Diagnosis Of Fibromyalgia Research Articles

The relationship between metacognition, anger, and pain intensity among fibromyalgia patients: a serial mediation model

ABSTRACT Fibromyalgia is a burdensome pain causing patients a very negative emotional state that can worsen their clinical profile, perceived disability, and treatment outcomes. In particular, anger can negatively affect pain and patient adjustment to the disease. Recent studies suggest that metacognitions and anger rumination can negatively affect anger, which in turn can amplify the intensity of pain. This study aims to investigate whether anger rumination and state anger serially mediate the relationship between metacognitions and the intensity of pain. The study included 446 subjects who: declared having received a fibromyalgia diagnosis by a rheumatologist/pain physician; completed measures of metacognitions, anger rumination, state-anger, and pain intensity. The serial mediation analysis was conducted using Hayes’ PROCESS macro (Model 6). Negative beliefs about worry and beliefs about the need to control thoughts indirectly influenced the intensity of pain through two significant mediating pathways: state-anger and anger rumination to state-anger. Cognitive self-consciousness affected pain intensity directly (β = .11, p < .05) and indirectly through two significant mediating pathways: state-anger and anger rumination to state-anger. This study highlights the role of serial mediation of anger rumination and state-anger in the relationship between metacognitions and pain intensity in the field of fibromyalgia. Our work introduces new targets for anger management interventions for patients with fibromyalgia. Such interventions could be effectively addressed with a metacognitive approach considering its specific focus on dysfunctional metacognitive beliefs and repetitive negative thinking.

Functional Cognitive Disorder and Mild Cognitive Impairment: A Thin Line

AimsFunctional cognitive disorders (FCDs) refer to conditions where patients present with persistent problematic subjective memory complaints that are not consistent with their observed level of cognitive functioning. The demonstrated symptoms are also not in keeping with a recognized psychiatric or neurodegenerative process. FCD is likely to be underdiagnosed in clinical practice with the place-holder label of mild cognitive impairment being used in some cases due to lack of clarity about its symptomatology. In this paper, we describe two cases whose presentations were suggestive of FCDs.MethodsMrs X, 53 years old female not previously known to mental health services referred for increasing difficulties with her memory over 2 years which she believed was impacting her activities of daily living. She has a history of ischaemic heart disease, fibromyalgia, Insulin-dependent diabetes mellitus, depression, and polycystic ovarian syndrome. On assessment MOCA = 15/30, and MMSE = 25/30.Mr Y, 57 years old male not known to mental health services. Although, has been treated for anxiety and depression by GP. He presented with a 3-year history of struggling with his memory. He reported being forgetful of appointments and he has to paste sticky papers on the fridge for reminders. Similarly, he has a diagnosis of Fibromyalgia and essential hypertension. On Assessment MOCA – 19/30 and MMSE – 25/30.ResultsFCDs can be quite challenging because the clinical picture overlaps with other neurodegenerative conditions. Typically, patients report issues around memory function in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and observations at assessment. Regarding our cases, the primary presenting issues were increasing difficulties with memory, and forgetfulness. Other noteworthy observations were a mismatch between their scores in the MOCA, MMSE, their level of functioning, and reported memory problems. Neurological examinations and neuroimaging were not suggestive of any neurodegenerative disorders. A differential diagnosis of functional cognitive disorder was considered due to the discrepancies between symptoms reported, the level of their functioning, observations at assessments as well as absence of relevant neuropathology on imaging.ConclusionFCD is a condition that is common in clinical practice but underdiagnosed. Hence, it is imperative that clinicians keep this diagnosis in mind when patients present with memory difficulties that do not meet the diagnostic criteria for dementia and is not due to a recognized medical or psychiatric condition. Correctly identifying and diagnosing FCD can positively impact patient outcomes.

