Fibromyalgia Tender Points Research Articles

Prevalence and characteristics of fibromyalgia according to three fibromyalgia diagnostic criteria: A secondary analysis study.

The purpose of this study was to explore the prevalence of fibromyalgia (FM) according to different diagnostic criteria in a clinical sample and to explore the clinical characteristics in cases and non-cases by the diagnostic criteria used. A sample of 182 participants, both positive (n = 120) and negative (n = 62) FM individuals according to a clinical, pragmatic classification was used. Their characteristics were explored according to three different FM diagnostic criteria, i.e., the American College of Rheumatology (ACR) 1990, ACR 2016, and APS Pain Taxonomy (AAPT), respectively. Thus, impact of FM (FIQ), symptoms of anxiety and depression (HADS), tender point (TP) counts, and mechanical pressure sensitivity (in kPa) were compared in cases versus non-cases depending on diagnostic criteria of FM used. Descriptive analyses used chi-square statistic for categorical variables and non-parametric Mann-Whitney U tests for continuous variables. From the clinical positive FM sample (n = 120), n = 99, 108, and 110 persons were diagnosed positive according to the ACR 1990, ACR 2016, and AAPT FM diagnostic criteria, respectively. All these three diagnostic tools discriminated FM positively from diagnostic FM non-cases when measuring TP-counts, mechanical pressures, and most FIQ-items, but they varied for anxiety and depression. The prevalence of FM differed somewhat with the use of ACR 1990, ACR 2016, and the AAPT as diagnostic tools. The anxiety and depression symptoms differed significantly between cases and non-cases using some but not all the diagnostic criteria. Regarding other FM symptoms, e.g., TPs and most FIQ items, all diagnostic criteria contrasted case from non-case.

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.

Evaluation of the agreement between the ACR 1990 fibromyalgia tender points and an enthesitis score in patients with axial spondyloarthritis.

Coexistence of FM represents a challenge in the evaluation of enthesitis in patients with axial spondyloarthritis (axSpA) due to a possible overlap between the tender points (TP) due to enthesitis and those of FM. The objective was to assess the agreement between the MASES enthesitis score and the tender points of the ACR 1990 criteria in patients with axSpA. This was a cross-sectional ancillary analysis of the Predict-SpA study (NCT03039088). Patients had a diagnosis of axSpA according to their rheumatologist and an indication to start a TNFα blocker. All patients were screened for FM according to the FiRST questionnaire. A physician was asked to assess 31 anatomically described sites in a random order without knowing to which instrument the site belonged (i.e. the 18 ACR 1990 TP and the 13 MASES sites). Agreement between the MASES and the ACR 1990 TPs by the intraclass correlation coefficient (ICC), also stratified by the presence/absence of concomitant FM according to the FiRST. Among the 526 patients, 53% were men and 202 (38%) had FM. Radiographic sacroiliitis and MRI sacroiliitis were present in 56% and 68% patients, respectively. Patients were mostly men (53.4%) with radiographic and MRI sacroiliitis in 56% and 68% patients, respectively. Mean number of ACR 1990 TP was 5.4 (s.d. 4.6) and mean MASES was 4.2 (s.d. 3.6). ICC between both scores was 0.7 [95% CI (0.6, 0.8)]. ICC between both scores was 0.6 [95% CI (0.3, 0.8)] and 0.7 [95% CI (0.6, 0.7)] for patients with and without FM, respectively. These results suggest a significant overlap between both scores in patients with axSpA, including in those without concomitant FM. clinicaltrials.gov, https://clinicaltrials.gov, NCT03039088.

Possible relations between arterial hypertension and cervical spine fibromyalgias (literature review)

