The goal of this observational study is to determine whether there is decrease in muscle mass and muscle strength in Fibromyalgia Syndrome (FMS) patients in comparison to controls. And to determine whether these parameters are correlated with clinical ones. Briefly the main questions investigators aims to answer are: * Is there a significant difference in muscle morphology between FMS and controls? * Is there a significant difference in muscle strength between FMS and controls? * Is there a relationship between muscle thickness and pennation angle of the Quadriceps, gastrocnemius medialis, gastrocnemius lateralis and Tibialis anterior muscles and disease activity, pain and functionality? * Is there a correlation between muscle strength in FMS and disease activity, pain and functionality?
Fibromyalgia syndrome (FMS) was named by Smythe and Moldofsky when they defined tender points in 1970s. It is defined as chronic, generalized musculoskeletal pain accompanying with fatigue, sleep disturbance , cognitive and somatic disturbance. FMS has variable prevalence as %0,7-11 and usually affects middle aged women. It is second most common rheumatologic disease after osteoarthritis and thought to be the most common reason for musculoskeletal pain in middle aged women. Recent studies have reported that both sarcopenia and decreased muscle strength occur in patients with chronic inflammatory diseases such as rheumatoid arthritis. There are concerns that sarcopenia may affect exercise tolerance, activities of daily living, and ultimately have a negative impact on cardiovascular fitness and physical and emotional well-being. On the other hand there is researches that support inflammation-driven pathways in the pathogenesis of fibromyalgia. Given the risk of pain related reduction in physical activity, patients are expected to have accelerated muscle wasting , decreased muscle strength and endurance and functionality. However, there is no study that focused on muscle architecture and strength in FMS. This led us to design our study which will evaluate patients lower extremity muscles' thickness and pennation angles by ultrasound , most daily used muscles' strength by dynamometer, functionality by timed-up test and try to find whether there is a correlation between these parameters and patients' disease activity which will be determined with FMS specific scales.
Study Type
OBSERVATIONAL
Enrollment
30
aims to collect basic demographic data( Age reported by years , weight and height will be combined to report Body Mass index (BMİ) in kg/m2, Smoking habit reported as smoker or non-smoker , Level of Education reported as illiterate, literate, Primary school, Middle school, High school, University or Post-graduate, Profession type, Significant medical records and Medications.
The Widespread Pain Index is a 19-point checklist that assesses the presence of pain or tenderness (within the prior seven days) in 19 specific areas of the body; each affected area receives one point. The 19 regions on the WPI include the following: Right and left jaw, Right and left shoulder girdle, Right and left upper arm, Right and left lower arm, Right and left hip/buttock Right and left upper leg Right and left lower leg Upper and lower back Neck Chest Abdomen A fibromyalgia diagnosis is confirmed if a WPI is ≥7 with an SS scale ≥5 OR a WPI range between 4-6 with an SS scale ≥ 9.
SS scale score: Fatigue, waking unrefreshed, and cognitive symptoms. For each of the three symptoms above, indicate the severity level over the past week utilizing the following scale: 0 no problem; 1 slight or mild problems, generally mild or intermittent; 2 moderate, considerable problems, often present and/or at a moderate level; 3 severe: pervasive, continuous, life-disturbing problems. Considering somatic symptoms in general, indicate whether the patient has: 0 for no symptoms, 1 for a few symptoms, 2 for a moderate number of symptoms, and 3 for many symptoms. The SS scale score sums the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the severity) of general somatic symptoms. The final score is between 0 and 12.
The FIQ is an assessment and evaluation instrument developed to measure fibromyalgia (FM) patient status, progress and outcomes. The FIQ is composed of 10 items. The first item contains 11 questions related to physical functioning - each question is rated on a 4 point Likert type scale. Items 2 and 3 ask the patient to mark the number of days they felt well and the number of days they were unable to work (including housework) because of fibromyalgia symptoms. Items 4 through 10 are horizontal linear scales marked in 10 increments on which the patient rates work difficulty, pain, fatigue, morning tiredness, stiffness, anxiety and depression.
Tender points are specific sites on the body that cause pain when pressed.. There are 9 pairs of tender points. Each pair has one point on each side of the body, for a total of 18 points.Prior to 2010, the diagnosis of fibromyalgia required at least 11 painful point of 18 but now tender points are no longer used as a diagnostic tool. The score will be reported as the number of tender points found with palpation.
