The evaluation in terms of sarcopenia of patients with fibromyalgia syndrome
- Handgrip strength (HS) and walking speed (WS) scores in the fibromyalgia syndrome (FMS) group were significantly lower than the control group (p=0.517).
- Treatment effectiveness and follow-up process can contribute to better evaluation of female patients with FMS using the sarcopenia evaluation parameters.
FMS is an extra-articular chronic rheumatic disease characterized by widespread body pain, tenderness in certain anatomical areas, decreased pain threshold; sleep disturbances, fatigue, and psychological distress. Although the etiology of FMS has not been clarified yet, it is thought that neuroendocrine dysfunction, as well as central pain mechanisms and central sensitization take part in the occurrence of it.
FMS is an extra-articular chronic rheumatic disease characterized by widespread body pain, tenderness in certain anatomical areas, decreased pain threshold; sleep disturbances, fatigue, and psychological distress. Although the etiology of FMS has not been clarified yet, it is thought that neuroendocrine dysfunction, as well as central pain mechanisms and central sensitization take part in the occurrence of it. Generalized loss of muscle mass and strength is named as sarcopenia. Usually physical inactivity, decreased mobility, slow walking, and poor physical endurance are accompanied with sarcopenia which are also common features of the fragility syndrome.
Fibromyalgia and sarcopenia have common etiological factors or clinical characteristics such as reduction in IGF-I levels, an increase in pro inflammatory cytokines, reduction in muscle endurance, which might give the idea that there may be a relationship between fibromyalgia and sarcopenia.
Rationale behind research
Despite of the common etiological and clinical characteristics, there are not any studies regarding FMS patients, who were assessed using the parameters of sarcopenia in the literature.
To evaluate the FMS patients by using the sarcopenia evaluation parameters such as bio-impedance analysis (BIA), anthropometric methods, hand grip strength (HS), and walking speed (WS) and comparing them with healthy subjects.
NOTE: This was a cross-sectional study.
- Study outcomes
- Fibromyalgia impact questionnaire (FIQ): This scale is used to evaluate the patient with FMS. A higher score indicates that FMS’s negative effects are more severe
- Visual analog scale (VAS): It was used to assess the subjective pain intensity. Scale was scored from 0-10, where 0 means no pain and 10 as most severe pain
- Beck depression inventory (BDI): This scale measures physical, emotional, cognitive, motivational symptom seen in depression.
- Pittsburgh sleep quality index (PSQI): This scale was used to assess the quality of sleep of individuals for the previous month.
- Assessment of sarcopenia: Various parameters like height, waist circumference (WC), HS, and body composition parameters were evaluated and staging of sarcopenia was based on the reference data of the European working group on sarcopenia. Presarcopenia stage involves low muscle mass plus low muscle strength or low physical performance whereas in sarcopenia, all three, low muscle mass, low muscle strength and low physical performance are present.
- Baseline: VAS, BDI and PSQI scores of FMS patients were significantly higher than control group.
- Handgrip strength (HS) and walking speed (WS) scores in the FMS group were significantly lower than the control group (p=0.517)
- VAS score of FMS patients was significantly correlated with BIA, body mass index (BMI), WC, HS and WS scores (r=0.284, p=0.012; r=0.228, p=0.045; r=0.249, p=0.028; r= -0.361, p=0.001 and r= -0.230, p=0.043)
- FIQ of patients was significantly correlated with BIA, WC, HS, WS, and BMI (r=0.267, p=0.018; r=0.291, p=0.010; r= -0.319, p=0.004; r= -0.360, p=0.001; and r= 0.304, p=0.007). There was significant positive correlation between BDI score WC and BMI
- On the other hand, partial correlation analysis between VAS and BIA were done controlling for BMI to eliminate the effect of BMI (r = 0.243, p = 0.033). Correlation between BIA and VAS was remained significant after elimination effect of BMI.
The standard and objective test or parameters to be especially used in determining the severity of disease and measurement of treatment effectiveness are not available for patients with FMS. Therefore, evaluation of female patients with FMS, using the sarcopenia evaluation parameters can contribute to a more objective evaluation of treatment effectiveness.
In the literature, there are many studies indicating that depression scores in patients with FMS are worse than healthy control group. However, the causal relationship between depression and pain has not been fully elucidated. In our study, depression scores in the FMS group were found to be significantly higher compared to the control group. However, a significant positive correlation was determined between BDI scores and WC, BMI in the FMS group