This narrative review summarizes the current knowledge of the genetic and epigenetic contributions to the development of fibromyalgia (FM). Although there is no single gene that results in the development of FM, this study reveals that certain polymorphisms in genes involved in the catecholaminergic pathway, the serotonergic pathway, pain processing, oxidative stress, and inflammation may influence susceptibility to FM and the severity of its symptoms. Furthermore, epigenetic changes at the DNA level may lead to the development of FM. Likewise, microRNAs may impact the expression of certain proteins that lead to the worsening of FM-associated symptoms.

Summary: Background: Ribavirin is associated with haemolytic anaemia. Antioxidants have been reported to decrease severity of this anaemia.Aim: To determine effect of vitamin E supplementation on ribavirin‐associated haemolysis in chronic hepatitis C treated with standardα‐interferon and ribavirin.Methods: Fifty‐one naive chronic hepatitis C patients were randomized to receive eitherα‐interferon/ribavirin therapy (control) or therapy plus vitamin E 800 IU b.d. with 24‐week follow‐up. Alanine aminotransferase ALT, haemoglobin and reticulocyte percentage were monitored. Symptoms and health‐related quality of life were also monitored at each visit.Results: Forty‐seven subjects were treated (27 vitamin E /20 controls). Thirteen withdrew because of adverse effects or non‐compliance. Groups were similar in demographics, genotype and baseline lab indices. Comparison with baseline, treatment and follow‐up values showed a significant haemoglobin and ALT reduction in both groups. There was no significant difference in haemoglobin and reticulocyte percentage between groups. Sustained viral response was not significantly different between vitamin E (11/18) and control (6/16) groups. Three patients required ribavirin dose‐reduction in the vitamin E group compared with two controls. Health‐related quality of life during and end‐of‐treatment was not different between groups.Conclusions: Vitamin E supplementation alone during standardα‐interferon and ribavirin therapy does not appear to diminish ribavirin‐associated haemolysis.