The literature review analyses and systematises currently available information on fi-bromyalgia etiology and pathogenesis, hypertension classification and causes, and considers pos-sible relationships between cervical fibromyalgia and hypertension. Statistical data on mortality in
 Ukraine related to cardiovascular diseases, including hypertension, are highlighted. A concise clas-sification of arterial hypertension according to the International Classification of Diseases-10 (ICD-10) and the International Classification of Diseases-11 (ICD-11) is provided, and its pathogenesis
 (emission hypertension, resistance hypertension and hypervolemia) is outlined. Physiological rela-tions between cervical spine and cardiovascular system are considered. The main diagnostic criteria
 for fibromyalgia classification and its development stages are described. Prevalence of fibromyalgiais identified and its forms are classified in accordance with ICD-11. The available data on the likelycauses of fibromyalgia pain and any established mechanisms of fibromyalgia pathogenesis, including,but not limited to peripheral and central sensitisation, neurogenic inflammatory processes occurringin the disease-associated peripheral tissues, spinal cord and brain, as well as potential involvementof genetic, endocrine, psychopathological factors and sleep disorders in fibromyalgia development
 are discussed. The current formal criteria for fibromyalgia classification (revised in 2016), togeth-er with assessment of the main pharmacological and non-pharmacological fibromyalgia treatment
 methods and approaches based upon available published clinical trials outcomes are described. The
 main directions of fibromyalgia research are identified, and further prospective studies covering dif-ferent relationship aspects between hypertension and cervical fibromyalgia are evaluated. Among
 the available literature sources, the only study of patients with comorbid fibromyalgia (fibromyalgiawas diagnosed using 1990 American College of Rheumatology criteria and evaluated by Revisedfibromyalgia impact questionnaire (FIQR)) and hypertension (blood pressure levels were assessedusing the WHO protocol) has been reported. However, this group has only studied the dynamics ofchanges in cortisol, melatonin and serotonin blood levels, which accompany these pathologies, andthese authors have found that fibromyalgia tender points’ quantity and FIQR scores are much higher
 in hypertensive patients with fibromyalgia in comparison with the rest, which has led them to the con-clusion that hypertension prevalence in patients with fibromyalgia could be related to fibromyalgia severity. Thus, this thorough literature review demonstrates that clinical studies examining possiblerelationships between hypertension and cervical spine fibromyalgia are at lack and require furtherconsiderations.

Metal-induced oxidative stress level in patients with fibromyalgia syndrome and its contribution to the severity of the disease: A correlational study

Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease characterised by widespread chronic musculoskeletal pain. Metal-induced oxidative stress contributes to the severity of FMS. First, this study evaluated the association between plasma levels of toxic heavy metals and essential metals with oxidative stress (OS) markers. Second, the OS markers and metal contents were correlated with the disease severity by assessing the Fibromyalgia Impact Questioner Revised (FIQR) and tender points (TP). A total of 105 FMS patients and 105 healthy controls of similar age and sex were recruited. OS parameter such as lipid peroxidation (LPO), protein carbonyl group (PCG), nitric oxide (NO) and essential metals such as zinc (Zn), magnesium (Mg), manganese (Mn), copper (Cu) and toxic heavy metals such as aluminium (Al), arsenic (As), lead (Pb) were estimated. Levels of LPO, PCG, NO (p< 0.001) and Cu, Mn, and Al (p< 0.001), were significantly higher, and Mg (p< 0.001) and Zn (p< 0.001) were significantly lower in patients compared to controls. A positive association was observed between OS parameters, FIQR and TP with Cu, Al and Mn. A significant negative association was observed between Zn and Mg with FIQR, TP and OS parameters. Heavy metals such as Al induce OS parameters and decrease the levels of essential trace elements such as Mg and Zn, which may be responsible for the severity of FMS.

Effectiveness Of Mesotherapy In Treatment Of Fibromyalgia Tender Points

Background: Fibromyalgia is the second most common disease encountered in rheumatology practice Aim: This study designed to assess the potential effect of mesotherapy in treatment of tender points in primary fibromyalgia (PFM) patients. Methods: Thirty PFM patients who fulfilled the American Colleague of Rheumatology 1990 criteria, joined this study. They were divided into 2 groups randomly according to the treatment program received; Injection mesotherapy group (Group I: No=15 patients) who received a mixture of 2 ml of Ketoprofen (100mg/2ml) added to 3 ml of Saline Solution, once cession per week for a total of 6 successive weeks and other 15 patients (Group II) who received Ketoprofen 100 mg Extended- Release capsules once daily for 2 successive weeks which represent the control group. Patients‟ pain severity, quality of life and depression were assessed using visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ) and the Hamilton Rating Scale (HDRS) respectively before treatment and after the 3rd & the 6th cession then data were recorded and compared. Results: We found significant improvements (p<0.001) tender point‟s number, VAS, FIQ and HDRS in the injection mesotherapy group compared to the control group with no major adverse effects were described. Conclusion: This study supports the hypothesis that injection mesotherapy could offer a great therapeutic advantage in treatment of fibromyalgia tender points especially in the presence of associated comorbidities where there is a high risk of drug interaction, polypharmacy, or when conventional (oral or parenteral) NSAIDs use is contraindicated.

