Fibromiyalji Sendromu Tanısında Oksidatif Stres İndeksi ve C Vitamini

Öz

Amaç: FMS tanısı için spesifik bir laboratuvar belirteci yoktur ve esas olarak klinik muayeneye bağlıdır. Serum C vitamini düzeylerinin ve oksidatif stres indeksinin (OSI) Fibromiyalji Sendromu (FMS) tanısında kullanılıp kullanılamayacağını değerlendirmeyi amaçladık. Gereç ve Yöntem: Kesitsel çalışmamıza 53 kadın hasta ve 35 sağlıklı kadın kontrol dahil edildi. Hastalara VAS, BDI ve FIQ uygulandı. C vitamini seviyeleri HPLC ile ölçüldü. Toplam Antioksidan Kapasitesi (TAC) ve Toplam Oksidan Durumu (TOS) seviyeleri Spektrofotometrik yöntemle belirlendi. Bulgular: FMS hastalarının vitamin C ve TAC düzeyleri kontrollere göre anlamlı olarak düşük iken, hastalarda OSİ anlamlı olarak daha yüksekti (sırasıyla p= 0,004, p= 0,009 ve p= 0,048). Hassas noktalar ile FIQ arasında orta düzeyde pozitif ve anlamlı bir ilişki vardı (r = 0,505; p <0,001). ROC analizi ile Vitamin C ve TAC'nin tanısal performansı sırasıyla AUC = 0,678, p= 0,003 ve AUC = 0,639, p= 0,028 olarak bulundu. Sonuç: FMS hastalarında serum TAC ve vitamin C seviyeleri düşmekte ve OSİ artmaktadır. Bu üç parametrenin FMS tanısı için ek bir araç olarak düşünülebileceği önerilebilir.

Anahtar Kelimeler

• Fibromiyalji Sendromu
• TAC
• OSI
• C Vitamini
• Kronik ağrı

Oxidative Stress Index and Vitamin C in The Diagnosis of Fibromyalgia Syndrome

Öz

Aim: Still there is no any specific laboratory marker for diagnosis of FMS and it mainly depends on clinical examination. So that we aimed to evaluate whether serum Vitamin C levels and oxidative stress index (OSI) can be used in the diagnosis of Fibromyalgia Syndrome (FMS). Material and Method: 53 female patients and 35 healthy female controls were enrolled to our cross-sectional study. VAS, BDI and FIQ were applied to the patients. Vitamin C levels were measured by HPLC. Total Antioxidant Capacity (TAC) and Total Oxidant Status (TOS) levels were determined by Spectrophotometric Assay method. Results: While vitamin C and TAC levels of FMS patients were significantly lower than those of the controls, OSI was significantly higher in patients (p= 0.004, p= 0.009 and p= 0.048, respectively). There was a moderate positive and significant relationship between the tender points and FIQ, (r = 0.505; p <0.001). The diagnostic performance of Vitamin C and TAC with ROC analysis were found: AUC = 0.678, p= 0.003, AUC = 0.639, p= 0.028 respectively. Conclusion: Serum TAC and vitamin C levels decrease and OSI increases in FMS patients. It can be suggested that these three parameters can be considered as an additional tool for diagnosis of FMS.

Anahtar Kelimeler

• Fibromyalgia Syndrome
• TAC
• OSI
• Vitamin C
• Chronical pain

Kaynakça

1. Referans1. Arnold LM, Clauw DJ, McCarberg BH, editors. Improving the recognition and diagnosis of fibromyalgia. Mayo Clinic Proceedings; 2011: Elsevier.
2. Referans2. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheumatic Disease Clinics. 2009;35(2):421-35.
3. Referans3. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis & Rheumatism. 2002;46(5):1333-43.
4. Referans4. Cordero M, de Miguel M, Moreno-Fernandez A. Mitochondrial dysfunction in fibromyalgia and its implication in the pathogenesis of disease. Medicina Clínica. 2010;136(6):252-6.
5. Referans5. Cordero MD. Oxidative stress in fibromyalgia: pathophysiology and clinical implications. Reumatol Clin. 2011;7(5):281-3.
6. Referans6. Yamamoto T. Autoimmune mechanisms of scleroderma and a role of oxidative stress. Self/nonself. 2011;2(1):4-10.
7. Referans7. Kurtze N, Svebak S. Fatigue and patterns of pain in fibromyalgia: Correlations with anxiety, depression and co‐morbidity in a female county sample. British Journal of Medical Psychology. 2001;74(4):523-37.
8. Referans8. Ellis SD, Kelly ST, Shurlock JH, Hepburn ALN. The role of vitamin D testing and replacement in fibromyalgia: a systematic literature review. BMC rheumatology. 2018;2:28.

9. Referans9. Hisli N. A study on validity and reliability test of the Beck Depression Scale. Journal of Psychology. 1988;6(22):118-22.
10. Referans10. Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatology international. 2000;20(1):9-12.
11. Referans11. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods. 2009;41(4):1149-60.
12. Referans12. Muss C, Mosgoeller W, Endler T. Mood improving potential of a vitamin trace element composition—a randomized, double blind, placebo controlled clinical study with healthy volunteers. Neuroendocrinology Letters. 2016;37(1):18-28.)
13. Referans13. Bengtsson A, Henriksson K, Larsson J. Reduced high‐energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1986;29(7):817-21.
14. Referans14. Bagis S, Tamer L, Sahin G, Bilgin R, Guler H, Ercan B, et al. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatology international. 2005;25(3):188-90.
15. Referans15. Neyal M, Yimenicioglu F, Aydeniz A, Taskin A, Saglam S, Cekmen M, et al. Plasma nitrite levels, total antioxidant status, total oxidant status, and oxidative stress index in patients with tension-type headache and fibromyalgia. Clinical neurology and neurosurgery. 2013;115(6):736-40.
16. Referans16. Cordero MD, Cano-García FJ, Alcocer-Gómez E, De Miguel M, Sánchez-Alcázar JA. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q 10 effect on clinical improvement. PloS one. 2012;7(4):e35677.
17. Referans17. Bozkurt M, Yüksel H, Em S, Oktayoglu P, Yildiz M, Akdeniz D, et al. Serum prolidase enzyme activity and oxidative status in patients with Behçet's disease. Redox Report. 2014;19(2):59-64.
18. Referans18. Cordero MD, Díaz-Parrado E, Carrión AM, Alfonsi S, Sánchez-Alcazar JA, Bullón P, et al. Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia? : Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2013.
19. Referans19. Fassbender H, Wegner K. Morphology and pathogenesis of soft-tissue rheumatism. Zeitschrift fur Rheumaforschung. 1973;32(9):355.
20. Referans20. Lund N, Bengtsson A, Thorborg P. Muscle tissue oxygen pressure in primary fibromyalgia. Scandinavian Journal of Rheumatology. 1986;15(2):165-73.
21. Referans21. Naziroğlu M, Şimşek M, Kutlu M. Moderate exercise with a dietary vitamin C and E combination protects against streptozotocin-induced oxidative damage to the blood and improves fetal outcomes in pregnant rats. Clinical Chemistry and Laboratory Medicine (CCLM). 2004;42(5):511-7.
22. Referans22. Joustra ML, Minovic I, Janssens KA, Bakker SJ, Rosmalen JG. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis. PloS one. 2017;12(4):e0176631