FTIR, RAMAN and biochemical tools to detect reveal of oxidative Stress-Related lipid and protein changes in fibromyalgia

In this study, our aim was to investigate the pathogenesis and diagnosis of fibromyalgia (FM), a complex disorder with poorly understood causes. We focused on examining the role of oxidative stress and associated lipid and protein alterations in FM patients. To achieve this, we conducted a comprehensive analysis of serum samples obtained from 60 FM patients and 40 healthy individuals. In our analysis, we employed various biochemical assays and spectroscopic techniques including Fourier Transform Infra-Red (FTIR) and Raman spectroscopy. Moreover, we applied advanced statistical methods such as chemometrics and machine learning algorithms to analyze the collected data.The obtained results showed higher levels of oxidative stress, around 113% on the visual analogue scale score and around 5800% higher when C = O vibrations from lipids visible in FTIR spectra were analyzed. Also, lower levels of total antioxidants and oxidants in FM patients were observed compared with the healthy group.Moreover, FTIR spectra of serum collected from FM patients showed significantly higher absorbance of bands corresponding to polysaccharides, proteins, and lipids, while differences were not found in the Raman spectra. The principal component analysis (PCA) of the obtained spectroscopic data showed that it is possible to distinguish patients suffering from FM and healthy control groups with 100% accuracy using FTIR spectroscopy. PLS analysis showed significance in the differentiation of lipid vibrations among groups. In summary, FTIR coupled with chemometrics has the potential for fibromyalgia diagnosis.

Gender differences in the revised Fibromyalgia Impact Questionnaire: a pilot study.

Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with symptoms such as fatigue, sleep disturbances and cognitive impairment. Prevalence is higher in females but the application of the 2010/2011 and 2016 revision of the American College of Rheumatology (ACR) criteria reduced prevalence differences and the actual female:male ratio is approximately 3:1. Even if lately some studies have been conducted regarding FM gender differences, disease severity is still assessed using questionnaires, such as the Revised Fibromyalgia Impact Questionnaire (FIQR), designed and validated through a predominantly female sample. The aim of this pilot study was to compare the 21 items of the FIQR among male and female patients in order to evaluate the possible existence of a gender bias. In this case-control study, consecutive patients with a diagnosis of FM (2016 ACR criteria) were asked to answer an online survey, including demographic characteristics, disease variables and the Italian version of the FIQR. Among the 544 patients that compiled the questionnaire, 78 patients, 39 males and 39 females, matched for age and disease duration, were consecutively enrolled in order to compare their FIQR scores. The univariate analysis showed that total FIQR scores and physical function domain scores were significantly higher in females and, among the 21 items of the FIQR, the female group obtained significantly higher scores in 6 of them. Our results showed that female patients obtain significantly higher scores in the FIQR total score and physical function domain score, in particular in 5 out of the 9 sub-items of the FIQR physical function domain. These preliminary results indicate that the use of the FIQR as a severity index in male patients probably underestimates the disease impact in this group.

Pain Biomarkers in Fibromyalgia Syndrome: Current Understanding and Future Directions.

Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.

A multicomponent physical activity home-based intervention for fibromyalgia patients: effects on clinical and skin biopsy features.

Adapted physical activity (APA) has been recommended for fibromyalgia (FM) treatment as an essential component of a biopsychosocial therapeutic approach for patients. Previous studies report that aerobic and resistance training are the most effective programs in improving the quality of life and psycho-physical well-being. Patients with FM are frequently affected by an impairment of small fibers innervation, which is evident in the proximal somatic districts. Therefore, this pilot randomised controlled not pharmacological trial aimed to investigate if a 12-week home-based multicomponent (aerobic and resistance training and mobility) physical activity (PA) intervention was effective in improving pain perception, FM-related disability, and IntraEpidermal Nerve Fibers Density (IENFD) in adult FM patients. Thirty-four female subjects with a fibromyalgia diagnosis (51.5±11.88 years) were randomly assigned to an experimental group (n=17) that received a supervised home-based multicomponent PA intervention twice a week and a control group (n=17) that received a generic program of aerobic exercise. Skin biopsy was performed before the physical program and after 18 months with constant execution of the supervised PA intervention or generic aerobic exercise. Both groups assumed pharmacological treatment with duloxetine and/or pregabalin. We found that the group performing physical activity in a supervised and regular way showed a significant improvement in the Fibromyalgia-linked invalidity questionnaire (FIQ) as well as epidermal fibers density at proximal and distal sites. Physical activity could improve FM outcomes, with a possible beneficial impact on peripheral factors contributing to pain-related disability.

Prevalence and Contextual Factors of Juvenile Fibromyalgia in a Population-Based Italian Sample of Children and Adolescents.

