Keywords
oxidative stress
diagnosis
biomarkers
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Abstract
Introduction: Fibromyalgia is a chronic, widespread pain disorder accompanied by fatigue, nonrestorative sleep, cognitive difficulties, and psychiatric comorbidity. Diagnosis remains clinical, and no objective biomarker has been established, yet growing evidence implicates oxidative stress in its pathophysiology. Objective: To synthesize current evidence on oxidative stress biomarkers and their relationship to the clinical presentation of fibromyalgia, and to evaluate their potential diagnostic and therapeutic relevance. Methods: A narrative review of the literature indexed in PubMed, Scopus, and Google Scholar (2005–2025, English language) was conducted, focusing on enzymatic and non-enzymatic antioxidants, oxidative damage markers, and validated symptom measures. Results: Reduced activities of superoxide dismutase, glutathione peroxidase, and catalase, together with increased markers of lipid and DNA oxidation (malondialdehyde, 4-hydroxynonenal, 8-oxo-dG), are associated with greater symptom severity on validated clinical scales such as the Fibromyalgia Impact Questionnaire. Composite indices (total oxidant status, total antioxidant status, oxidative stress index) and multi-marker panels provide more robust assessments than single analytes, given compensatory changes within the antioxidant network and pre-analytical influences such as diet and sample handling. Methodological constraints of common assays (TBARS, immunoassays) argue for chromatographic and mass-spectrometric approaches for symptom-specific quantification and for standardized sampling protocols. Conclusion: Redox imbalance is mechanistically linked to the core clinical features of fibromyalgia, including pain, fatigue, and impaired quality of life. Validated, multi-layered biomarker panels combined with standardized laboratory practice may improve patient phenotyping and stratification and inform interventions targeting oxidative mechanisms, although rigorous controlled studies are required.
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Copyright (c) 2026 Gergana Miteva-Ilieva, Mariela Geneva-Popova, Ivan Yanakiev, Ivaylo Sokolov, Krasimir Kraev, Vesela Hristeva, Sanie Dzhambazova, Stanislava Popova-Belova (Author)