Clinical Diagnosis Of Fibromyalgia Syndrome Research Articles

Evaluation of clinical relationship of serum niacin and dopamine levels in patients with fibromyalgia syndrome.

Objectives The aim of this study was to investigate the role of serum niacin and dopamine (DA) levels and their clinical importance in fibromyalgia syndrome (FMS) patients. Patients and methods Between April 2018 and October 2018, a total of 53 female patients (mean age: 38.3±5.5 years; range, 21 to 45 years) with a clinical diagnosis of FMS and 35 healthy female controls (mean age: 36.7±5.2 years; range, 25 to 44 years) were included in this cross-sectional study. The Visual Analog Scale (VAS), Beck Depression Inventory (BDI), and Fibromyalgia Impact Questionnaire (FIQ) were applied to the patients. Serum levels of niacin and DA were measured by high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA) methods, respectively. Results Niacin and DA levels of the patient group were significantly lower than those of control group (p=0.003 and p=0.02, respectively). A very strong positive correlation was found between niacin and DA levels (r=0.96 p<0.001). Evaluation of the diagnostic performance of niacin and DA by the receiver operating characteristic analysis yielded an area under the curve (AUC) of 0.73 (p<0.001, 95% confidence interval [CI]: 0.62-0.85) and an AUC of 0.68 (p=0.004, 95% CI: 0.56-0.80), respectively. Conclusion Serum niacin and DA levels decrease in FMS patients in relation to the tender point numbers. It can be suggested that the levels of these two markers can be considered additional tools in the diagnosis of FMS.

Concomitant Diagnosis of Fibromyalgia and Ankylosing Spondylitis: Relation to Clinical Features and Plasma Pentraxin -3 Level.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease that specifically affects the spine and sacroiliac joint. AS diagnosis is often delayed in the clinical practice and this delay may cause the patients to miss the chance of early treatment. Fibromyalgia (FM) is a frequently encountered clinical syndrome, fibromyalgianess is a term used when patients who are diagnosed with inflammatory arthropathies meet the criteria for FM syndrome as shown in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome, and AS. We aimed primarily to assess the frequency of concomitant diagnosis of FM syndrome in AS patients and study its impact on clinical disease aspects. Secondary, our aim extended as a preliminary pilot study to assess the Plasma Pentraxin-3(PTX-3) as a potential marker for the diagnosis of FM syndrome in AS patients. Plasma PTX-3 in 61 AS patients was compared to 60 matched controls. FM was diagnosed by FM Rapid Screening Tool. Bath AS disease activity index (BASDAI) and AS disease assessment score using C- reactive protein (ASDAS-CRP), Bath AS functional impairment index (BASFI), Bath AS metrology index (BASMI), AS quality of life (ASQoL) scale, Beck Depression Inventory, and Bath AS Radiology Index (BASRI) were assessed. The patients were categorized into two groups according to the concomitant diagnosis of FM syndrome. Group I included 14 (22.9%) AS patients who fulfilled the clinical diagnosis of FM syndrome. Group II included 47 (77.1%) AS patients without FM syndrome. AS patients with FM (Group I) had significantly(p<0.001) increased an average of ages, disease duration, diagnostic delay of AS, switching of bDMARDs, morning stiffness duration, ASDAS-CRP, BASFI, ASQoL score, BASDAI (p=0.008), and BDI score (p=0.005) compared to AS patients without FM (Group II). PTX-3 levels were significantly (p<0.001) higher in Group I (p<0.001) (median, 0.23; IQR, 0.15-0.41 ng/ml) than Group II (median, 0.13; IQR, 0.035-0.21ng/ml) which showed no significant differences (p>0.05) compared to the controls. PTX-3 levels had significant positive correlations (p<0.05) with disease duration, BASFI, and ASQOl. Age, female sex, switch of biologic, ASDAS - CRP, and PTX-3 were significant predictors of FM in AS patients. These results indicate that concomitant FM is a significant problem in patients with AS and its presence is associated with higher disease activity, impaired function as well as an overall negative impact on QoL. Easy scanning of suspicious cases of FM with FiRST questionnaire can be done in daily practice. PTX-3 is more or less accurate as the clinical features to improve the diagnostic certainty of FM in the presence of AS with a proven sensitivity of 62.3%, a specificity of 90%, a positive predictive value of 82.75%, and a negative predictive value of 73.9%.

Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n=8) with atotal of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Asystematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach aconsensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

Objectives. Fibromyalgia syndrome (FMS), characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified) preliminary American College of Rheumatology (ACR) 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines.

