Background Fibromyalgia (FM) is a common and complex clinical condition characterized by chronic widespread musculoskeletal pain, fatigue and muscle tenderness. The pathophysiology of FM is still not well elucidated. In recent years, oxidative stress and lipid peroxidation has been implicated in the aetiology of FM. The presence of excess oxygen-derived free radicals capable of inducing pain, inflammation and impairment of muscle function appear to be the cause of some of the symptoms of FM. Coenzyme Q10 (CoQ10) is an essential electron carrier in the mitochondrial respiratory chain and a powerful antioxidant. Low CoQ10 levels have been detected in FM patients. There is to date no effective treatment for this prevalent disabling condition.
Objectives The aim of the present work was to assess the effect of oral CoQ10 supplementation on clinical symptoms and on oxidative markers in FM patients.
Methods We conducted a double-blind, randomized controlled trial in which 46 FM patients (39 females, 7 males), mean age 49.5 years diagnosed according to the American College of Rheumatology (ACR) criteria for FM were randomized 1:1; 23 received 200 mg/day CoQ10 and 23 received placebo for 24 weeks. Thirty-five age-sex-body mass index-matched healthy controls to provide normal reference baseline values for oxidative stress markers were also recruited. Primary outcome measures included improvement in clinical symptoms. Secondary outcome measures included reduction in oxidative stress markers. Patients were evaluated clinically using the visual analogue scale for pain (VAS 0-100mm), Fibromyalgia Impact Questionnaire (FIQ) and Beck Depression Inventory (BDI). Oxidative stress was determined by measuring lipid peroxidation (LPO) levels of malondialdehyde (MDA) in plasma and blood mononuclear cells (BMCs). All measures were assessed at baseline and after 6 months of intervention.
Results At baseline, levels of MDA were significantly increased in BMCs and plasma in patients compared to controls, p<0.005. Oral CoQ10 supplementation led to a significant decrease in MDA levels and induced a significant improvement in clinical symptoms in the intervention group compared to the placebo group. After therapy, the CoQ10 group achieved statistically significant improvements compared to the placebo group in VAS for pain (p<0.001), FIQ (p<0.001) and BDI (p<0.005). A significant correlation between MDA and clinical parameters was observed for VAS; r =0.488, p<0.001, FIQ total score; r =0.573, p<0.001and BDI; r =0.575, p<0.005. No adverse events were observed.
Conclusions The results of this study suggest a role for oxidative stress in the symptoms associated with FM. Thus, determination of CoQ10 deficiency and consequent supplementation may result in clinical improvement. CoQ10 may be a useful addition in the therapeutic armamentarium for FM and merits long-term study in larger study populations.
Disclosure of Interest : None declared
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