P284 Disentangling fibromyalgia from spondyloarthopathy in the patient with inflammatory bowel disease

Abstract Background Joint pain is common in subjects affected by Inflammatory bowel disease (IBD) and is linked to several factors including spondyloarthritis (SpA), drug therapy, concomitant osteoarthritis and fibromyalgia (FM). The primary aim of this study was to estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of IBD patients. The secondary aim was to assess the impact of FM on clinimetric scores and ultrasonographic features. Methods Consecutive cases with IBD attending two IBD Units were assessed by a rheumatologist for ASAS criteria for SpA or the 2010 ACR criteria for FM. The rheumatological assessment included a 66 swollen joint count (SJC) and 68 tender joint count (TJC), Maastricht Ankylosing Spondylitis Score (MASES), Leeds Enthesitis Index (LEI) and the FM tender points examination, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). One hundred and fifty-eight patients seen at Reggio Emilia centre underwent US entheseal examination. MRI and HLA-B27 determination were requested if needed for diagnostic confirmation. Results 301 patients were enrolled with 148 completing the clinical and imaging/laboratory assessment if requested for diagnostic purpose. A total of 37 IBD patients (12%) met the ACR criteria for FM: 27 patients (9%) presented the criteria for primary FM and 10 patients (3.3%) presented FM and SpA. Patients who met FM criteria were mostly female (81%, p &amp;lt; 0.001), slightly older, with longer duration of disease; no correlation with smoking, sedentary job, body mass index (BMI) or psoriasis. Of note FM patients presented higher LEI, BASDAI and BASFI scores than SpA patients. At US examination patients who satisfied ASAS criteria for SpA had significantly higher mean enthesis/patient PD positive as compared with IBD and FM group (p &amp;lt; 0.001 for the two comparison) and had more patients with at least one PD positive enthesis (p &amp;lt; 0.001 and p = 0.028 respectively). Acute entheseal lesions had a higher prevalence in the ASAS+ group as compared with the other two groups (p = 0.002 vs. IBD group and p = 0.009 vs. FM group). Chronic entheseal lesions had the same prevalence in the three groups of patients. Conclusion FM is common among IBD patients and more prevalent in females and patients aged ≥ 45 years old. In this subgroup of patients SpA disease activity indices performed poorly for distinguishing patients with disease activity from those with functional impairment. On the contrary, US examination showed a promising discriminating capacity in SpA patients.

Peripheral spondyloarthritis: Concept, diagnosis and treatment.

Peripheral spondyloarthritis refers to spondyloarthritis with predominant peripheral (arthritis, enthesitis or dactylitis) involvement. Diagnosis can be challenging, particularly in the absence of SpA extra-articular manifestations such as uveitis, psoriasis or inflammatory bowel disease. Evaluation of disease activity should always include assessment of objective signs of inflammation, particularly in the presence of enthesitis as the sole peripheral manifestation, mainly due to the potential misdiagnosis with fibromyalgia tender points. Several recommendations for management/treatment of psoriatic arthritis have been published by EULAR and GRAPPA but none for peripheral SpA in general. NSAIDs and glucocorticoids are recommended as the first step of treatment in all peripheral manifestations, while conventional synthetic (cs) DMARDs seem only efficacious in arthritis. Several biologics and targeted synthetic (ts) DMARDs (TNFi, anti-IL17 and JAK-inhibitors) have been proven to be efficacious in peripheral involvement in PsA (arthritis and enthesitis), but studies on peripheral SpA are lacking.

Serum levels of serotonin as a biomarker of newly diagnosed fibromyalgia in women: Its relation to the platelet indices.