Diagnosis and diagnostic tests for fibromyalgia (syndrome)

To present diagnostic criteria for the clinical diagnosis of fibromyalgia syndrome (FMS) and to offer a scheme for diagnostic work-up in clinical practice. Narrative review of the literature, consensus documents by the American College of Rheumatology (ACR), evidence-based interdisciplinary German guidelines on the diagnosis and management of FMS. The ACR 1990 classification criteria emphasized tender points and widespread pain as the key features of FMS. In 2010, the ACR proposed preliminary diagnostic criteria for fibromyalgia that abandoned the tender point count and placed increased emphasis of patient symptoms. A later modification of the ACR 2010 criteria for use in surveys employed a self-report questionnaire (Fibromyalgia Survey Questionnaire FSQ) to assess patient symptoms. The FSQ can be used to assist physician's diagnosis of FMS. We recommend a stepwise diagnostic work-up of patients with chronic widespread pain (CWP) in primary care: Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, screening for other functional somatic symptoms and mental disorders, and referring to mental health specialists in case of mental disorder. The diagnosis of FMS is easy in most patients with CWP and does not ordinarily require a rheumatologist. A rheumatologist's expertise might be needed to exclude difficult to diagnose or concomitant inflammatory rheumatic diseases. In the presence of mental illness referral to a mental health specialist for evaluation is recommended.

Das Fibromyalgiesyndrom

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9scientific medical societies and 2patient self-help organizations. Eight working groups with a total of 50members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. The clinical diagnosis of FMS can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with tender point examination), by the modified preliminary diagnostic ACR 2010 criteria or by the diagnostic criteria of the German interdisciplinary guideline (AWMF) on FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Diagnosis of Fibromyalgia Syndrome—A Comparison of Association of the Medical Scientific Societies in Germany, Survey, and American College of Rheumatology Criteria

The survey and the Association of the Medical Scientific Societies in Germany (AWMF) criteria had been developed to overcome problems associated with tender point criterion of the American College of Rheumatology (ACR) (lacking validation for clinical diagnosis, inconsistent use by rheumatologists, and nonrheumatologists) for the clinical diagnosis of fibromyalgia syndrome (FMS). We compared the concordance between these 3 criteria. Consecutive patients of different clinical settings referred for the evaluation of chronic widespread pain or management of established FMS diagnosis were assessed by medical history, a complete physical examination including tender points, and questionnaires [self-constructed symptoms questionnaire, regional pain scale (RPS), Patient Health Questionnaire (PHQ 9 and 15)]. FMS according to AWMF-criteria was diagnosed by the history of widespread pain (axial and all 4 extremities), the symptoms sleep disturbances, fatigue, and feeling of swelling or stiffness of the hands or feet or face (Numeric rating scale >or=1/10 each symptom) and the exclusion of somatic diseases sufficiently explaining the symptoms. FMS according to survey criteria was diagnosed by regional pain scale score >or=8 and fatigue score >or=6/10 on a visual analogue scale. Out of 310 patients, 292 could be analysed. AWMF and ACR were concordant in 86.6%, AWMF and survey criteria were concordant in 78.8% and survey and ACR-criteria were concordant in 79.5% of the cases. AWMF, survey, and ACR criteria were moderately concordant. As AWMF and survey criteria do not require tender point examination, these criteria can be used by nonrheumatologists for the clinical diagnosis of FMS.

Validierung der deutschen Version der regionalen Schmerzskala zur Diagnose des Fibromyalgiesyndroms

Use of the American College of Rheumatology classification criteria for the clinical diagnosis of fibromyalgia syndrome (FMS) is under debate. The Regional Pain Scale (RPS) had been developed for the diagnosis of FMS in clinical practice and in survey settings (survey criteria of FMS). So far a German version has not been validated. A total of 216 patients with FMS, 53 with active rheumatoid arthritis (RA) and 60 with depressive disorder, recruited from clinical institutions completed the RPS. Forty-three patients with FMS filled in the RPS within 8 weeks a second time. The intraclass coefficient of FMS diagnosis after 8 weeks was 0.78 (test-retest reliability). The 7-day interval of pain was criticized by physicians. The absence of some articular pain regions was criticized by patients (face validity). The concordance of FMS diagnoses to survey and ACR criteria was 84.7% (+/-1.1); 45.3% of the patients with RA and 38.3% of the patients with depressive disorder met the survey criteria of FMS (discriminant validity). The RPS has good reliability and convergent validity, but limited discriminant validity. The RPS is suited as a screening instrument for the diagnosis of FMS in clinical practice.

Treatment of Fibromyalgia Syndrome with Intravenous Lidocaine:

Objective: To conduct a pilot study to determine whether intravenous infusion of lidocaine might further improve the clinical status of fibromyalgia patients already in conventional therapy. Method: Twenty-one patients with a clinical diagnosis of fibromyalgia syndrome were treated conventionally for at least one year. Eleven patients from this group were randomly selected for additional treatment with four sessions of intravenous infusion of lidocaine at weekly intervals. Their clinical status before and after the course of lidocaine therapy was compaired with the clinical status of the remaining 10 patients in the original group who had also continued their conventional therapy but did not receive lidocaine. Outcome measures included visual analog scale [VAS] for pain and patient global improvement. Results: The lidocaine treated and untreated groups did not differ in age or initial VAS scale for pain. There was significantly greater improvement in VAS pain scale among the lidocaine-treated group but global improvement did not meet significance criteria. Conclusions: The data from this pilot study suggest that periodic intravenous infusion of lidocaine may provide additional benefit for fibromyalgia patients already receiving conventional medication. Therefore, a prospective, randomized placebo-controlled study is warranted to assess the value of supplemental lidocaine therapy in fibromyalgia.