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Fibromiyalji Hastalarında Serum Homosistein Düzeyleri ile Hastalık Aktivitesi Arasındaki İlişki

Year 2025, Volume: 17 Issue: 3, 273 - 280, 29.10.2025

Abstract

Amaç: Fibromiyalji sendromu (FMS), çok çeşitli semptomları olan bir romatizmal hastalıktır. Yüksek homosistein (Hcy) düzeyleri; böbrek fonksiyon bozuklukları, kardiyovasküler hastalıklar, vitiligo, kanser, diyabet, iskemik inme, epilepsi, demans, otizm ve çeşitli nörolojik bozukluklarla ilişkilendirilmiştir. Bu retrospektif çalışma, FMS'nin etiyolojisinde Hcy'nin rolünü ve hastalık aktivitesi ile ilişkisini değerlendirmek amacıyla yapılmıştır.
Yöntem: Çalışmamıza, Amerikan Romatoloji Koleji 2010 kriterlerine göre FMS tanısı konmuş 42 kadın hasta dahil edildi. Yaşları hasta grubuyla benzer 20 sağlıklı kadın, kontrol grubunu oluşturmuştur. Tüm hastaların ve kontrol grubundaki katılımcıların ayrıntılı anamnez ve sosyodemografik verileri kaydedildi. Tüm hastalarda ve kontrol grubunda hemogram, rutin biyokimya, vitamin B12, folik asit, tiroid fonksiyon testleri, eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP), 25-hidroksi vitamin D ve serum Hcy düzeyleri hasta dosyasından kaydedildi.
Bulgular: Serum Hcy, CRP ve ESR düzeyleri, FMS grubunda kontrol grubuna göre istatistiksel olarak daha yüksekti (sırasıyla p=0,003, p=0,004 ve p=0,011). Ancak, Hcy düzeyleri ile Fibromiyalji Etki Anketi, Vizüel Analog Skala, Beck Depresyon Envanteri, Pittsburgh Uyku Kalitesi İndeksi veya Kısa Form-36 skorları arasında istatistiksel olarak anlamlı bir korelasyon yoktu.
Sonuç: FMS, etiyolojisi aydınlatılamamış kompleks bir hastalıktır. FMS'nin birden fazla sistemi etkilediği ve Hcy’nin çeşitli fizyolojik süreçlerde rol oynadığı göz önüne alındığında FMS ile Hcy arasındaki ilişkiyi açıklamak için daha kapsamlı çalışmalara ihtiyaç vardır.

