Investigation of Serum Sialic Acid Levels and Correlation Between Inflammatory Markers in Patients with Fibromyalgia

Aysun Toker 1 * , Hümeyra Çiçekler 2, Fatma Hümeyra Yerlikaya 1, Sami Küçükşen 3, Adem Küçük 4
More Detail
1 Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Biyokimya Anabilim Dalı, Konya
2 Atatürk Devlet Hastanesi, Biyokimya Laboratuvarı, Zonguldak
3 Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Konya
4 Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Romatoloji Anabilim Dalı, Konya
* Corresponding Author
EUR J BASIC MED SCI, Volume 3, Issue 2, pp. 24-28.
Download Full Text (PDF)


Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons and joints. It is also characterized by restless sleep, tiredness, fatigue, anxiety, depression. It is assumed that pro- and anti-inflammatory cytokines play a role in the induction and maintenance of pain. Studies to investigate cytokine levels in patients with fibromyalgia include different results. Sialic acid is an acetylated derivative of neuraminic acid and it is attached to non reducing residues of carbonhydrate chains of glycoproteins and glycolipids. The etiology of fibromyalgia remains unknown. In this study, we have investigated serum sialic acid and CRP levels and erythrocyte sedimentation rate (ESR) in patients with fibromyalgia and the correlation between these parameters. Materials and methods: 52 patients with fibromyalgia and 32 healthy individuals were contributed in our study. The diagnosis of fibromyalgia was based on the classification criteria declared by American College of Rheumatology at 1990. Serum sialic acid levels were measured by Warren’s method. CRP and ESR measurements were performed using routine laboratory methods. Serum sialic acid and CRP levels and ESR were significantly higher in patients with fibromyalgia compared with the healthy controls. In addition, a positive correlation was found between serum sialic acid and CRP levels and ESR values. Although fibromyalgia is known as a non-inflammatory condition, increased serum sialic acid levels in fibromyalgia indicate that an inflammatory component may play role in the pathogenesis of fibromyalgia.


Toker A, Çiçekler H, Yerlikaya FH, Küçükşen S, Küçük A. Investigation of Serum Sialic Acid Levels and Correlation Between Inflammatory Markers in Patients with Fibromyalgia. Eur J Basic Med Sci. 2013;3(2):24-8.