The three head of Quadratus femoris ( Vastus lateralis, Vastus Medialis and Rectus Femoris), Tibialis Anterior, the two heads of Gastrocnemius ( vastus Lateralis and vastus Medialis) ultrasonography will be performed to evaluate muscle thickness, pennation angle and fascicle length.
Cervical Flexion (CF), Cervical Extension (CE), Right and Left Cervical Lateral Flexion (CLF R/L), Truncal flexion (TF), Truncal extension (TE), Shoulder flexion (SF), Shoulder extension (SE), Shoulder abduction (SAB), Shoulder internal rotation (SIR) and Shoulder external rotation (SER), Hip flexion (HF), Hip extension (HE), hip abduction (HAB), hip internal rotation (HIR), hip external rotation (HER), knee extension (KE), Knee Flexion (KF), Ankle Dorsiflexion (ADF) and Ankle Plantar flexion (APF) muscle strengths will be evaluated with hand held dynamometer
The test will be used by investigators as a simple evaluative test used to measure participants functional mobility.
Bezmialem Vakif University
Istanbul, Fatih, Turkey (Türkiye)
RECRUITINGQuadriceps Femoris Vastus Lateralis Muscle Thickness
Vastus lateralis ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Quadriceps Femoris Vastus Lateralis Fascicle Length
Vastus lateralis ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Quadriceps Femoris Vastus Medialis Muscle Thickness
Vastus Medialis ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Quadriceps Femoris Vastus Medialis Fascicle Length
Vastus Medialis ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Quadriceps Femoris Rectus Femoris Muscle Thickness
Rectus Femoris ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Quadriceps Femoris Rectus Femoris Fascicle Length
Rectus Femoris ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Tibialis Anterior Muscle Thickness
Tibialis Anterior ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Tibialis Anterior Muscle Fascicle Length
Tibialis Anterior ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Gastrocnemius Muscle Vastus Medialis Muscle Thickness
Gastrocnemius muscle vastus medialis ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Gastrocnemius Muscle Vastus Medialis Fascicle Length
Gastrocnemius muscle vastus medialis ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Gastrocnemius Muscle Vastus Lateralis Muscle Thickness
Gastrocnemius muscle vastus lateralis ultrasonography will be performed to evaluate muscle thickness.
Time frame: through study completion, an average of 16 weeks
Gastrocnemius Muscle Vastus Lateralis Fascicle Length
Gastrocnemius muscle vastus lateralis ultrasonography will be performed to evaluate fascicle length through measuring pennation angle (PA).
Time frame: through study completion, an average of 16 weeks
Cervical Muscle strength
Isometric Cervical Flexion (CF), Isometric Cervical Extension (CE) and Right and Left Isometric Cervical Lateral Flexion (CLF R/L) strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Truncal Muscle strength
Isometric Truncal flexion (TF)and Isometric Truncal extension (TE) strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Shoulder Muscle strength
Isometric Shoulder flexion (SF), Isometric Shoulder extension (SE), Isometric Shoulder abduction (SAB), Isometric Shoulder internal rotation (SIR) and Isometric Shoulder external rotation (SER) strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Hip Muscle strength
Isometric Hip flexion (HF), Isometric Hip extension (HE), Isometric Hip abduction (HAB), Isometric Hip internal rotation (HIR) and Isometric Hip external rotation (HER), strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Knee Muscle strength
Isometric Knee extension (KE) and Isometric Knee Flexion (KF) strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Ankle Muscle strength
Isometric Ankle Dorsiflexion (ADF) and Isometric Ankle Plantar flexion (APF) strengths will be calculated with hand-held dynamometer(Lafayette Manual Muscle Tester ) and reported as kilograms.
Time frame: through study completion, an average of 16 weeks
Timed Up & Go (TUG)
The patient sits in the chair with his/her back against the chair back. On the command "go," the patient rises from the chair, walks 3 meters at a comfortable and safe pace, turns, walks back to the chair and sits down. Timing begins at the instruction "go" and stops when the patient is seated and will be reported by seconds. This test aim to determine patients functional state and mobility .
Time frame: through study completion, an average of 16 weeks
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