Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study


We proposed to assess antioxidant status and nitric oxide in fibromyalgia (FM) patients in comparison to healthy controls. Additionally, the association between the serum antioxidant levels and clinical findings in FM patients was also investigated. Thirty-seven FM patients and 37 healthy controls were enrolled in this study. Severity of fatigue and pain were determined by Visual Analogue Scale. Functional capacity in daily living activities was evaluated by fibromyalgia impact questionnaire. Serum NO, catalase and glutathione were measured. Serum glutathione and catalase levels were significantly lower in FM patients than controls. However, no significant difference was seen in serum NO levels between the two groups. A significant correlation was evident between serum NO level and pain. Additionally, the correlation between glutathione level and morning stiffness was found to be significant. These findings support other studies, we assume that these two antioxidants might have impact on the pathogenesis of FM disease.

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  1. 1.

    Bennett RM (1997) The fibromyalgia syndrome. In: Kelley WN, Haris ED, Ruddy S, Sledge CB (eds) Textbook of rheumatology. Saunders, Philadelphia, pp 511–519

    Google Scholar 

  2. 2.

    Mease P (2005) Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl 75:6–21

    PubMed  Google Scholar 

  3. 3.

    Ozgocmen S (2006) New strategies in evaluation of therapeutic efficacy in fibromyalgia syndrome. Curr Pharm Des 12:67–71. doi:10.2174/138161206775193271

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Altindag O, Celik H (2006) Total antioxidant capacity and the severity of the pain in patients with fibromyalgia. Redox Rep 11(3):131–135. doi:10.1179/135100006X116628

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Eisenger J, Gandolfa C, Zakarian H, Ayavou T (1997) Reactive oxygen species, antioxidant status and fibromyalgia. J Musculoskeletal Pain 5:5–15. doi:10.1300/J094v05n04_02

    Article  Google Scholar 

  6. 6.

    Ozgocmen S, Ozyurt H, Sogut S, Akyol O (2006) Current concepts in the pathophysiology of fibromyalgia: the potential role of oxidative stress and nitric oxide. Rheumatol Int 26:585–590. doi:10.1007/s00296-005-0078-z

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Alaşehirli B, Demiryürek S, Arica E, Gürsoy S, Demiryürek AT (2007) No evidence for an association between the Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and fibromyalgia syndrome. Rheumatol Int 27(3):275–280. doi:10.1007/s00296-006-0199-z

    PubMed  Article  Google Scholar 

  8. 8.

    Bagis S, Tamer L, Sahin G, Bilgin R, Guler H, Ercan B, Erdogan C (2005) Free radicals and antioxidants in primary fibromyalgia: an oxidative stres disorder? Rheumatol Int 25(3):188–190. doi:10.1007/s00296-003-0427-8

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172. doi:10.1002/art.1780330203

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Burckhardt CS, Clark SR, Bennett RM (1991) The fibromyalgia impact questionnaire: development and validation. J Rheumatol 18:728–733

    PubMed  CAS  Google Scholar 

  11. 11.

    Sarmer S, Ergin S, Yavuzer G (2000) The validity and reliability of the Turkish version of the fibromyalgia ımpact questionnaire. Rheumatol Int 20:9–12. doi:10.1007/s002960000077

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Fassbender HG, Wegner K (1973) Morphology and pathogenesis of soft-tissue rheumatism. Z Rheumaforsch 32(9):355–374

    PubMed  CAS  Google Scholar 

  13. 13.

    Lund N, Bengtsson A, Thorborg P (1986) Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 15(2):165–173. doi:10.3109/03009748609102084

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Jeschonneck M, Grohmann G, Hein G, Sprott H (2000) Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia. Rheumatology (Oxford) 39(8):917–921. doi:10.1093/rheumatology/39.8.917

    Article  CAS  Google Scholar 

  15. 15.

    Wu G, Fang YZ, Yang S, Lupton JR, Turner ND (2004) Glutathione metabolism and its implications for health. J Nutr 134(3):489–492

    PubMed  CAS  Google Scholar 

  16. 16.