  • Clauw DJ, Crofford LJ. Chronic widespread pain and fibromyalgia:what we know, and what we need to know. Best Pract Res Clin Rheumatol 2003; 17: 685-701.
  • Cui Z, Zhao Y, Novick D, Faries D. Predictors of duloxetine adherence and persistence in patients with fibromyalgia. J Pain Res 2012; 5: 193-201.
  • Mease P.Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl 2005; 75: 6-21.
  • Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia syndrome: an overview of pathophysiology, diagnosis and management. Oman Med J 2012; 27(3): 192-5.
  • White KP, Harth M. Classification epidemiology and natural history of fibromyalgia. Curr Pain Headache Rep 2001; 5: 320-9.
  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al; Report of the Multicenter Criteria Committee. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990; 33(2): 160-72.
  • Crofford LJ. The relationship of fibromyalgia to neuropathic pain syndromes. J Rheumatol 2005; 32: 41-5.
  • Alturfan AA, Uslu E, Alturfan EE, Hatemi G, Fresko I, Kokoglu E. Increased serum sialic acid levels in primary osteoarthritis and inactive rheumatoid arthritis. Tohoku J Exp Med 2007; 213(3): 241-8.
  • Joshi M, Patil R. Estimation and comparative study of serum total sialic acid levels as tumor markers in oral cancer and precancer. J Cancer Res Ther 2010; 6(3): 263-6.
  • Pönniö M, Alho H, Nikkari ST, Olsson U, Rydberg U, Sillanaukee P. Serum sialic acid in a random sample of the general population. Clin Chem 1999; 45(10): 1842-9.
  • Chrostek L, Cylwik B, Panasiuk A, Brodowska-Adamusiak D, Gruszewska E. Lipid-bound sialic acid (LSA) in liver diseases of different etiologies. Ann Hepatol 2011; 10(2): 150-4.
  • Sillanaukee P, Ponnio M, Jaaskelainen IP. Occurrence of sialic acid in healthy humans and different disorders. Eur JClin Invest 1999; 29: 413-25.
  • Amel Kashipaz MR, Swinden D, Todd I, Powell J. Normal production of inflammatory cytokines in chronic fatigue and fibromyalgia syndromes determined by intracellular cytokine staining in short-term cultured blood mononuclear cells. Clin Exp Immunol 2003; 132: 360-5.
  • Müller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatol Int 2007; 27: 1005-10.
  • Van West D, Maes M. Neuroendocrine and immune aspects of Fibromyalgia,BioDrugs. 2001; 15: 521-31.
  • Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20: 9-12.
  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71.
  • Kucukdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 2004; 51: 14-9.
  • Warren L. The thiobarbituric acid assay of sialic acids. J BiolChem 1959; 234: 1971-5.
  • Omoigui,S. The biochemical origin of pain: The origin of all pain is inflammation and the inflammatory response. Part 1of 3 – A unifying law of pain. Med Hypotheses 2007; 69: 70-82.
  • Omoigui,S. The biochemical origin of pain: The origin of all pain is inflammation and the inflammatory response. Part 1of 3 – Inflammatory profile of pain syndrome. Med Hypotheses 2007; 69: 1169-78.
  • Russell U, Orr M D, Littman B, Vipraio GA, Alboukrek D, Michalek JE, et al. Elevated cerebrospinal fluid levels of substance P in patients with fibromyalgia syndrome. Arthit Rheum 1994; 37: 1593-601.
  • Vaerøy H, Helle R, Førre O, Kåss E, Terenius L. Elevated CSF levels of substance P and high incidence of Raunaud phenomenon in patients with fibromyalgia: new features for diagnosis, Pain 1988; 32: 21-6.
  • Ortega E, García JJ, Bote ME, Martín-Cordero L, Escalante Y, Saavedra JM, et al. Exercise in fibromyalgia and related inflammatory disorders: known effects and unknownchances. Exerc Immunol Rev 2009; 15: 42-65.
  • Wallace DJ. Is there a role for cytokine based therapies in fibromyalgia? Curr Pharm Des 2006; 12: 17-22.
  • Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH. Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study, Rheumathology 2001; 40: 743-9.
  • Crofford LJ. The hypothalamic-pituitary-adrenal axis in fibromyalgia and chronic fatigue syndrome, Z.Rheumatol 1998; 57: 67-71.
  • Crofford LJ, Pillemer SR, Kalogeras KT, Cash JM. Hypothalamic-pituitaryadrenal axis perturbations in patients with fibromyalgia, Arthritis.Rheum 1994; 37: 1583-92.
  • Torpy DJ, Papanicolaou DA, Lotsikas AJ, Wilder RL, Chrousos GP, Pillemer S R. Response of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis to interleukin-6: a pilot study in fibromyalgia, Arthritis.Rheum 2000; 43: 872-80.
  • Salemi S, Rethage J, Wollina U, Michel BA, Gay RE, Gay S, Sprott HDetection of interleukin 1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha in skin of patients with fibromyalgia. J Rheumatol 2003; 30(1): 146-50.
  • Xiao Y, Haynes WL, Michalek JE, Russell IJ. Elevated serum high-sensitivity C-reactive protein levels in fibromyalgia syndrome patients correlate with body mass index, interleukin-6, interleukin-8, erythrocyte sedimentation rate. Rheumatol Int. 2012 Nov 4.
  • Maury CP, Teppo AM, Wegelius O. Relationship between urinary sialylated saccharides, serum amyloid A protein, and C-reactive protein in rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis 1982; 41(3): 268-71.
  • A K Susheela, T K Das, J S Khurana, A Jayaswal, and P K Dave.Circulating levels of sialic acid and glycosaminoglycans: a diagnostic test for ankylosing spondylitis. Ann Rheum Dis. 1988; 47(10): 833–37.