Pathophysiology: Muscle biopsies from patients with FM show numerous histological, ultrastructural and biochemical abnormalities including defects in mitochondrial structure and function, reduced numbers of capillaries in skeletal muscle, thickened capillary endothelium, and ragged red fibers consistent with the development of mitochondrial myopathy.

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Pathophysiology: Muscle biopsies from patients with FM show numerous histological, ultrastructural and biochemical abnormalities including defects in mitochondrial structure and function, reduced numbers of capillaries in skeletal muscle, thickened capillary endothelium, and ragged red fibers consistent with the development of mitochondrial myopathy. The histologic finding of rubber-band morphology with reticular threads connecting neighboring cells in muscle biopsies of FM patients is associated with prolonged contractions in adjacent muscle fibers resulting in a low-energy state within myocytes.[i] Other studies have also shown disorganization of actin filaments, accumulation of lipofuscin bodies consistent with premature muscle aging, accumulation of glycogen and lipid accumulation consistent with mitochondrial impairment, significant reductions in the number of mitochondria, increased DNA fragmentation, and focal areas of chronic muscle contraction.[ii] Despite the importance of these histologic abnormalities, and consistent with the view that FM is a disease of metabolic dysfunction rather than tissue destruction, ultrastructural and biochemical abnormalities appear to be more relevant and consistent than obvious histologic changes in skeletal muscle biopsy samples. Numerous mitochondrial enzyme defects are seen including reduced activity of 3-hydroxy-CoA dehydrogenase, citrate synthase, and cytochrome oxidase.

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[i] Olsen NJ, Park JH. Skeletal muscle abnormalities in patients with fibromyalgia. Am J Med Sci. 1998 Jun;315(6):351-8

[ii] Sprott H, Salemi S, Gay RE, Bradley LA, Alarcon GS, Oh SJ, Michel BA, Gay S. Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres. Ann Rheum Dis. 2004 Mar;63(3):245-51

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