References

  • 1. Rehman T, Shabbir MA, Inam-Ur-Raheem M, Manzoor MF, Ahmad N, Liu ZW, et al. Cysteine and homocysteine as biomarker of various diseases. Food Sci Nutr. 2020;8(9):4696–707.
  • 2. Stipanuk MH. Sulfur amino acid metabolism: pathways for production and removal of homocysteine and cysteine. Annu Rev Nutr. 2004;24:539–77.
  • 3. Majumder A, Singh M, Behera J, Theilen NT, George AK, Tyagi N, et al. Hydrogen sulfide alleviates hyperhomocysteinemia-mediated skeletal muscle atrophy via mitigation of oxidative and endoplasmic reticulum stress injury. Am J Physiol Cell Physiol. 2018;315(5):C609–22.
  • 4. Veeranki S, Tyagi SC. Defective homocysteine metabolism: potential implications for skeletal muscle malfunction. Int J Mol Sci. 2013;14(7):15074–91.
  • 5. Lehotský J, Tothová B, Kovalská M, Dobrota D, Beňová A, Kalenská D, et al. Role of homocysteine in the ischemic stroke and development of ischemic tolerance. Front Neurosci. 2016;10:538.
  • 6. Herrmann W, Herrmann M, Obeid R. Hyperhomocysteinaemia: a critical review of old and new aspects. Curr Drug Metab. 2007;8(1):17–31.
  • 7. Veeranki S, Winchester LJ, Tyagi SC. Hyperhomocysteinemia associated skeletal muscle weakness involves mitochondrial dysfunction and epigenetic modifications. Biochim Biophys Acta. 2015;1852(5):732–41.
  • 8. Regland B, Andersson M, Abrahamsson L, Bagby J, Dyrehag LE, Gottfries CG. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rheumatol. 1997;26(4):301–7.
  • 9. Vasiljevic D, Tomic Lucic A, Živanović S, Milosavljevic M, Radovanovic S, Anđelković N, et al. Plasma homocysteine concentrations in patients with rheumatoid arthritis. Ser J Exp Clin Res. 2015;16(3):207–11.
  • 10. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl. 2005;75:6–21.
  • 11. Tawfik A, Elsherbiny NM, Zaidi Y, Rajpurohit P. Homocysteine and age-related central nervous system diseases: Role of Inflammation. Int J Mol Sci. 2021;22(12):6259.
  • 12. Herrmann W, Obeid R. Homocysteine: a biomarker in neurodegenerative diseases. Clin Chem Lab Med. 2011;49(3):435–41.
  • 13. Kado DM, Karlamangla AS, Huang MH, Troen A, Rowe JW, Selhub J, et al. Homocysteine versus the vitamins folate, B6, and B12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging. Am J Med. 2005;118(2):161–7.
  • 14. Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015;35(7):1115–25.
  • 15. Munipalli B, Strothers S, Rivera F, Malavet P, Mitri G, Abu Dabrh AM, et al. Association of Vitamin B12, Vitamin D, and Thyroid-Stimulating Hormone With Fatigue and Neurologic Symptoms in Patients With Fibromyalgia. Mayo Clin Proc Innov Qual Outcomes. 2022;6(4):381–7.
  • 16. Gharibpoor F, Ghavidel-Parsa B, Sattari N, Bidari A, Nejatifar F, Montazeri A. Effect of vitamin B12 on the symptom severity and psychological profile of fibromyalgia patients; a prospective pre-post study. BMC Rheumatol. 2022;6(1):51.
  • 17. Regland B, Forsmark S, Halaouate L, Matousek M, Peilot B, Zachrisson O, et al. Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. PLoS ONE. 2015;10(4):e0124648.
  • 18. Kanwar YS, Manaligod JR, Wong PW. Morphologic studies in a patient with homocystinuria due to 5, 10-methylenetetrahydrofolate reductase deficiency. Pediatr Res. 1976;10(6):598–609.
  • 19. Bengtsson A. The muscle in fibromyalgia. Rheumatology (Oxford). 2002;41(7):721–4.
  • 20. Kolling J, Scherer EBS, Siebert C, Hansen F, Torres FV, Scaini G, et al. Homocysteine induces energy imbalance in rat skeletal muscle: is creatine a protector? Cell Biochem Funct. 2013;31(7):575–84.
  • 21. Swart KMA, Enneman AW, van Wijngaarden JP, van Dijk SC, Brouwer-Brolsma EM, Ham AC, et al. Homocysteine and the methylenetetrahydrofolate reductase 677CT polymorphism in relation to muscle mass and strength, physical performance and postural sway. Eur J Clin Nutr. 2013;67(7):743–8.
  • 22. van Schoor NM, Swart KMA, Pluijm SMF, Visser M, Simsek S, Smulders Y, et al. Cross-sectional and longitudinal association between homocysteine, vitamin B12 and physical performance in older persons. Eur J Clin Nutr. 2012;66(2):174–81.
  • 23. da Cunha MJ, da Cunha AA, Ferreira AGK, Machado FR, Schmitz F, Lima DD, et al. Physical exercise reverses glutamate uptake and oxidative stress effects of chronic homocysteine administration in the rat. Int J Dev Neurosci. 2012;30(2):69–74.
  • 24. 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? Antioxid Redox Signal. 2013;18(7):800–7.
  • 25. Sławek J, Białecka M. Chapter 57 - Homocysteine and dementia. In: Martin CR, Preedy VR, editors. Diet and nutrition in dementia and cognitive decline. San Diego: Elsevier; 2015. p. 611–21.
  • 26. Brum E da S, Fialho MFP, Fischer SPM, Hartmann DD, Gonçalves DF, Scussel R, et al. Relevance of mitochondrial dysfunction in the reserpine-induced experimental fibromyalgia model. Mol Neurobiol. 2020;57(10):4202–17.
  • 27. Martínez-Lara A, Moreno-Fernández AM, Jiménez-Guerrero M, Díaz-López C, De-Miguel M, Cotán D, et al. Mitochondrial imbalance as a new approach to the study of fibromyalgia. Open Access Rheumatol Res Rev. 2020;12:175–85.
  • 28. Lippi G, Mattiuzzi C, Meschi T, Cervellin G, Borghi L. Homocysteine and migraine. A narrative review. Clin Chim Acta. 2014;433:5–11.
  • 29. Isobe C, Terayama Y. A remarkable increase in total homocysteine concentrations in the CSF of migraine patients with aura. Headache. 2010;50(10):1561–9.
  • 30. Whealy M, Nanda S, Vincent A, Mandrekar J, Cutrer FM. Fibromyalgia in migraine: a retrospective cohort study. J Headache Pain. 2018;19(1):61.
  • 31. Küçükşen S, Genç E, Yılmaz H, Sallı A, Gezer İA, Karahan AY, et al. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. 2013;32(7):983–90.
  • 32. Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH. Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study. Rheumatology (Oxford). 2001;40(7):743–9.
  • 33. Townsend DM, Tew KD, Tapiero H. Sulfur containing amino acids and human disease. Biomed Pharmacother. 2004;58(1):47–55.
  • 34. Zhao Y, Qian L. Homocysteine-mediated intestinal epithelial barrier dysfunction in the rat model of irritable bowel syndrome caused by maternal separation. Acta Biochim Biophys Sin. 2014;46(10):917–9.
  • 35. Garofalo C, Cristiani CM, Ilari S, Passacatini LC, Malafoglia V, Viglietto G, et al. Fibromyalgia and irritable bowel syndrome interaction: a possible role for gut microbiota and gut-brain axis. Biomedicines. 2023;11(6):1701.
  • 36. James SJ, Cutler P, Melnyk S, Jernigan S, Janak L, Gaylor DW, et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004;80(6):1611–7.
  • 37. Levine J, Stahl Z, Sela BA, Gavendo S, Ruderman V, Belmaker RH. Elevated homocysteine levels in young male patients with schizophrenia. Am J Psychiatry. 2002;159(10):1790–2.
  • 38. Uguz F, Çiçek E, Salli A, Karahan AY, Albayrak İ, Kaya N, et al. Axis I and Axis II psychiatric disorders in patients with fibromyalgia. Gen Hosp Psychiatry. 2010;32(1):105–7.

Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia

Year 2025, Volume: 17 Issue: 3, 273 - 280, 29.10.2025

Abstract

Objective: Fibromyalgia syndrome (FMS) is a rheumatic disorder characterized by a wide spectrum of symptoms. Elevated homocysteine (Hcy) levels have been associated with a variety of conditions including renal dysfunction, cardiovascular disease, vitiligo, cancer, diabetes, ischemic stroke, epilepsy, dementia, autism, and various neurological disorders. This retrospective study aimed to evaluate the role of Hcy in the etiology of FMS and its relationship with disease activity.
Method: This study included 42 female patients diagnosed with FMS according to the American College of Rheumatology 2010 criteria, along with 20 age-matched healthy female controls. Detailed medical history and sociodemographic data were collected from all participants. Hemogram, routine biochemical tests, vitamin B12, folic acid, thyroid function tests, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), 25-hydroxy vitamin D, and serum Hcy levels were recorded from medical files in both groups.
Results: Serum Hcy, CRP, and ESR levels were significantly higher in the FMS group compared to controls (p=0.003, p=0.004, and p=0.011, respectively). However, no statistically significant correlation was found between Hcy levels and Fibromyalgia Impact Questionnaire, Visual Analog Scale, Beck Depression Inventory, Pittsburgh Sleep Quality Index, or Short Form-36 scores.
Conclusions: FMS is a complex disease with an unclear etiology. Considering that FMS affects multiple systems and that Hcy plays a role in various physiological processes, further comprehensive studies are warranted to elucidate the relationship between FMS and Hcy.