Background:This study aimed to assess the serum serotonin levels in the newly diagnosed fibromyalgia (FM) and to relate these levels to the presenting signs and symptoms.Materials and Methods:This case–control study included 35 healthy women (Group I) served as controls and 130 women with newly diagnosed FM (Group II). The diagnosis of FM was confirmed by the diagnostic criteria of the American College of Rheumatology-10. The assessment of pain using a revised fibromyalgia impact questionnaire and tender points scoring, blood platelet indices, and serum serotonin levels were determined.Results:Group II patients had significantly (P < 0.001) higher values of mean platelet volume (MPV) (10.60 ± 1.57fL) and platelet width distribution (16.25 ± 1.45%) than the corresponding values in Group I (8.73 ± 0.81fL and 15.0 ± 1.15%). Significant low-serum serotonin levels observed in Group II patients compared with Group I healthy individuals (187.3 ± 50.3 ng/ml vs. 219.5 ± 78.3 ng/ml, P = 0.026). Multiple linear regression analysis showed the nonsignificant correlations between serum serotonin levels and platelet indices in Group II patients.Conclusion:Newly diagnosed FM women have significantly low-serum serotonin levels, which does not correlate with a significant increment of the platelet activity expressed as increase MPV and platelet width distribution percentage. Therefore, this study highlighted that the correction of serum serotonin level by medicines could help the patients.

Response inhibition, set shifting, and complex executive function in patients with chronic lower back pain

ObjectiveThe aim of our study was to evaluate how response inhibition, set shifting, and complex executive function (represented by risky decision-making) are altered in chronic lower back pain patients. Materials and methodsA total of 29 patients with chronic lower back pain (CLBP >6 months) aged 49–69 years and 30 healthy volunteers matched for age, gender, and education were enrolled in a case–control study. The study was conducted in the Departments of Neurology and Neurosurgery of Panevėžys Regional Hospital, Lithuania. Pain was evaluated by the visual analog scale, Pakula Pain Questionnaire (Lithuanian analog of McGill Pain Questionnaire), and Fibromyalgia Tender Points Examination. A battery of neuropsychological tests used included Stroop Test Victoria version, Trail Making Test parts A and B, and Game of Dice Task (GDT). ResultsCLBP patients did not score significantly worse in any examined neuropsychological tests. Response Inhibition correlated inversely with number of tender points in CLBP patients. GDT performance showed no significant difference in net score (number of safe minus risky decisions). Unexpectedly, both groups favored risky decisions. ConclusionsWe found no statistically significant difference in response inhibition, set shifting, or complex executive function between CLBP patients and healthy older adults. Moreover, a risky decision-making pattern found in the Lithuanian population may underscore the importance of cultural context when examining complex executive function. However, further studies are needed to prove this point.

Impact of Number of Fibromyalgia Tender Points on Disease Activity in Systemic Lupus Erythematosus Patients

Background: Fibromyalgia tender points (FMTP) have consistently reported higher number count in systemic lupus erythematosus (SLE) patients compared with the general population.Objective: The purpose of this study was to determine the association and impact of fibromyalgia tender points on disease activity in SLE patients.Methods: Sixty seven female SLE patients and equal number of asymptomatic, age and sex matched control subjects were enrolled in this observational study. The study was performed between April 2005 and October 2006. After fulfilling the certain inclusion criteria, obtained data were recorded in a structured questionnaire. 18 FMTP sites and 6 control sites were examined by standardized manual tender point survey system. Systemic lupus erythematosus disease activity index (SLEDAI) was used covering all 9 organs and 24 descriptors with pre assigned severity weights. The scores ranged from 0 ( no disease activity) to 105 ( maximum disease activity). Both the SLE cases and the control group were classified into two subgroups namely ‘0-10 FMTP’ having 10 or less FMTP and &gt;11 FMTP’ bearing 11or more tender points.Results: The age (mean ± SD) of the SLE patients and controls were 26.82 ± 8.02 and 29.67± 10.80 years respectively. No significant difference in age (p = 0.091) and in family income (p = 0.065) was observed but significant difference was observed in level of education ( p = 0.009) and in occupation ( p = 0.004) . At enrolment, the number of FMTP (mean ± SD) in SLE patients and control groups were 8.80±6.40 and 3.63±4.90 respectively. The difference was significant (p&lt;0.001). The SLEDAI score (mean ± SD) in SLE patients was 11.75±9.85. Further, the SLEDAI score of ‘0-10 FMTP’ and &gt;11FMTP’ subgroups of SLE were 8.49±7.34 and 17.58±11.17 respectively. The difference was again significant (p&lt;0.001). Hence the disease activity was positively correlated (r=+0.439, p&lt;0.001) with FMTPs in SLE patients. Meanwhile, no significant correlation was observed between disease duration (r= +0.085, p = 0.495) and SLEDAI and similarly no significant correlation was also observed in disease duration with FMTP; 0-10 and &gt;11FMTP groups of SLE (p = 0.605)Conclusions: SLE patients with higher number of FMTPs are significantly associated with increased scores of SLEDAI. Hence, it can be said that there is a linear correlation between the number of FMTPs and the disease activity in SLE patients. Interestingly, no significant correlation was observed between ‘disease duration and SLEDAI’ as well as between ‘disease duration and FMTP’.J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 99-107

