What happens to muscles in fibromyalgia syndrome, 2019,

Andy

Andy

Retired committee member
Background
The main somatic symptoms of fibromyalgia syndrome (FMS) are chronic musculoskeletal pain, stiffness, and fatigue, all of which are related to the muscle system and its functioning.

Aims
The aim of this study was to evaluate whether the asymptomatic upper and lower extremity muscles evaluated using ultrasonography (US) were different from healthy controls in both newly diagnosed and established FMS and to assess whether muscle measurements were related to fatigue and disease severity, as well as quality of life.

Methods
This study was conducted on 152 subjects (102 patients and 50 healthy controls) as a cross-sectional controlled trial. Real-time imaging of cross-sectional thickness (CST) (for deltoid, biceps brachii, triceps brachii, forearm flexor, tibialis anterior, and gastrocnemius medialis), and cross-sectional areas (CSAs) (quadriceps femoris (QF)) measurements were performed using US. Fatigue and disease severity as well as quality of life scales were given to all participants.

Results
In both patient groups, decreased QF muscle CSA was significantly correlated with increased fatigue severity and decreased overall quality of life and energy levels. Moreover, in patients with established disease, there was a significant correlation between the decrease in QF muscle CSA and increased social isolation and between the decrease in biceps brachii muscle CST and increased fatigue severity.

Conclusions
Whether in newly diagnosed or established disease, muscle measurement values and quality of life parameters were significantly decreased in patients with FMS compared with healthy controls.
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Paywall, https://link.springer.com/article/10.1007/s11845-019-02138-w
Scihub, https://sci-hub.se/10.1007/s11845-019-02138-w
 
This seems weak at first glance because of how crude muscle mass is but:
One of the major results of this study was the presence of muscle involvement even in newly diagnosed disease, in other words, inactivity-related muscle weakness, fatigue, and related inactivity when the vicious cycle is not yet fully developed, suggesting that inactivity cannot explain the intramuscular changes in muscle weakness in FMS alone as reported previously. Therefore, contrary to studies proposing inactivity related peripheral muscle effects and atrophy in the muscles, we believe that the condition is much more related with the disease itself, maybe creating a vicious cycle of disease progression, and inactivity-related muscle changes become prominent. Also, there was no correlation between physical mobility and muscle measurements, which supports our view.
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However given how long it typically takes to get diagnosed, symptoms will have usually already have had an impact on physical activity, though we are talking about a reduction of activity, not months of complete bed rest. There's a big issue as with ME about time of diagnosis not necessarily being nearly as significant as time of symptom appearance. It's not clear in discussion how thorough they were to establish a rough time for when symptoms became significant enough to affect functionality vs. time of diagnosis.

This is discussed here, but it's hard to be precise when so little is known about disease progression:
The mean duration of disease was 19.67 (20.31) months. The mean disease duration was 48.24 (11.75) months and 1.67 (0.50) months in the established FMS group (n = 52, group 1) and in the newly diagnosed group (n = 50, group 2), respectively.
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Would look at that: common sense, measuring muscle groups not typically involved in regular physical activity and bypass the issue of deconditioning. More of that, please.
As a first in the literature, in the present study, instead of evaluating the most involved and frequently studied muscles such as the trapezius, we assessed multiple upper and lower extremity muscles in which contradictory results have been reported using musculoskeletal US, which is a non-invasive, safe, and inexpensive method of direct imaging of the muscle.
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What's with the deltoid?
As a result of our study, all muscle sizes except the deltoid muscle were found to be decreased compared with healthy controls. We think that this result cannot be explained only by inactivity because patients with newly diagnosed and established FMS were evaluated in 2 different groups, unlike the studies reported above, where only patients with established FMS were included. As a first study in the literature, it was found that the muscles were affected from the onset of the disease.
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It would pretty much take complete inactivity to avoid using deltoid muscles altogether so that's interesting. It would be interesting to be able to measure muscle density, to determine whether the mass has decreased or has simply become more densely packed, less flexible. After all muscle power is all about contracting fibers so if they are stiffer it could have the same outcome.

Didn't look like much but altogether interesting.
 
Just for the record, from research in the 1990s, no pathology found in the muscle tissue via microscopic analysis of fibro patients.
 
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