: MONDO:0005002 dismech -> MONDO:0005546 dismech

Mapping notes:ICEES reports this pair as a positive correlation. Chi-square is not multiple-testing corrected and is conditioned on the PCD base population, so it corroborates rather than establishes the association. The row quoted is the strongest PCD cohort-year (2020).

Temporal: A before B: , B before A: , Same time:

CHI_SQUARE: 52.3223044040033

CI: -

p: 4.709944488099253e-13

FDR:

ICEES PCD 2020 cohort co-occurrence of COPD and fibromyalgia (N=4753); strong, highly significant positive association.

ICEES:MONDO_0005002__MONDO_0005546 (SUPPORT)

Source: OTHER

"PCD_UNC_patient_2020_v6_binned_deidentified | 52.3223044040033 | 1 | 4.709944488099253e-13 | 4753"

ICEES UNC EHR cohort shows a strong, highly significant COPD-fibromyalgia co-occurrence in the 2020 PCD cohort.

Hypotheses

Hypothesis: chronic pain, systemic inflammation, sleep disturbance, and depressive symptoms in COPD promote central sensitization, increasing the likelihood of comorbid fibromyalgia, particularly in women.

PMID:40852783 (SUPPORT)

Source: HUMAN_CLINICAL

"The prevalence of fibromyalgia syndrome was significantly greater in individuals with chronic obstructive pulmonary disease (16%) than in healthy controls (3%)"

Cross-sectional study quantifies the elevated fibromyalgia prevalence in COPD relative to matched controls.

PMID:40852783 (SUPPORT)

Source: HUMAN_CLINICAL

"These findings underscore the clinical relevance of fibromyalgia syndrome as a comorbidity in chronic obstructive pulmonary disease, particularly in women"

Authors frame fibromyalgia as a clinically relevant COPD comorbidity, with a female predominance.

Pathophysiology:

Central sensitization from chronic COPD burden: Persistent pain, inflammatory burden, hypoxia-related symptoms, poor sleep, and mood disturbance in COPD may provoke central sensitization, lowering pain thresholds and manifesting as fibromyalgia.

Biological processes:

PMID:40852783 (PARTIAL)

Source: HUMAN_CLINICAL

"Patients with both chronic obstructive pulmonary disease and fibromyalgia syndrome frequently reported increased fatigue, sleep disturbances, and depressive symptoms."

Co-affected patients report fatigue, sleep disturbance, and depression, features consistent with a central-sensitization phenotype.

Raw YAML

Show YAML

name: com_Chronic_Obstructive_Pulmonary_Disease__Fibromyalgia
creation_date: '2026-06-26T00:00:00Z'
curation_status: CANDIDATE
notes: >-
  Cross-system comorbidity: fibromyalgia is over-represented in COPD. Surfaced
  as a strong positive both-in-dismech ICEES EHR signal (UNC PCD cohort,
  chi-square=52.3, p=4.7e-13) and corroborated by a cross-sectional study
  reporting higher fibromyalgia prevalence in COPD than controls. Directionality
  is UNKNOWN (cross-sectional evidence); the proposed mechanism is central
  sensitization driven by chronic pain, systemic inflammation, poor sleep, and
  depression in COPD.

disease_a:
  slug: Chronic_Obstructive_Pulmonary_Disease
  preferred_term: chronic obstructive pulmonary disease
  term:
    id: MONDO:0005002
    label: chronic obstructive pulmonary disease

disease_b:
  slug: Fibromyalgia
  preferred_term: fibromyalgia
  term:
    id: MONDO:0005546
    label: fibromyalgia

directionality: UNKNOWN

hypotheses:
- description: >-
    Hypothesis: chronic pain, systemic inflammation, sleep disturbance, and
    depressive symptoms in COPD promote central sensitization, increasing the
    likelihood of comorbid fibromyalgia, particularly in women.
  evidence:
  - reference: PMID:40852783
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The prevalence of fibromyalgia syndrome was significantly greater in individuals with chronic obstructive pulmonary disease (16%) than in healthy controls (3%)"
    explanation: >-
      Cross-sectional study quantifies the elevated fibromyalgia prevalence in
      COPD relative to matched controls.
  - reference: PMID:40852783
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "These findings underscore the clinical relevance of fibromyalgia syndrome as a comorbidity in chronic obstructive pulmonary disease, particularly in women"
    explanation: >-
      Authors frame fibromyalgia as a clinically relevant COPD comorbidity,
      with a female predominance.
  pathophysiology:
  - name: Central sensitization from chronic COPD burden
    description: >-
      Persistent pain, inflammatory burden, hypoxia-related symptoms, poor sleep,
      and mood disturbance in COPD may provoke central sensitization, lowering
      pain thresholds and manifesting as fibromyalgia.
    biological_processes:
    - preferred_term: sensory perception of pain
      term:
        id: GO:0019233
        label: sensory perception of pain
    evidence:
    - reference: PMID:40852783
      supports: PARTIAL
      evidence_source: HUMAN_CLINICAL
      snippet: "Patients with both chronic obstructive pulmonary disease and fibromyalgia syndrome frequently reported increased fatigue, sleep disturbances, and depressive symptoms."
      explanation: >-
        Co-affected patients report fatigue, sleep disturbance, and depression,
        features consistent with a central-sensitization phenotype.

association_signals:
- source: ICEES
  method: EHR_COHORT_ASSOCIATION
  signal_disorder_a_id: MONDO:0005002
  signal_disorder_b_id: MONDO:0005546
  population: >-
    ICEES KG 8-20-2024, UNC Health primary-ciliary-dyskinesia (PCD) cohort
    (condition-specific base population), patient-level chi-square contingency.
  mapping_notes: >-
    ICEES reports this pair as a positive correlation. Chi-square is not
    multiple-testing corrected and is conditioned on the PCD base population,
    so it corroborates rather than establishes the association. The row quoted
    is the strongest PCD cohort-year (2020).
  directionality: UNKNOWN
  statistics:
    metrics:
    - metric_type: CHI_SQUARE
      metric_value: 52.3223044040033
      p_value: 4.709944488099253e-13
      notes: >-
        ICEES PCD 2020 cohort co-occurrence of COPD and fibromyalgia (N=4753);
        strong, highly significant positive association.
  evidence:
  - reference: ICEES:MONDO_0005002__MONDO_0005546
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "PCD_UNC_patient_2020_v6_binned_deidentified | 52.3223044040033 | 1 | 4.709944488099253e-13 | 4753"
    explanation: >-
      ICEES UNC EHR cohort shows a strong, highly significant COPD-fibromyalgia
      co-occurrence in the 2020 PCD cohort.

Source:GitHub