FIBROMYALGIA AND MUSCLE MORPHOLOGY

Date: 09-17-95
Copyright Restriction: Public Domain

Single cell morphology of muscle in patients with chronic muscle pain

JACOBSEN-S; BARTELS-E-M; DANNESKIOLD-SAMSOE-B
SCANDINAVIAN JOURNAL OF RHEUMATOLOGY 20(5): 336-343

In 119 patients referred with suspected fibromyalgia, biopsies from the quadriceps muscle were analyzed for "rubber band" morphology, and isokinetic quadriceps strength was measured. Eighty-four fulfilled the criteria for fibromyalgia, 26 had chronic myofascial pain (CMP) and 9 had other diseases including 5 with concomitant fibromyalgia. Twenty-four CMP patients and 48 fibromyalgia patients were randomly selected to match with regard to sex, age, smoking and drinking habits.

"Rubber band" morphology was blindly graded on a biopsy score scale from 0 to 2. A statistically significant difference in biopsy score was found between the two matched groups (P=0.003); median biopsy score in fibromyalgia was 0.42 and 0.25 in CMP. A cut-off value at 0.33 gave a specificity of 71% and a sensitivity of 63%. Isokinetic muscle strength did not differ in the fibromyalgia and CMP groups and was not related to the biopsy score.

"Rubber band" morphology is seen more often in fibromyalgia patients than in CMP patients. The exact genesis of this phenomenon is still unknown but theories connected with the possible pathogenesis of the syndrome are presented.


Phosphorus-31 Magnetic resonance spectroscopy of skeletal muscle in patients with fibromyalgia

JACOBSEN-S; JENSEN-K-E; THOMSEN-C; DANNESKIOLD-SAMSOE-B; HENRIKSEN-O
JOURNAL OF RHEUMATOLOGY 19(10): 1600-1603

31Phosphorus nuclear magnetic resonance (31P NMR) spectroscopy of painful calf muscle was performed in 12 patients with fibromyalgia (FS) and 7 healthy subjects during rest, aerobic and anaerobic exercising conditions, and postexercise recovery.

Ratios of inorganic phosphate and creatinine phosphate (Pi/PCr) and pH were calculated from the collected 31P NMR spectra. Resting values of Pi/PCr were normal in the patients. Patients delivered only 49% of the muscle power of the controls (p = 0.05). Patients and controls had similar rates of Pi/PCr andpH changes during work and recovery. The controls were able to change their Pi/PCr and pH more than the patients, due to the greater workload reached. However, statistical significance was reached only for the anaerotic static exericse (p = 0.003).

It was concluded that patients with FS had a reduced voluntary capacity for work, but normal biochemical response to work and recovery.


Platelet tritiated imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia-fibrositis syndrome

RUSSELL-I-J; MICHALEK-J-E; VIPRAIO-G-A; FLETCHER-E-M; JAVORS-M-A; BOWDEN-C-A
JOURNAL OF RHEUMATOLOGY 19(1): 104-109

The density of serotonin reuptake receptors on peripheral platelets from 22 patients with primary fibromyalgia syndrome (FS) and the serum serotonin concentrations in 9 patients with FS were compared with those of matched healthy controls.

The mean serum serotonin concentration was lower (p = 0.01) in FS than in controls, while the binding of 3H-imipramine was higher (p = 0.035) and normalized with treatment using a combination of ibuprofen and alprazolam. Improvement in selected clinical measures of FS disease activity during treatment correlated with the change in platelet 3H-imipramine binding.

These findings support the proposed hypothesis of aberrant pain perception in FS resulting from a deficiency of serotonin.


Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis

RUSSELL-I-J; VAEROY-H; JAVORS-M; NYBERG-F
ARTHRITIS AND RHEUMATISM 35(5): 550-556

Objective: To compare the levels of biogenic amines in the cerebrospinal fluid (CSF) of primary fibromyalgia syndrome (PFS) patients with those in the CSF of controls.

Methods: Metabolities of serotonin, norepinephrine, and dopamine were identified in CSF, using high performance liquid chromatography with coulometric detection.

Results: CSF levels of metabolites from all 3 neurotransmitters were lower in PFS patients than in controls.

Conclusion: A low rate of turnover of several neurotransmitters supports the proposed hypothesis of a metabolic defect in PFS and suggests that the defect occurs at a neuroregulatory level.


Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan:
A 90-day open study

SARZI-PUTTINI-P; CARUSO-I
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH 20(2):182-189

The efficacy and tolerability of 5-hydroxy-L-tryptophan (5-HTP) were studied in an open 90-day study in 50 patients affected by primary fibromyalgia syndrome.

When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement (P lt 0.001). The overall evaluation of the patient condition assessed by the patient and the investigator indicated a 'good' or 'fair' clinical improvement in nearly 50% of the patients during the treatment period.

A total of 15 (30%) patients reported side-effects but only one patient was withdrawn from the treatment for this reason. No abnormality in the laboratory evaluation was observed.

It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains it efficacy throughout the 90-day period of treatment.


Physiological effects of exhaustive physical exercise in primary fibromyalgia syndrome (PFS): Is PFS a disorder of neuroendocrine reactivity?

VAN-DENDEREN-J-C; BOERSMA-J-W; ZEINSTRA-P; HOLLANDER-A-P; VAN-NEERBOS-B-R
SCANDINAVIAN JOURNAL OF RHEUMATOLOGY 21(1): 35-37

The influence of maximum exercise has been studied in 10 patients with primary fibromyalgia syndrome (PFS) and 10 healthy sedentary control persons. The exercise consisted of a bicycle ergometertest and a steptest, both till exhaustion. In both tests, the mean maximum workload of the PFS patients was lower than that of the controls.

Significantly lower values of serum creatinekinase, myoglobin, cortisol, epinephrine and norepinephrine were found in PFS patients. A striking finding was a lower heart rate in PFS patients compared to the controls under the same workload. The lower (nor) epinephrine concentration together with the lower heart rate suggests a disturbance of the sympathetic acitivty in PFS patients.

The preliminary conclusion in that there is a disturbed reactivity of the sympathetic system as well as of the HPA axis in PFS.


Plasma tryptophan and other amino acids in primary fibromyalgia:
A controlled study

YUNUS-M-B; DAILEY-J-W; ALDAG-J-C; MASI-A-T; JOBE-P-C
JOURNAL OF RHEUMATOLOGY 19(1): 90-94

To test the hypothesis that plasma tryptophan and/or its transport ratio is decreased in primary fibromyalgia (PF), we measured plasma tryptophan and its transport ratio in 29 patients with PF and 30 healthy controls without significant pain, in a blinded manner. Twenty-one other amino acids were also similarly analyzed among these study subjects.

Transport ratio of tryptophan was found to be significantly (p lt 0.01) decreased in PF compared with the control group (0.09 +- 0.02 vs 0.10 +- 0.02). Plasma tryptophan level was lower in PF (45 +- 10 nmol/ml) than in healthy controls (51 +- 15 nmol/ml), showing a trend towards significance (p lt 0.09). Additionally, plasma histidine and serine levels were found to be significantly (p lt 0.01) lower in patients with PF than in controls.

Our results suggest that a decreased brain serotonin level, as possibly reflected by a decreased transport ratio of plasma tryptophan, may play a pathophysiologic role in PF.

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