Association of Number of Fibromyalgia Tender Points With Health Status in Systemic Lupus Erythematosus (Sle) Patients

Fibromyalgia Tender Points (FMTPs) and functional health status measured by Health Assessment Questionnaire (HAQ) as well as health related quality of life by short form-36 (SF-36) in Systemic Lupus Erythematosus (SLE) patients have integrated adherent to each other. Comparison of fibromyalgia tender points and health status in many studies revealed remarkable correlation in both chronic rheumatologic diseases. We observed higher HAQ score and significant positive correlation between FMTP and HAQ score and we also found significant negative correlation in almost all domains of SF-36 with FMTP in SLE patients. Therefore, reduced functional status was found in SLE patients with higher FMTP count. To determine influence of the number of fibromyalgia tender points on functional health status as well as health related quality of life in SLE patients. The observational study carried out enrolling 67 female SLE patients and equal number of asymptomatic female subjects in Lupus Clinic of Rheumatology Wing, BSMMU, Dhaka from April 2005 to October 2006.After fulfilling the inclusion criteria with a detailed history and thorough physical examinations, obtained data were recorded in a pro-forma. 18 FMTP sites and 6 control sites were examined. Positive FMTP scores were recorded in a body chart. Culturally adopted and validated Bengali version of HAQ and SF-36 were filled-up to assess the self-reported health status. Both of the SLE patients and control subjects were classified into two subgroups. 0-10 FMTP’ group and &gt; 11 FMTP group. The HAQ score (Mean + SD) of SLE patients and of controls were 0.54 + 0.54 and 0.17 + 0.25 respectively. The difference was statistically significant (p &lt;0.001). The score (Mean + SD) of all domains’ of SF-36 in both the studied groups were also significantly different. In this SLE series significant correlation (R - + 0.390, p 0.001) was observed between HAQ score and FMTP. And significant correlation was also observed almost in all domains of SF-36 with FMTP. Health status in SLE patients was poor in those who have higher number of FMTP count. Health status was more reflective by SF-36 in comparison to HAQ. JCMCTA 2015 ; 26 (2) : 44 - 52

Comorbid Conditions Do Not Differ in Children and Young Adults with Functional Disorders with or without Postural Tachycardia Syndrome

To determine if several multisystem comorbid conditions occur more frequently in subjects with tilt-table defined postural tachycardia syndrome (POTS) compared with those without. Retrospective chart review of 67 subjects aged 6-24 years, referred to a tertiary care neurogastroenterology and autonomic disorders clinic for a constellation of functional gastrointestinal, chronic pain, and autonomic complaints. All patients underwent formal autonomic testing, Beighton scores assessment for joint hypermobility (0-9), and fibromyalgia tender points (0-18) (43 subjects). Twenty-five subjects (37%) met tilt table criteria for POTS. The median age of 16 years (range, 12-24 years) in the POTS group differed from 15 years (range, 6-21 years) in the no-POTS group (P = .03). Comorbidities including chronic fatigue, sleep disturbances, dizziness, syncope, migraines, functional gastrointestinal disorders, chronic nausea, fibromyalgia, and joint hypermobility did not differ between groups. All subjects with fibromyalgia by tender point-examination had a Beighton score ≥ 4 (P = .002). Comorbid conditions are equally prevalent in children and young adults with and without tilt-table defined POTS, suggesting that POTS itself is not a cause of the other comorbidities. Instead, POTS likely reflects another comorbid condition in children with functional disorders. Dizziness and syncope, classically associated with POTS, are not predictive of a diagnosis of POTS by tilt table, a test that is still required for formal diagnosis. These results suggest a paradigm shift in the concept of POTS as the physiological basis of many functional symptoms.