Juvenile Fibromyalgia (JFM) is poorly known, leading to delay in the identification of the syndrome. On the other hand, early diagnosis in children is important to prevent the worsening of the disease. This study aims to estimate the prevalence of JFM in an Italian population-based convenience sample, using different criteria (2010 and 2016 ACR, Yunus and Masi), by involving family pediatricians. It also aims to assess the relationships between JFM and contextual factors of the children and their parents, as well as to raise awareness of JFM among pediatricians. Children's data were collected using an ad hoc electronic questionnaire. Overall, 7275 questionnaires were collected (48.5% females; mean age: 8.2 ± 3.6 years). Thirty-eight children (0.5%) met the 2010 ACR criteria, and 4 (0.1%) met the 2016 ACR criteria. The likelihood of meeting the 2010 ACR criteria was significantly higher for children older than 8 years (OR: 2.42), those who had injuries during the leisure time that caused persistent pain (OR: 6.49), whose parents (at least one) had a diagnosis of fibromyalgia (OR: 2.54) or diffuse pain (OR: 9.09). In conclusion, 2010 ACR criteria are confirmed as the more appropriate for children and adolescents and the analysis of contextual factors suggests the need for family pediatricians to pay particular attention to the most important predictors of JFM.

Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

BackgroundThe role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.AimThe aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies.MethodsCriteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016).ResultsACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered.Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up.ConclusionsThe correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.

The value of inquiring patients about local discomfort during blood pressure measurement for fibromyalgia detection. A cross-sectional study

BackgroundFibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. ObjectiveTo evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. Patients and methodsAll adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: “I am going to take your blood pressure; tell me if the cuff's pressure causes pain”. Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated “did it hurt much or little”. Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. ResultsFour hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having “much” local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. ConclusionsInquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia.

Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy. A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain. A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, p < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, p = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, p < 0.001). Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.

Cross-sectional evaluation of socioeconomic and clinical factors and the impact of fibromyalgia on the quality of life of patients during the COVID-19 pandemic.

The fibromyalgia impact questionnaire (FIQ) relates to the functional capacity, professional situation, psychological disorders, and physical symptoms, and can identify the factors that determine the impact of the syndrome and characteristics of its carriers; the higher the score, the greater the impact of fibromyalgia on the quality of life. To evaluate the impact of fibromyalgia on the quality of life of individuals with fibromyalgia, who were categorized according to the FIQ during the coronavirus disease pandemic. A cross-sectional study was conducted at an institution of higher education in Taquara, RS, Brazil. A quantitative study was carried out, with the application of a sociodemographic and clinical questionnaire, and the FIQ in 163 Brazilian individuals with a medical diagnosis of fibromyalgia. Data were collected using SurveyMonkey software. Of the female carriers, 98.2% were living in urban areas, working, and under pharmacological and complementary treatment. The FIQ results showed that seven of the 10 items had the maximum score. The items "physical function" and "feel good" had intermediate scores, and the item "missed work" had a low score. The average total score was 79.9 points, indicating that fibromyalgia had a severe impact on the participants' lives. A severe impact of fibromyalgia was observed in 61.3% of the participants, a moderate impact in 30.7%, and a low impact in 8%. The survey findings suggest a severe impact in the majority of the Brazilian fibromyalgic population.

