Muscle-tendon weakness contributes to chronic fatigue syndrome in Gaucher's disease

Roca-Espiau, Mercedes; Andrade-Campos, Marcio; Cebolla, Jorge J.; López de Frutos, Laura; Medrano-Engay, Blanca; López-Royo, Maria-Pilar; Giraldo, Pilar

doi:http://dx.doi.org/10.1186/s13018-019-1452-y

Muscle-tendon weakness contributes to chronic fatigue syndrome in Gaucher's disease

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Roca-Espiau M, Andrade-Campos M, Cebolla JJ, López de Frutos L, Medrano-Engay B, López-Royo MP, et al. Muscle-tendon weakness contributes to chronic fatigue syndrome in Gaucher's disease. J Orthop Surg Res. 2019 Nov 21; 14(1): 383. DOI: 10.1186/s13018-019-1452-y

Abstract

Background: Chronic fatigue (CFg) is a prevalent symptom in Gaucher disease (GD) at diagnosis (79%) and remains in a quarter of patients after years of therapy. Bone abnormalities are present in over 70% and peripheral neuropathy in about 11% of the patients, which contributes to the disabling and debilitating complications. Our hypothesis is that other factors such as muscle-tendinous weakness could have influence in the development of CFg. Methods: We have evaluated the fiber structure and elasticity of muscle-tendinous unit by strain-elastography (S-ELA) and analyzed their influence in the CFg. S-ELA study was performed in Achilles tendon in 25 type 1 and two type 3 GD patients, all of them with fatigue and were on enzymatic replacement therapy for mean 13 years; simultaneously, bone marrow burden by MRI and calcaneus ultrasound densitometry were evaluated. Blood cell counts, plasma biomarkers, GBA1 genotyping, and SF36 quality of life scale (QoL) were also performed. Statistical analysis: descriptive and comparative test. Results: All patients showed a normal Achilles tendinous structure. Abnormal stiff grade 2-3 was found in 17/27 (62.9%); in 11/27 (40.7%) of patients, the alteration was bilateral. There were no correlations between the S-ELA results to other variables; nevertheless, a significant correlation between the degree of tendon hardness and the low score on the QoL scales (p = 0.0035) was found. The S-ELA is a sensitive painless, fast, and low cost method to detect muscle-tendinous subclinical dysfunction that could contribute to CFg in GD. The identification of subclinical tendon alteration would be a sign of alarm, focused on the risk of development of bone complications. Conclusion: Intratendinous alteration in strain-elastography is an independent variable in GD patients with persistent fatigue.