Socioeconomic impact of fibrositis: A study of 81 patients with primary fibrositis☆
Abstract
Demographics and health service utilization were studied for 81 patients with fibrositis during 1985. Patients reported high levels of pain, mild disability, and moderate impairment of global health. Work disability was limited and only 6.3 percent described themselves as disabled. Employed patients were able to work full work weeks. Utilization of outpatient medical services was increased compared with that of control subjects and national averages during the study year, but was consistent with other rheumatic disorders such as osteoarthritis and low back pain. Medication usage was limited and seemed appropriate. Very high hospitalization rates were noted prior to diagnosis of fibrositis, both for musculoskeletal and non-musculoskeletal hospitalizations, but these rates dropped during the post-diagnosis study year.
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Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment
2022, Reumatologia ClinicaEvitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables.
Un panel multidisciplinar de expertos identificó las áreas claves, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado».
Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parte I se reflejan las 27 primeras, referidas a las 2 primeras áreas.
Establecer el diagnóstico mejora el afrontamiento del paciente y reduce los costes sanitarios. Se deben evitar AINE, opioides mayores y benzodiacepinas por los efectos adversos. No existe una evidencia sólida que justifique la asociación de fármacos. Tampoco existe una buena evidencia para recomendar ningún tipo de terapia complementaria. Las cirugías muestran más complicaciones y un grado de satisfacción menor por el paciente por lo que deben evitarse si la indicación no está claramente establecida.
To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable.
A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques.
A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas.
Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.
La fibromyalgie est une maladie douloureuse chronique pour laquelle le reconditionnement physique est le traitement de première intention d’après les recommandations (HAS 2010, EULAR 2016, Rapport Députés 2016). « Fibromyactiv », étude monocentrique, prospective et randomisée, évalue l’efficacité d’un programme d’activité physique adaptée organisé par le Centre d’évaluation et du traitement de la douleur (CETD) du CHU Timone, AP–HM. Son étude pilote en évalue la faisabilité.
Deux groupes de 10 patients ont reçu les mêmes soins standards. Le groupe P a participé en plus au programme pendant 6 mois. Les séances de 2 heures, trihebdomadaires, ont été encadrées par des éducateurs sportifs formés par le CETD. L’objectif principal a consisté à comparer, dans les 2 groupes, 6 mois après l’inclusion, l’efficacité du programme sur la qualité de vie des patients par recueil du Questionnaire d’Impact de la Fibromyalgie (QIF).
Une différence significative est observée à M4 : le QIF du groupe P est amélioré (p < 0,05). À 6 mois, le QIF est amélioré de 8 points dans les 2 groupes. Le score de dépression est amélioré dans le groupe P (p < 0,05), la souplesse des membres inférieurs est améliorée de 15 cm (p < 0,05). La mesure de la douleur, la fatigue et l’humeur recueillie avec des échelles numériques avant et après chaque séance, est améliorée dès le premier mois et ce, durant 6 mois. La participation aux séances a été de 100 % jusqu’à M3, de 90 % à M4 et de 70 % à M6.
L’efficacité du programme sur la qualité de vie est montrée dès M4 mais la différence de QIF s’annule à M6 par amélioration du groupe T. On note des résultats significatifs de dépression et de souplesse à M6 et une efficacité immédiate post séance sur douleur fatigue et humeur pour le groupe P.
L’efficacité de ce programme et sa faisabilité permettent la poursuite de l’étude complète.
Fibromyalgia is a chronic painful affection for which physical reconditioning is the first-line treatment according to the recommendations (HAS 2010, EULAR 2016, Deputy Report 2016). “Fibromyactiv” is a single-center, prospective, randomized study evaluating an adapted physical exercise program for patient with fibromyalgia. The pilot study evaluates feasibility and efficacy of the program.
Two groups of 10 patients received the same standard of care. P Group also participated at the physical program for 6 months. The two-hour sessions, 3 times a week, were supervised by physical educators trained by the CETD. The main objective was to compare the efficacy of the program on the quality of life of patients by collecting the Fibromyalgia Impact Questionnaire (FIQ) in both groups, 6 months after inclusion.
A significant difference is observed at M4: the QIF of the P group is improved (P < 0.05). At 6 months, the QIF is improved by 8 points in both groups. Depression score is improved in the P group (P < 0.05), the flexibility of the lower limbs is improved by 15 cm (P < 0.05). Pain, fatigue and mood, evaluated with numerical scales before and after each session, are improved during 6 months. Participation in the sessions was 100% up to M3, 90% at M4 and 70% at M6.