Fibromyalgia and Multiple Psychiatric Diagnosis

Fibromyalgia is a chronic pain disorder that includes somatic and emotional symptoms. The evidence supports a relationship between fibromyalgia and varios forms of psychopathology, especially affective disorders. The aim of this study is to determinate whether the patients with Fibromyalgia could be diagnosed with several psychiatric disorders. We were also interested in the perception of their health status and functioning. We included 15 outpatients (13 women and 2 men), mean age 49,6 diagnosed with Fibromyalgia (tender points). They completed the Somatoform Dissociation Questionnaire (SDQ-20), the Hamilton Depression Rating Scale, and the Short Form Health Survey (SF-36). The Psychiatrist scheduled an interview to determinate if they met criterias for Histrionic Personality Disorder Diagnostic Criteria (ICD-10) or Somatization Disorder Diagnostic Criteria (ICD-10). All patients had scores below 50 on the SF-36 Health Survey. Two-thirds of patients met diagnostic criteria for Somatization Disorder Diagnostic, and the rest of patients would have met diagnostic criteria if age criteria A considered would have been 35 years old. Four patients met diagnostic criteria for Histrionic Personality Disorder and 80% of the patients had scores greater than 20 on the Hamilton Depression Rating Scale. Fibromyalgia patients could have more than one psychiatric diagnosis. Most of the patients could met the criteria for somatization disorder. All patients had a low level of funcioning and health perception.

Joint Hypermobility: A Common Association with Complex Functional Gastrointestinal Disorders

To evaluate the prevalence of joint hypermobility (JH) and comorbid conditions in children and young adults referred to a tertiary care neurogastroenterology and autonomic disorders clinic for functional gastrointestinal complaints. This was a retrospective chart review of 66 new patients aged 5-24 years who fulfilled at least 1 pediatric Rome III criteria for a functional gastrointestinal disorder (FGID) and had a recorded Beighton score (n = 45) or fibromyalgia tender point score (n = 45) based on physician examination. Comorbid symptoms were collected and autonomic testing was performed for evaluation of postural tachycardia syndrome (POTS). The median patient age was 15 years (range, 5-24 years), 48 (73%) were females, and 56% had JH, a significantly higher rate compared with population studies of healthy adolescents (P < .001; OR, 10.03; 95% CI, 5.26-19.13). POTS was diagnosed in 34% of patients and did not correlate significantly with hypermobility. Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%). JH and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs. POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.

The Chartographer of Hysteria and Fibromyalgia Tender Points

©2014 Turkish League Against Rheumatism. All rights reserved. A relevant component of the now largely discredited theory of hysteria, developed by the French neurologist Jean-Martin Charcot in the 19th century, was the concept of the “hysterogenic zones”. These zones were defined by Charcot as “more or less circumscribed regions of the body on which pressure or simple rubbing produces quite readily the phenomenon of aura, and which, if you persist, may be followed by the hysterical attack. These points or patches may in addition be the site of permanent hypersensibility and, before an attack, of spontaneous painful irritation”.1 During his lifelong studies on hysteria, Charcot conducted a thorough examination with each patient, managing to plot the distribution of these hysterogenic points on a body chart.

AB0856 Ultra Sonographic Confirmation of Enthesitis in Patients with Fibromyalgia

BackgroundAiming to evaluate whether the clinical overlap identified and presented before [1] between enthesitis sites (ES) and Fibromyalgia (FM) tender points (TeP) in patients with Inflammatory back pain corresponds to...

