**8. Conclusions**

The key points from this discussion are:


## **Author details**

William S. Wilke

Address all correspondence to: wswilkemd@gmail.com

Rheumatology Department, Clinic Orthopedic and Rheumatology Institute, Cleveland, OH, USA

#### **References**


[3] Miranda-Diaz AG, Odriguez-Lara SQ. The Role of Oxidants/Antioxidants, Mitochondrial Dysfunction, Autophagy in Fibromyalgia. InTech

centrally mediated pain. We are still left with the lack of clinical response to moderate daily prednisone and even more aggressive antirheumatic, anti-inflammatory treatments which

There is little question that FMS does associate with mild cytokine change, such as reduced diurnal variation of IL-6 compared to healthy individuals [56]. Forensic objectivity, however, would seem to indicate that the described modest changes in inflammatory mediators, whether primary or secondary, do not seem sufficient to be responsible for clinically relevant FMS symptoms. Furthermore, in some very legitimate contemporary hypotheses of FMS etio-

**1.** Although a minority of studies found CRP elevated in FMS compared to healthy controls,

**2.** Depression, which is very often comorbid with FMS, was not well controlled in many cytokine/chemokine analyses. When it was, it was shown to significantly contribute to

**3.** Fibromyalgia symptoms, whether as the primary diagnosis or as comorbid in RA, do not

**4.** Both stimulated and unstimulated cytokine and chemokine studies have employed a variety of methods of measurements that make cytokine levels difficult to analyze between diseases. A few comparisons have shown relatively trivial values in FMS compared to proven inflam-

Rheumatology Department, Clinic Orthopedic and Rheumatology Institute, Cleveland, OH, USA

[2] Brito RG, Santos PL, Olivera MA, et al. Natural Products as Promising Pharmacological

[1] Kocak FA, Kurt EE. Nonpharmacologic Treatment of Fibromyalgia. InTech

Tools for the Management of Fibromyalgia Symptoms: A Review. InTech

have been shown to reduce inflammation due to cytokines [67, 68, 71, 77].

pathogenesis, there is no role for chronic cytokine-mediated processes [78, 79].

**8. Conclusions**

The key points from this discussion are:

6 Discussions of Unusual Topics in Fibromyalgia

higher cytokine values.

matory disease such as RA.

**Author details**

William S. Wilke

**References**

the mean high value was still within the normal range.

respond to anti-inflammatory, anti-immune therapy.

Address all correspondence to: wswilkemd@gmail.com


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**Chapter 2**

**Provisional chapter**

**The Role of Oxidants/Antioxidants, Mitochondrial**

Fibromyalgia (FM) is a syndrome that presents primarily in women and is characterized by generalized pain, muscle rigidity, poor quality of sleep, fatigue, cognitive dysfunction, anxiety, episodes of depression, overall sensitivity, and deterioration in the performance of day-to-day activities. In the pathophysiology of fibromyalgia neuroendocrine factors, anomalies of the autonomous nervous system, genetic characteristics, and environmental and psychosocial factors are implicated. Alterations to the cells of the central nervous system that are present in fibromyalgia are due to the toxic effects of free radicals by the high concentrations of polyunsaturated fatty acids of the membranes that are easily oxidized and the low level of protective antioxidant enzymes. In FM, defects are produced in any part of the cycle in the generation of adenosine-5′-triphosphate (ATP) by the mitochondria, which can alter energy production by the mitochondria and cause the characteristic symptoms of FM. The degradation of the mitochondria dependent on autophagy or mitophagy is an important process for maintaining the critical integrity of the mitochondria and limiting the production of reactive oxygen species (ROS). Therefore, the deregulation of autophagy and mitochondrial dysfunction could represent key aspects in the pathophysiology of FM. Management with antioxidants, vitamins, coenzyme Q10, and melatonin, in addition to the antidepressants and structural analogs of the gamma-aminobutyric acid, could modify the florid symptomatology that

**The Role of Oxidants/Antioxidants, Mitochondrial** 

DOI: 10.5772/intechopen.70695

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

© 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

**Keywords:** fibromyalgia, oxidative stress, mitochondrial dysfunction, autophagy,

**Dysfunction, and Autophagy in Fibromyalgia**

**Dysfunction, and Autophagy in Fibromyalgia**

Alejandra Guillermina Miranda-Díaz and

Alejandra Guillermina Miranda-Díaz and

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Simón Quetzalcóatl Rodríguez-Lara

Simón Quetzalcóatl Rodríguez-Lara

http://dx.doi.org/10.5772/intechopen.70695

patients with FM have.

antioxidants, antioxidant vitamins

**Abstract**


**Provisional chapter**