PD05-08 ELEVATED FM/a BLOOD TEST IN PATIENTS WITH INTERSTITIAL CYSTITIS / BLADDER PAIN SYNDROME

You have accessJournal of UrologyCME1 Apr 2023PD05-08 ELEVATED FM/a BLOOD TEST IN PATIENTS WITH INTERSTITIAL CYSTITIS / BLADDER PAIN SYNDROME Claire Burton, Ashu Mohammad, Sean Berquist, and Amy Dobberfuhl Claire BurtonClaire Burton More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Sean BerquistSean Berquist More articles by this author , and Amy DobberfuhlAmy Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The FM/a test is a cytokine assay of in vitro stimulated peripheral blood mononuclear cells that has been previously validated for the diagnosis of fibromyalgia (FM). FM and Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) share many common features, and cytokine abnormalities have been previously identified in both conditions. It has been hypothesized that the non-Hunner Lesion (HL) phenotype of IC/BPS may be more related to systemic pain syndromes and have overlap with FM. We hypothesized that patients with IC/BPS would also test positive on the FM/a test. METHODS: Men and women ≥18 years of age with a diagnosis of IC/BPS were included in the study. Patients were excluded if they were taking immunosuppressants or oral or inhaled steroids. All patients were prospectively enrolled and completed the blood test as well as the AUA-SS and the O’Leary-Sant Symptom and Problem Indices. Charts were reviewed for chronic overlapping pain conditions (COPCs) which include Irritable bowel syndrome, FM, chronic fatigue syndrome, migraine, and temporomandibular joint disorder as well as the prevalence of HL. RESULTS: A total of 15 patients enrolled in the study. 73% (11/15) of patients tested positive for FM/a with a score >50. Distribution of FM/a results is presented in Figure 1. One patient who tested negative reported being on Flonase and was excluded from further analysis. 13/14 had previously undergone cystoscopy for evaluation of HL. Demographic data is presented in Table 1. There was no difference in FM/a results among subjects with and without COPCs (70.8 vs 55.3, p=0.31) or HL vs Non-HL IC/BPS (65.2 vs 64.8, p=0.98). CONCLUSIONS: The FM/a test is highly positive in this small sample of patients with IC/BPS, the majority of whom do not carry a prior FM diagnosis. While the clinical utility of this test is uncertain, there may be potential to use this test to further phenotype patients with IC/BPS and/or clarify the diagnosis if in question. Further study of the sensitivity and specificity of the FM/a test in IC/BPS patients is warranted. Source of Funding: EpicGenetics paid for the laboratory fees and conducted the FM/a Test free of charge © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e151 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Burton More articles by this author Ashu Mohammad More articles by this author Sean Berquist More articles by this author Amy Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluating the Effect of Delayed Diagnosis on Disease Outcome in Fibromyalgia: A Multi-Center Cross-Sectional Study.

The impact of delayed diagnosis (DD) on fibromyalgia (FM) patients' symptomatology and disease outcome has not yet been systematically studied. To analyze the predictors of DD and the influence of DD on FM aggravation and disease evaluation measures. 370 FM patients were interviewed prospectively for this study. The following information was obtained: DD, widespread pain index (WPI), symptom severity scale (SSS), polysymptomatic distress scale (PDS) scale (SSS + WPI), and tender points. We identified three groups of patients: early diagnosis (ED: 2 years; 83 patients), late diagnosis (LD: > 2-7 years; 198 patients), and very late diagnosis (VLD: > 7 years; 89 patients). The patients' average age was 33.9 (9.8) years, and 79% were female. The SSS, PDS, and tender point means were 7.8 (1.6), 16.46 (4.1), and 14.31 (2.3), respectively. The correlation between DD and SSS (r = 0.14), the PDS scale (r = 0.37), and FM tender points (r = 0.16) was significant, but not with WPI (r = 0.06). When the three groups were examined, the SSS mean was 7.54 (1.6), 7.73 (1.4), and 8.25 (1.7), respectively (P 0.008), while the PDS mean was 15 (3.8), 15.95 (3.8), and 18.96 (4.4), respectively (P 0.008). (P 0.001). Early FM diagnosis is associated with lower SSS, total severity scale, and FM tender points, indicating a less severe condition.

Spectrochemical approach combined with symptoms data to diagnose fibromyalgia through paper spray ionization mass spectrometry (PSI-MS) and multivariate classification