Variation in pressure pain threshold correlates with rheumatoid arthritis disease activity, not with the inflammatory parameters

Background Pain is a chief symptom of rheumatoid arthritis (RA) indicating the disease flare. Variation in pain sensitivity with inflammatory load may assist in measuring the disease activity. Tender joint counts, one of the currently used pain measures, is more a measure of active joints rather than the pain. Although visual analogue scale (VAS) reflects the perception of pain, it does not indicate the true change in the pain. Aim To evaluate whether pressure pain threshold (PPT) represents disease activity by comparing it with DAS-28 and inflammatory markers like ESR and CRP. Materials and methods Twenty freshly diagnosed female RA subjects were recruited after careful exclusion of patients with fibromyalgia (FM). They were assessed for tender joint count, swollen joint count, visual analogue scale (pain/general health), ESR, and CRP during their three consecutive follow-up of six week intervals. PPT was measured using digital algometer at three pairs of joint areas (metacarpophalangeals, wrists and most inflamed joint) and at three FM tender point sites (sub-occipital, mid-trapezius and buttocks). Arithmetic mean of all areas (average PPT) and average PPT of FM points were calculated. The data was analyzed using Pearson correlation co-efficient, Deming regression analysis and correlation of change. Results Average PPT and PPT of most inflamed joint have moderate to large correlation with DAS-ESR and DAS-CRP. In contrast, small to trivial correlation with ESR and CRP was noted. Similar results were seen for FM tender point sites. Conclusion PPT at inflamed as well as at FM sites correlates significantly with DAS-ESR and DAS-CRP. It does not correlate independently with changes in inflammatory parameters ESR and CRP. PPT in conjuncture with DAS could be useful in routine clinical practice to measure the pain as well disease activity, in RA patients .

Effects of milnacipran on neurocognition, pain, and fatigue in fibromyalgia: a 13-week, randomized, placebo-controlled, crossover trial.

To investigate whether milnacipran is safe and effective in improving cognitive function in patients with fibromyalgia. Patients were randomly assigned to receive milnacipran or placebo for 6 weeks, followed by a 1-week washout and then crossover to the other arm for another 6 weeks. The overall trial lasted 13 weeks and was conducted between July 2011 and May 2013. Assessments were performed at each visit. Neurocognition was measured by the Brief Assessment of Cognition (BAC) and MATRICS. Pain was assessed by the visual analog scale (VAS) for pain. Global assessment of fibromyalgia symptoms was measured by the Fibromyalgia Impact Questionnaire (FIQ) and tender point examination. Depression was assessed by the Beck Depression Inventory (BDI). Fatigue was assessed by the Fatigue Severity Scale. Functional outcome was evaluated by the Health Assessment Questionnaire. The Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales and the Patients Clinical Global Impression of Change were used to measure the global impression of severity and improvement. 26 subjects were screened, and 20 subjects completed the trial. The change in verbal memory (P = .001) and the composite T score (P = .044) of the BAC and the change in the attention-vigilance domain T score (P = .042) were significantly improved, but there were no differences between the drug and placebo groups. The changes in the CGI-S scores were not significant, but the changes in the Clinical Impression-Improvement (CGI-I) scores showed worsening in the placebo group at week 1 (P = .032), week 2 (P = .024), week 4 (P = .024), and week 6 (P = .60) compared to baseline. The change in FIQ scores was not significant. Milnacipran may have a potential role in the improvement of pain, disability, and mood. The effect of milnacipran on cognition in fibromyalgia needs further research. ClinicalTrials.gov identifier: NCT01829243.

Ultrasound Assessment of the Entheses in Primary Sjögren Syndrome

Although tendon pain is commonly reported in primary Sjögren syndrome (pSS), the underlying mechanism is unknown. The objective of this study was to determine whether tendon pain in pSS is related to involvement of the tendons and entheses. We performed a physical examination of 288 entheseal insertion sites in 16 patients with active pSS and 162 entheseal insertion sites in 9 healthy controls without symptoms or medications. Then ultrasound was used to assess entheseal and tendon sites of these patients (n = 208) and controls (n = 117). Ultrasound was performed in B mode first to detect structural damages, and in power Doppler mode to detect blood flow abnormalities. By physical examination, 9 (56%) of the 16 pSS patients had pain to palpation of fibromyalgia tender points, two of whom had more than 11 tender points. The number of positive points ranged from 2 to 18, with a mean of 8 ± 6.0. None of the healthy controls had positive tender points. None had structural or blood-flow abnormalities by ultrasound. To conclude, this study provides the first data on ultrasound findings in patients with active pSS. Although 56% of patients had clinical tender points, none had structural or blood-flow abnormalities by ultrasound, suggesting the absence of inflammation of the tendons and entheses in this disease.