References

  • 1. Rehman T, Shabbir MA, Inam-Ur-Raheem M, Manzoor MF, Ahmad N, Liu ZW, et al. Cysteine and homocysteine as biomarker of various diseases. Food Sci Nutr. 2020;8(9):4696–707.
  • 2. Stipanuk MH. Sulfur amino acid metabolism: pathways for production and removal of homocysteine and cysteine. Annu Rev Nutr. 2004;24:539–77.
  • 3. Majumder A, Singh M, Behera J, Theilen NT, George AK, Tyagi N, et al. Hydrogen sulfide alleviates hyperhomocysteinemia-mediated skeletal muscle atrophy via mitigation of oxidative and endoplasmic reticulum stress injury. Am J Physiol Cell Physiol. 2018;315(5):C609–22.
  • 4. Veeranki S, Tyagi SC. Defective homocysteine metabolism: potential implications for skeletal muscle malfunction. Int J Mol Sci. 2013;14(7):15074–91.
  • 5. Lehotský J, Tothová B, Kovalská M, Dobrota D, Beňová A, Kalenská D, et al. Role of homocysteine in the ischemic stroke and development of ischemic tolerance. Front Neurosci. 2016;10:538.
  • 6. Herrmann W, Herrmann M, Obeid R. Hyperhomocysteinaemia: a critical review of old and new aspects. Curr Drug Metab. 2007;8(1):17–31.
  • 7. Veeranki S, Winchester LJ, Tyagi SC. Hyperhomocysteinemia associated skeletal muscle weakness involves mitochondrial dysfunction and epigenetic modifications. Biochim Biophys Acta. 2015;1852(5):732–41.
  • 8. Regland B, Andersson M, Abrahamsson L, Bagby J, Dyrehag LE, Gottfries CG. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rheumatol. 1997;26(4):301–7.
  • 9. Vasiljevic D, Tomic Lucic A, Živanović S, Milosavljevic M, Radovanovic S, Anđelković N, et al. Plasma homocysteine concentrations in patients with rheumatoid arthritis. Ser J Exp Clin Res. 2015;16(3):207–11.
  • 10. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl. 2005;75:6–21.
  • 11. Tawfik A, Elsherbiny NM, Zaidi Y, Rajpurohit P. Homocysteine and age-related central nervous system diseases: Role of Inflammation. Int J Mol Sci. 2021;22(12):6259.
  • 12. Herrmann W, Obeid R. Homocysteine: a biomarker in neurodegenerative diseases. Clin Chem Lab Med. 2011;49(3):435–41.
  • 13. Kado DM, Karlamangla AS, Huang MH, Troen A, Rowe JW, Selhub J, et al. Homocysteine versus the vitamins folate, B6, and B12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging. Am J Med. 2005;118(2):161–7.
  • 14. Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015;35(7):1115–25.
  • 15. Munipalli B, Strothers S, Rivera F, Malavet P, Mitri G, Abu Dabrh AM, et al. Association of Vitamin B12, Vitamin D, and Thyroid-Stimulating Hormone With Fatigue and Neurologic Symptoms in Patients With Fibromyalgia. Mayo Clin Proc Innov Qual Outcomes. 2022;6(4):381–7.
  • 16. Gharibpoor F, Ghavidel-Parsa B, Sattari N, Bidari A, Nejatifar F, Montazeri A. Effect of vitamin B12 on the symptom severity and psychological profile of fibromyalgia patients; a prospective pre-post study. BMC Rheumatol. 2022;6(1):51.
  • 17. Regland B, Forsmark S, Halaouate L, Matousek M, Peilot B, Zachrisson O, et al. Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. PLoS ONE. 2015;10(4):e0124648.
  • 18. Kanwar YS, Manaligod JR, Wong PW. Morphologic studies in a patient with homocystinuria due to 5, 10-methylenetetrahydrofolate reductase deficiency. Pediatr Res. 1976;10(6):598–609.
  • 19. Bengtsson A. The muscle in fibromyalgia. Rheumatology (Oxford). 2002;41(7):721–4.
  • 20. Kolling J, Scherer EBS, Siebert C, Hansen F, Torres FV, Scaini G, et al. Homocysteine induces energy imbalance in rat skeletal muscle: is creatine a protector? Cell Biochem Funct. 2013;31(7):575–84.
