Original Article

Handgrip Strength, Pulmonary Function Tests, and Pulmonary Muscle Strength in Fibromyalgia Syndrome: Is There Any Relationship?

Authors: Günşah Şahin, MD, Bahar Ulubaş, MD, Mukadder Çalkoǧlu, MD, Canan Erdoǧan, MD

Abstract

Objective: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength as a determinant of peripheral muscle strength and pulmonary muscle strength in patients with FMS by comparing them with healthy controls.


Methods: Forty-one consecutive women with FMS (diagnosed according to the American College of Rheumatology 1990 criteria) were compared with 40 age- and body mass index-matched healthy female controls. Pulmonary function tests were assessed by spirometry. Maximal pulmonary pressures were evaluated using an oral pressure meter. A dyspnea score was obtained. Pain was scored according to visual analogue scale and chest pain was classified (0–9) in fibromyalgia patients. Chest expansion was also measured in the two groups. Tender points were also evaluated in FMS patients. Grip strength (Jamar handheld dynamometer) was also measured in the two groups.


Results: The difference in pulmonary function tests was not statistically significant between groups. Maximal respiratory pressures (maximum inspiratory pressure and maximum expiratory pressure) and endurance (maximum ventilatory volume) were significantly lower in patients with FMS than in controls. There was also a statistically significant difference between groups regarding grip strength. There was also significant correlation between maximal inspiratory pressure and maximal expiratory pressure values and handgrip strength in patients with FMS.


Conclusion: These data indicate that handgrip strength may be a determinant of pulmonary muscle strength in fibromyalgia patients.


Fibromyalgia syndrome (FMS) is a chronic form of nonarticular rheumatism characterized by widespread pain, stiffness, and multiple tender points. It is regarded as part of a spectrum of chronic widespread pain. The etiopathogenesis remains unknown. It is associated with a variety of symptoms such as fatigue, poor sleep, anxiety, depression, headaches, dizziness, irritable bowel syndrome, and dyspnea. 1


Despite normal pulmonary spirometric values, patients with FMS have lower maximal respiratory pressures, which indicate reduced respiratory muscle strength. 2 Lurie et al 2reported that maximum inspiratory and expiratory muscle strength values were low in patients with FMS. They indicated that there was an isometric type muscle dysfunction in this syndrome. Caidahl et al 3 also suggested that effort dyspnea is related to reduced maximum inspiratory pressure in FMS patients. It has also been reported that not only the presence of dyspnea but also other factors such as reflex inhibition due to a fear of pain together with chest wall discomfort and markedly decreased voluntary muscle strength due to supraspinal factors may result in lower maximum respiratory pressures. 3


Key Points


* In this study, we aimed to investigate the possible relationship between hand grip strength and pulmonary muscle strength (maximum pulmonary pressures; MIP, MEP) in patients with primer fibromyalgia (PFM).


* Forty-one consecutive women (mean age 43.7 ± 6.9) with PFM were compared with 40 age and body mass index matched female controls (mean age 44.2 ± 6.4).


* Maximum respiratory pressures were significantly lower in PFM patients than controls (p ≤ 0.05).


* Hand grip strength was lower in PFM patients (p < 0.05).


* There was positive correlation between hand grip strength and maximal pulmonary pressures in PFM patients (p < 0.05).


It was also shown that handgrip strength is reduced in FMS patients. 4 In the present study, we examined the possible relationship between handgrip strength and maximal respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and endurance (maximum voluntary ventilation [MVV]) in patients with FMS. We assessed whether handgrip strength may be a determinant of pulmonary muscle strength in these patients.

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