    Yunus MB (2007) Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol 21(3):481–497. doi:10.1016/j.berh.2007.03.006

    PubMed  Article  Google Scholar 

  17. 17.

    Kumar A, Goyal R (2007) Possible involvement of GABAergic modulation in the protective effect of gabapentin against immobilization stress-induced behavior alterations and oxidative damage in mice. Fundam Clin Pharmacol 21(6):575–581. doi:10.1111/j.1472-8206.2007.00524.x

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Chakrabarty S, Zoorob R (2007) Fibromyalgia. Am Fam Physician 76(2):247–254

    PubMed  Google Scholar 

  19. 19.

    Willekens H, Inze D, Van Montagu M, Van Camp W (1995) Catalase in plants. Mol Breed 1:207–228. doi:10.1007/BF02277422

    Article  CAS  Google Scholar 

  20. 20.

    Turrents JF, Crapo JD, Freeman BA (1984) Protection against oxygen toxicity by intravenous injection of liposome-entrapped catalase and superoxide dismutase. J Clin Invest 73:87–95. doi:10.1172/JCI111210

    Article  Google Scholar 

  21. 21.

    Singh A, Naidu PS, Gupta S, Kulkarni SK (2002) Effect of natural and synthetic antioxidants in a mouse model of chronic fatigue syndrome. J Med Food 5(4):211–220. doi:10.1089/109662002763003366

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Wysenbeek AJ, Shapira Y (1991) Primary fibromyalgia and the chronic fatigue syndrome. Rheumatol Int 10:227–229. doi:10.1007/BF02274883

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    White KP, Speechley M, Harth M, Ostbye T (2000) Coexistence of choronic fatigue syndrome with fibromyalgia syndrome in the general population. Scand J Rheumatol 29:44–51. doi:10.1080/030097400750001798

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Kigwell BA (2000) Nitric oxide-mediated metabolic regulation during exercise: effects of training in health and cardiovascular disease. FASEB J 14(12):1685–1696. doi:10.1096/fj.99-0896rev

    Article  Google Scholar 

  25. 25.

    Bradley LA, Weigent DA, Sotolongo A, Alorcon GS, Arnold RE, Cianfrini LR (2000) Blood serum levels of nitric oxide are elevated in women with fibromyalgia:possible contributions to central and peripheral sensitization. Arthritis Rheum 43:173

    Google Scholar 

  26. 26.

    Larson AA, Giovengo SL, Russell IJ, Michalek JE (2000) Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia: implications for nitric oxide pathways. Pain 87(2):201–211. doi:10.1016/S0304-3959(00)00284-0

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Wu MW, Zeng ZL, Li S, Guo L, Zhang JX, Qiu F et al (2008) Circadian variation of plasma cortisol and whole blood reduced glutathione levels in nasopharyngeal carcinoma patients. Ai Zheng 27(3):237–242

    PubMed  CAS  Google Scholar 

  28. 28.

    Tuñón MJ, González P, López P, Salido GM, Madrid JA (1992) Circadian rhythms in glutathione and glutathione-S transferase activity of rat liver. Arch Int Physiol Biochim Biophys 100(1):83–87. doi:10.3109/13813459209035264

    PubMed  Article  Google Scholar 

  29. 29.

    Guerrero JM, Pablos MI, Ortiz GG, Agapito MT, Reiter RJ (1996) Nocturnal decreases in nitric oxide and cyclic GMP contents in the chick brain and their prevention by light. Neurochem Int 29(4):417–421

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Kanabrocki EL, George M, Hermida RC, Messmore HL, Ryan MD, Ayala DE et al (2001) Day-night variations in blood levels of nitric oxide, T-TFPI, and E-selectin. Clin Appl Thromb Hemost 7(4):339–345. doi:10.1177/107602960100700417

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Yasemin Turan.

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Sendur, O.F., Turan, Y., Tastaban, E. et al. Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study. Rheumatol Int 29, 629–633 (2009).

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  • Fibromyalgia
  • Nitric oxide
  • Catalase
  • Glutathione