  • 21. Swart KMA, Enneman AW, van Wijngaarden JP, van Dijk SC, Brouwer-Brolsma EM, Ham AC, et al. Homocysteine and the methylenetetrahydrofolate reductase 677CT polymorphism in relation to muscle mass and strength, physical performance and postural sway. Eur J Clin Nutr. 2013;67(7):743–8.
  • 22. van Schoor NM, Swart KMA, Pluijm SMF, Visser M, Simsek S, Smulders Y, et al. Cross-sectional and longitudinal association between homocysteine, vitamin B12 and physical performance in older persons. Eur J Clin Nutr. 2012;66(2):174–81.
  • 23. da Cunha MJ, da Cunha AA, Ferreira AGK, Machado FR, Schmitz F, Lima DD, et al. Physical exercise reverses glutamate uptake and oxidative stress effects of chronic homocysteine administration in the rat. Int J Dev Neurosci. 2012;30(2):69–74.
  • 24. 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? Antioxid Redox Signal. 2013;18(7):800–7.
  • 25. Sławek J, Białecka M. Chapter 57 - Homocysteine and dementia. In: Martin CR, Preedy VR, editors. Diet and nutrition in dementia and cognitive decline. San Diego: Elsevier; 2015. p. 611–21.
  • 26. Brum E da S, Fialho MFP, Fischer SPM, Hartmann DD, Gonçalves DF, Scussel R, et al. Relevance of mitochondrial dysfunction in the reserpine-induced experimental fibromyalgia model. Mol Neurobiol. 2020;57(10):4202–17.
  • 27. Martínez-Lara A, Moreno-Fernández AM, Jiménez-Guerrero M, Díaz-López C, De-Miguel M, Cotán D, et al. Mitochondrial imbalance as a new approach to the study of fibromyalgia. Open Access Rheumatol Res Rev. 2020;12:175–85.
  • 28. Lippi G, Mattiuzzi C, Meschi T, Cervellin G, Borghi L. Homocysteine and migraine. A narrative review. Clin Chim Acta. 2014;433:5–11.
  • 29. Isobe C, Terayama Y. A remarkable increase in total homocysteine concentrations in the CSF of migraine patients with aura. Headache. 2010;50(10):1561–9.
  • 30. Whealy M, Nanda S, Vincent A, Mandrekar J, Cutrer FM. Fibromyalgia in migraine: a retrospective cohort study. J Headache Pain. 2018;19(1):61.
  • 31. Küçükşen S, Genç E, Yılmaz H, Sallı A, Gezer İA, Karahan AY, et al. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. 2013;32(7):983–90.
  • 32. Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH. Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study. Rheumatology (Oxford). 2001;40(7):743–9.
  • 33. Townsend DM, Tew KD, Tapiero H. Sulfur containing amino acids and human disease. Biomed Pharmacother. 2004;58(1):47–55.
  • 34. Zhao Y, Qian L. Homocysteine-mediated intestinal epithelial barrier dysfunction in the rat model of irritable bowel syndrome caused by maternal separation. Acta Biochim Biophys Sin. 2014;46(10):917–9.
  • 35. Garofalo C, Cristiani CM, Ilari S, Passacatini LC, Malafoglia V, Viglietto G, et al. Fibromyalgia and irritable bowel syndrome interaction: a possible role for gut microbiota and gut-brain axis. Biomedicines. 2023;11(6):1701.
  • 36. James SJ, Cutler P, Melnyk S, Jernigan S, Janak L, Gaylor DW, et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004;80(6):1611–7.
  • 37. Levine J, Stahl Z, Sela BA, Gavendo S, Ruderman V, Belmaker RH. Elevated homocysteine levels in young male patients with schizophrenia. Am J Psychiatry. 2002;159(10):1790–2.
  • 38. Uguz F, Çiçek E, Salli A, Karahan AY, Albayrak İ, Kaya N, et al. Axis I and Axis II psychiatric disorders in patients with fibromyalgia. Gen Hosp Psychiatry. 2010;32(1):105–7.
There are 38 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Rumeysa Samanci 0000-0002-7772-7983