This study performs a chemical investigation of blood plasma samples from patients with and without fibromyalgia, combined with some of the symptoms and their levels of intensity used in the diagnosis of this disease. The symptoms evaluated were: visual analogue pain scale (VAS); fibromyalgia impact questionnaire (FIQ); Hamilton anxiety rating scale (HAM); Tampa Scale for Kinesiophobia (TAMPA); quality of life Questionnaire—physical and mental health (QL); and Pain Catastrophizing Scale (CAT). Plasma samples were analyzed by paper spray ionization mass spectrometry (PSI-MS). Spectral data were organized into datasets and related to each of the symptoms measured. The datasets were submitted to multivariate classification using supervised models such as principal component analysis with linear discriminant analysis (PCA-LDA), successive projections algorithm with linear discriminant analysis (SPA-LDA), genetic algorithm with linear discriminant analysis (GA-LDA) and their versions with quadratic discriminant analysis (PCA/SPA/GA-QDA) and support vector machines (PCA/SPA/GA-SVM). These algorithm combinations were performed aiming the best class separation. Good discrimination between the controls and fibromyalgia samples were observed using PCA-LDA, where the spectral data associated with the CAT symptom achieved 100% classification sensitivity, and associated with the VAS symptom achieved 100% classification specificity, with both symptoms at the moderate level of intensity. The spectral variable at 579 m/z was found to be substantially significant for classification according to the PCA loadings. According to the human metabolites database, this variable can be associated with a LysoPC compound, which comprises a class of metabolites already evidenced in other studies for fibromyalgia diagnosis. This study proposed an investigation of spectral data combined with clinical data to compare the classification ability of different datasets. The good classification results obtained confirm this technique is as a good analytical tool for the detection of fibromyalgia, and provides theoretical support for other studies about fibromyalgia diagnosis.

A Descriptive Study of Fibromyalgia Syndrome and Low Disease Activity Rheumatoid Arthritis

Objectives: To evaluate fibromyalgia syndrome in patients with rheumatoid arthritis (RA) with low disease activity. Settings and sampling: From January 2022 to February 2023, this descriptive research was carried out at Lady Reading Hospital in Peshawar. Based on the ACR 2010 criteria for RA, patients with rheumatoid arthritis were enrolled in the study. Clinical Disease Activity Index (CDAI) scores between 2.5 and 10 were considered mild disease activity, indicating that the disease was of low severity. Based on the 2016 ACR criteria for the diagnosis of fibromyalgia, fibromyalgia syndrome was identified. Results: A total of 78 patients were recruited, and 46 (58.9%) of them were female. Age ranged from 20 to 70 years, with a mean of 41.3±10.6 years. 17 individuals (21.8%) had the fibromyalgia syndrome. Conclusion: Due to the broad discomfort associated with inflammation, substantial disease activity may make a fibromyalgia diagnosis easier. Hence, before diagnosing FMS in a RA patient, strict disease activity management should be taken into account. Keywords: Rheumatoid Arthritis, Low Disease Activity, Fibromyalgia Syndrome,

Efficacy of mecobalamin (vitamin B12) in the treatment of long-term pain in women diagnosed with fibromyalgia: protocol for a randomised, placebo-controlled trial

IntroductionFibromyalgia causes long-term pain. It affects at least 2% of the population, the majority being women. In addition, extended symptoms corresponding to vitamin B12 deficiency occur. Findings from several studies...

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: PR3-versus MPO-ANCA-associated vasculitis, an exploratory cross-sectional study

Persistent fatigue is a common complaint in ANCA-vasculitis (AAV) patients and has a profound impact on patient's quality of life. The symptoms associated with this fatigue mirror those found in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia. Etiologic and pathophysiologic differences exist between PR3- and MPO-ANCA disease, yet differences in their fatigue manifestations have not been well researched. We compared fatigue and its associations in healthy controls, AAV patients and fibromyalgia controls. The Canadian consensus criteria were used for ME/CFS diagnosis, and American College of Rheumatology criteria for fibromyalgia diagnosis. Factors such as cognitive failure, depression, anxiety, and sleep disturbances were assessed by patient reported questionnaires. Clinical factors such as BVAS, vasculitis damage index, CRP and BMI were also collected. Our AAV cohort comprised 52 patients, with a mean age of 44.7 (20-79), 57% (30/52) of the patients were female. We found 51.9% (27/52) of patients fulfilled the diagnostic criteria for ME/CFS, with 37% (10/27) of those having comorbid fibromyalgia. Rates of fatigue were higher in MPO-ANCA patients, than in PR3-ANCA patients, and their symptoms were more similar to the fibromyalgia controls. Fatigue in PR3-ANCA patients was related to inflammatory markers. These differences may be due to the varied pathophysiology of the PR3- and MPO-ANCA serotypes. A large proportion of AAV patients suffer from debilitating fatigue consequential enough to meet the diagnostic criteria for ME/CFS. Fatigue associations were not the same between PR3- and MPO-ANCA patients, suggesting that the underlying mechanisms may be different. Future studies should consider ANCA serotype, as further research may inform different clinical treatment strategies for AAV patients suffering from ME/CFS. This manuscript was funded by the Dutch Kidney Foundation (17PhD01).