This program efficacy and its feasibility are sufficient to allow the full study continuation.
Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response
2015, International ImmunopharmacologyCitation Excerpt :Although fibromyalgia can strike at an early age, the mean age of onset in women has been reported as 44–53 years [1–3], similar to the mean age for menopause, 51 years [4].
To test our hypothesis that testosterone deficiency plays an important role in chronic pain, a Phase I/II pilot study was initiated with 12 fibromyalgia patients to verify that a daily dose for 28 days with transdermal testosterone gel would 1) significantly and safely increase mean serum testosterone concentrations from low baseline levels to mid/high-normal levels, and 2) effectively treat the pain and fatigue symptoms of fibromyalgia. Pharmacokinetic data confirmed that serum free testosterone concentrations were raised significantly above baseline levels, by assessment of maximum hormone concentration (Cmax) and area under the curve (AUC) parameters: free testosterone Cmax was significantly raised from a mean of 2.64 pg/mL to 3.91 pg/mL (p < 0.05), and 24 hour free testosterone AUC was significantly raised from a mean of 35.0 pg-hr/mL to 53.89 pg-hr/mL. Assessment of the typical symptoms of fibromyalgia by patient questionnaire and tender point exam demonstrated significant change in: decreased muscle pain, stiffness, and fatigue, and increased libido during study treatment. These results are consistent with the hypothesized ability of testosterone to relieve the symptoms of fibromyalgia. Symptoms not tightly related to fibromyalgia were not improved.
Fibromyalgia and psychiatry: 35 years later... What's new?
2012, Presse MedicaleFibromyalgia (FM) is a complex disorder that affects 2 to 5% of the general population worldwide at any age and any sex, but more frequently in adult women.
The variability of symptoms and the frequency of comorbidities among patients with fibromyalgia make this a difficult disorder to diagnose and treat.
New diagnostic criteria are available to improve the diagnosis and care of patients. We propose the first French translation of the new diagnostic criteria proposed by the American College of Rheumatology (ACR) 2010.
Although the etiology of fibromyalgia remains unclear, evidences suggest that biologic, genetic and environmental factors are involved.
This chronic psychophysical suffering state of fibromyalgia adversely affects the patient's quality of life, performance and mood.
Studies report a higher prevalence of psychiatric disorders in patients with fibromyalgia that requires careful history and evaluation for the presence of primary or secondary mood disturbances and psychological stress.
Despite the absence of strong evidence of the fibromyalgia pathogenesis, evidence base medecine lead us to consider a biopsychosocial model and a multidisciplinary treatment.
Treatment of fibromyalgia requires a comprehensive and multidimensional approach with patient education, cognitive behavior therapy, exercise, physical therapy and pharmacological therapy. Today, the serotonin noradrenaline reuptake inhibitors (milnacipran and duloxetine) and the antiepileptic (pregabalin) are the most effective drugs available for the treatment for fibromyalgia.
Therapeutic and pathophysiologic researches seem necessary in this disease and should establish an exemplary model for integrative disease where somatic and psychic form a continuum.
La fibromyalgie est une maladie complexe touchant 2 à 5 % de la population générale dans le monde, quels que soient le sexe ou l’âge, avec toutefois une fréquence plus élevée chez les femmes adultes.
La variabilité des symptômes et la fréquence des comorbidités chez les patients souffrant de fibromyalgie en font une maladie un diagnostic difficile et complexe à traiter.
De nouveaux critères diagnostiques sont disponibles, afin d’améliorer le diagnostic et la prise en charge des malades. Nous proposons ici la première traduction française des nouveaux critères diagnostiques proposés par American College of Rheumatology (ACR) de 2010.
Bien que les causes de la fibromyalgie demeurent incertaines, il semble que des facteurs biologiques, génétiques et environnementaux soient impliqués.
Cette maladie douloureuse chronique psychosomatique affecte la qualité de la vie du patient, ses performances et son humeur.
Les études rapportent une prévalence plus élevée de troubles psychiatriques chez les patients souffrant de fibromyalgie, ce qui doit conduire au recueil d’une anamnèse minutieuse ainsi qu’à la recherche de troubles de l’humeur primaires ou secondaires et de stress psychologiques.
Malgré l’absence d’étiopathogénie claire dans la fibromyalgie, la médecine fondée sur les preuves nous permet d’envisager une prise en charge selon un modèle bio psychosocial et multidisciplinaire du patient.