Merve Dede Akpınar 0000-0002-9724-2967

Volkan Murat Samanci 0000-0002-6577-1805

Sarfinaz Ataoğlu 0000-0002-0374-0712

Tuba Erdem Sultanoğlu 0000-0003-0021-5952

Submission Date November 26, 2024
Acceptance Date August 15, 2025
Publication Date October 29, 2025
Published in Issue Year 2025 Volume: 17 Issue: 3

Cite

APA Samanci, R., Dede Akpınar, M., Samanci, V. M., … Ataoğlu, S. (2025). Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia. Konuralp Medical Journal, 17(3), 273-280. https://doi.org/10.18521/ktd.1591451
AMA Samanci R, Dede Akpınar M, Samanci VM, Ataoğlu S, Erdem Sultanoğlu T. Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia. Konuralp Medical Journal. October 2025;17(3):273-280. doi:10.18521/ktd.1591451
Chicago Samanci, Rumeysa, Merve Dede Akpınar, Volkan Murat Samanci, Sarfinaz Ataoğlu, and Tuba Erdem Sultanoğlu. “Relationship Between Serum Homocysteine Levels and Disease Activity in Patients With Fibromyalgia”. Konuralp Medical Journal 17, no. 3 (October 2025): 273-80. https://doi.org/10.18521/ktd.1591451.
EndNote Samanci R, Dede Akpınar M, Samanci VM, Ataoğlu S, Erdem Sultanoğlu T (October 1, 2025) Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia. Konuralp Medical Journal 17 3 273–280.
IEEE R. Samanci, M. Dede Akpınar, V. M. Samanci, S. Ataoğlu, and T. Erdem Sultanoğlu, “Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia”, Konuralp Medical Journal, vol. 17, no. 3, pp. 273–280, 2025, doi: 10.18521/ktd.1591451.
ISNAD Samanci, Rumeysa et al. “Relationship Between Serum Homocysteine Levels and Disease Activity in Patients With Fibromyalgia”. Konuralp Medical Journal 17/3 (October2025), 273-280. https://doi.org/10.18521/ktd.1591451.
JAMA Samanci R, Dede Akpınar M, Samanci VM, Ataoğlu S, Erdem Sultanoğlu T. Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia. Konuralp Medical Journal. 2025;17:273–280.
MLA Samanci, Rumeysa et al. “Relationship Between Serum Homocysteine Levels and Disease Activity in Patients With Fibromyalgia”. Konuralp Medical Journal, vol. 17, no. 3, 2025, pp. 273-80, doi:10.18521/ktd.1591451.
Vancouver Samanci R, Dede Akpınar M, Samanci VM, Ataoğlu S, Erdem Sultanoğlu T. Relationship between Serum Homocysteine Levels and Disease Activity in Patients with Fibromyalgia. Konuralp Medical Journal. 2025;17(3):273-80.

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