Knowledge, Attitude, and Practice Regarding Fibromyalgia Among Primary Care Physicians in Tabuk, Saudi Arabia.

Adequately informed family physicians have the greatest potential to correctly identify the diagnosis of fibromyalgia (FM) and develop an initial treatment plan. Therefore, it is substantial to determine the levels of weakness and inaccuracy among primary care physicians regarding FM diagnostic criteria and management strategies. This study aimed to assess the knowledge, attitude, and practices regarding FM among primary care physicians in Tabuk, Saudi Arabia. This cross-sectional study included family physicians who were board-certified or registered in the family medicine training program and working at the government family healthcare centers in Tabuk. A pre-designed, structured questionnaire was distributed either in written form or as an online survey. This study included 52 primary healthcare physicians. Twenty-two (42.3%) participants incorrectly recorded localized pain as a diagnostic symptom, and 45 (86.5%) incorrectly recorded nonsteroidal anti-inflammatory drugs (NSAIDs), prednisolone, and/or opioids as drugs that are used for treating FM. Only 59.6% were confident in recognizing the symptoms of FM, and 55.8% were confident in differentiating FM from other similar diseases. The primary healthcare physicians working in the government's primary healthcare centers in Tabuk City, Saudi Arabia, have low levels of knowledge about diagnostic criteria and treatment strategies for FM. These findings highlight the need for continuous professional development involving family physicians in the primary healthcare setting with suitable continuous medical education (CME) programs concerning FM.

Gender, Mental Health and Socioeconomic Differences in Fibromyalgia: A Retrospective Cohort Study Using Real-World Data from Catalonia

A retrospective cohort study was designed using the Information System for Research Development in Primary Care database. All patients with FM were included (n = 56,098) and matched to the control group in a 1:2 pairing ratio (n = 112,196). The demographic variables studied were sex, age and socio-economic status. Patients with FM have a lower survival rate if they are also diagnosed with anxiety and depression during the entire study period, with the rate being 26.6% lower in FM patients at an 8-year follow-up (0.58, 95%CI: 0.57-0.59 vs. 0.79, 95%CI: 0.78-0.79). There is a 58% reduction in the risk of developing anxiety and/or depression in the control group vs. the FM group (p-value < 0.05), and by 45% in male vs. female sex (p-value < 0.05). FM is a disease that is associated with anxiety and depression, and men are at lower risk of anxiety and depression after FM diagnosis.

Circulating microRNA expression signatures accurately discriminate myalgic encephalomyelitis from fibromyalgia and comorbid conditions

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and fibromyalgia (FM) are two chronic complex diseases with overlapping symptoms affecting multiple systems and organs over time. Due to the absence of validated biomarkers and similarity in symptoms, both disorders are misdiagnosed, and the comorbidity of the two is often unrecognized. Our study aimed to investigate the expression profiles of 11 circulating miRNAs previously associated with ME/CFS pathogenesis in FM patients and individuals with a comorbid diagnosis of FM associated with ME/CFS (ME/CFS + FM), and matched sedentary healthy controls. Whether these 11 circulating miRNAs expression can differentiate between the two disorders was also examined. Our results highlight differential circulating miRNAs expression signatures between ME/CFS, FM and ME/CFS + FM, which also correlate to symptom severity between ME/CFS and ME/CFS + FM groups. We provided a prediction model, by using a machine-learning approach based on 11 circulating miRNAs levels, which can be used to discriminate between patients suffering from ME/CFS, FM and ME/CFS + FM. These 11 miRNAs are proposed as potential biomarkers for discriminating ME/CFS from FM. The results of this study demonstrate that ME/CFS and FM are two distinct illnesses, and we highlight the comorbidity between the two conditions. Proper diagnosis of patients suffering from ME/CFS, FM or ME/CFS + FM is crucial to elucidate the pathophysiology of both diseases, determine preventive measures, and establish more effective treatments.