Le traitement de la fibromyalgie devrait bénéficier d’une approche globale et multidimensionnelle mêlant l’éducation du patient, la thérapie cognitivo-comportementale, l’exercice, la thérapie physique et la pharmacothérapie. Aujourd’hui, les inhibiteurs de la sérotonine et de la noradrénaline (milnacipran et duloxétine) et les antiépileptiques (prégabaline) sont actuellement les médicaments les plus efficaces disponibles pour le traitement de la fibromyalgie.
Des recherches thérapeutiques et étiopathogéniques semblent nécessaires dans cette maladie et permettront peut-être de constituer un modèle exemplaire intégratif de maladie où somatique et psychisme forment un continuum.
Sleep Disturbance in Fibromyalgia
2007, Sleep Medicine ClinicsFibromyalgia (FM), characterized by diffuse myalgia, multiple topographically specific tender points, chronic fatigue, psychosocial distress, and disturbed, unrefreshing sleep, is a significant health problem. Clinical survey studies suggest that the majority of FM patients present with insomnia complaints, including difficulty initiating sleep, sleep maintenance problems, or persistent nonrestorative sleep. Studies of clinical FM patients have shown that a worsening of sleep enhances subsequent daytime distress and pain complaints, whereas exacerbations of daytime pain or psychosocial distress often are followed by increased nocturnal sleep disruption. Given such findings, it seems reasonable to speculate that sleep disturbance is mechanistically important to the etiology or symptom maintenance of the FM syndrome. This article provides an overview of FM-related sleep difficulties and their treatment.
Systematic review: Does a diagnosis of fibromyalgia per se have a harmful effect on prognosis?
2006, Reumatologia ClinicaEl objetivo era conocer hasta qué punto la etiqueta de fibromialgia (FM) podía determinar un peor desenlace a corto o largo plazo a los pacientes.
Revisión sistemática. Se seleccionaron, mediante una estrategia sensible, todos los estudios publicados en PubMed (desde 1961), Embase (desde 1991) y Cochrane Library Plus hasta abril de 2005. Se aceptó la inclusión de ensayos clínicos o estudios de pronóstico. Para ello, se revisaron los títulos y los resúmenes de los artículos resultado de la búsqueda.
De un total de 650 referencias proporcionadas por la búsqueda, solo 5 se analizaron en detalle. Dos eran estudios longitudinales que cumplían completamente los criterios de inclusión, realizados en escenarios distintos (Canadá y Reino Unido) y con una muestra suficiente y representativa. En ambos se evidencia un menor uso de recursos sanitarios tras el diagnóstico de FM. Los otros estudios se analizaron en detalle aunque no cumplían criterios de inclusión: 1 estudio longitudinal para ver la evolución del diagnóstico de FM, 1 estudio cualitativo y 1 revisión narrativa. No se encontró ningún estudio en contra de la hipótesis.
No existen indicios de que el diagnóstico per se de FM pueda conllevar un peor pronóstico a los pacientes con este problema. De hecho, la evidencia existente de calidad moderada-buena, hace suponer que, por el contrario, el diagnóstico reduce la presión asistencial por parte de estos pacientes.
The aim of the present study was to determine the extent to which a label of fibromyalgia (FM) could have a harmful effect on short- and long-term prognosis.
We performed a systematic review using a sensitive search strategy. All studies published in PubMed (since 1961), Embase (since 1991) and Cochrane Library Plus (up to 2005) were selected. The titles and abstracts of articles retrieved from the search were reviewed and clinical trials and studies on prognosis were included.
Of a total of 650 references retrieved, only 5 were analyzed in detail. Two were longitudinal studies that completely fulfilled the inclusion criteria. These studies were performed in different countries (Canada and the United Kingdom) with sufficient and representative samples. Both studies reported lower resource utilization after a diagnosis of FM. The remaining studies were analyzed in detail, although they did not fulfill the inclusion criteria: there was one longitudinal study to determine the accuracy of the diagnosis of FM, one qualitative study, and a review article. No studies against the hypothesis that a diagnosis of FM worsens prognosis were found.
There is no evidence that a diagnosis of FM per se could worsen prognosis in patients with this condition. Indeed, the available evidence, which is of moderate-good quality, suggests that, on the contrary, diagnosis reduces healthcare utilization by patients.
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This work was supported in part by a grant from the Kansas Chapter, Arthritis Foundation, and funding from the National Institutes of Health (AM-21393).