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Background: Inflammation may trigger migraine development through neurovascular reactions in the brain. Most of the migraine patients, particularly the younger ones, do not have any risk factors for this disease. Hence, we assessed whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases the risk of migraine., Objective: We aim to evaluate the risk of migraine among female and middle-age COM patients with a large patient sample., Study Design: A retrospective cohort study was conducted in this study., Setting: The data used in this study were extracted from the Taiwan National Health Insurance (NHI) Research Database., Methods: A study group with 2,012 COM patients and 8,048 randomly chosen gender- and age-matched controls were chosen from the Taiwan NHI Research Database (NHIRD) from the start of 2000 to the end of 2009. The risk of migraine was estimated with Cox proportional regression model. Both COM and control groups were followed-up until the occurrence of migraine during the study period (2000-2011). Prevalent covariates, such as age, gender, hypertension, diabetes, hyperlipidemia, stroke, coronary artery disease, depression, anxiety, sleep disorder, bipolar disorder, and epilepsy, were included for further evaluation. The hazard ratio (HR) of migraine was measured with Cox proportional hazard regression model. The primary outcome was the overall migraine risk among COM patients, and the secondary outcome was the migraine risk among COM patients lacking the comorbidities. Additional outcomes included migraine risk among COM patients in different age and gender subgroups., Results: The overall migraine risk was increased in COM patients (adjusted hazard ratio [aHR] 1.74, 95% confidence interval [CI] 1.14-2.65). Even without any prevalent comorbidities, COM patients still exhibited an increased risk of migraine (aHR 2.05, 95% CI 1.06-3.97) than the controls did. Moreover, this risk was relatively higher in COM patients aged < 40 and 45-54 years (aHR 2.07, 95% CI 0.97-4.46 and aHR 2.11, 95% CI 0.97-4.57, respectively) than in their counterparts. Female COM patients had a relatively higher migraine risk (aHR 1.85, 95% CI 1.05-3.24) than male patients did (aHR 1.68, 95% CI 0.89-3.16)., Limitations: The messages about personal behaviors were unavailable in the Taiwan NHIRD. Other neurovascular risk factors that might increase migraine cannot be excluded completely in this research., Conclusion: An association between COM and increased risk of migraine was shown in this study. The results suggest that COM is a significant migraine predictor, and thus imply the necessity for rigorous migraine prevention in COM patients, especially female and younger ones., Key Words: Inflammation, migraine, chronic osteomyelitis, Taiwan National Health Insurance Research Database.

Chronic inflammation, which changes the neurotransmitter metabolism and kindles neuroendocrine system dysfunction in the central nervous system, might cause fibromyalgia (FM) formation. In FM patients without traditional FM risk factors, such as hypertension, hyperlipidemia, diabetes, sleep disorder, depression, and anxiety, the chronic inflammatory process is a possible risk factor for FM. Thus, we investigated whether chronic osteomyelitis (COM), a disease characterized by chronic inflammation, increases FM risk. Including data for 1 million enrollees, the Longitudinal Health Insurance Database was used, and 1,244 COM patients without FM history and 4,976 randomly selected sex- and age-matched control subjects without COM or FM history were extracted. The development of FM over a 13-year follow-up period from 1999 to 2011 was evaluated, and FM risk was estimated using the Cox proportional regression model. The aforementioned FM risk factors were more common in COM patients, who had a significantly greater FM risk than did the control subjects. Compared with those who had no associated risk factors, patients with COM had a greater FM risk than did the control subjects (adjusted hazard ratio [aHR] = 1.32, 95% confidence interval [CI], .99-1.75). Younger people had an even greater risk (age younger than 35 years: aHR = 1.58, 95% CI, 1.03-2.44; age 60 years or older: aHR = 1.03, 95% CI, .78-1.36). To our knowledge, this is the first study to link COM to an enhanced risk of FM development. The results imply that COM is a predictor of FM, suggesting that close follow-up for patients with COM is required to prevent FM, especially in younger populations., Perspective: COM is associated with the augmented risk of developing FM, and rigorous treatments for COM patients might decrease the future risk of FM formation, especially in those with relatively younger ages., (Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.)

An association between occult infection and the development of rheumatoid arthritis (RA) has been suggested. This study aimed to determine if patients with chronic osteomyelitis (COM) are at increased risk of developing RA. A national insurance claim dataset of 22 million enrollees in Taiwan was used to identify 21,105 hospital inpatients with COM and 84,420 reference subjects matched by sex, age, and index date of diagnosis with a mean of 5.12 years of follow-up from 2000 to 2011. The risk of RA development was analyzed using Cox proportional hazards modeling. The mean age of hospital inpatients with COM was 55.8 ± 19.4 years. The incidence of RA was 5.43 per 10(4) person-years in the case cohort, which was more than twofold higher than that of 2.20 per 10(4) person-years in the reference cohort. After adjustment, the hazard ratio (HR) was 2.21 (95 % confidence interval, 1.51-3.24). The HR was greatest in the youngest age group (<45 years, HR [95 % confidence interval] = 9.08 [3.22-25.6]; 45-64 years, 1.76 [1.01-3.06]; ≥65 years, 1.68 [0.88-3.24]). In addition, HR was greatest in inpatients with more severe COM (HR [95 % confidence interval] = 0.72 [0.40-1.30] and 11.2 [6.63-18.9] for patients with ≤1 or >2 hospitalization due to recurrent osteomyelitis every two follow-up years, respectively). This is the first report linking COM to risk of incident RA. Patients of a younger age and with frequently recurrent COM had a greater increase in RA risk.