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Posted to Co-Cure Thu, 31 Aug 2000 17:39:36 +0000

Fibromyalgia syndrome in men

Fibromyalgia syndrome in men.
Semin Arthritis Rheum 2000 Aug;30(1):47-51
Buskila D, Neumann L, Alhoashle A, Abu-Shakra M
Epidemiology Department, Ben Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel. E-Mail: lily@bgumail.bgu.ac.il
PMID: 10966212, UI: 20419396

Abstract

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Posted to Co-Cure Sun, 27 Aug 2000 15:03:55 -0400 by Fred Springfield

A high-recovery extraction procedure for quantitative analysis of substance P and opioid peptides in human cerebrospinal fluid

A high-recovery extraction procedure for quantitative analysis of substance P and opioid peptides in human cerebrospinal fluid.
Peptides 2000 Jun 1;21(6):853-860
Liu Z, Welin M, Bragee B, Nyberg F
Department of Pharmaceutical Biosciences, Divison of Biological Research on Drug Dependence, Uppsala University, P.O. Box 591, S-751 24, Uppsala, Sweden
PMID: 10959008

This study reports an improved approach for the determination of neuropeptide levels in human cerebrospinal fluid (CSF). The method is based on sample acidification followed by liquid-liquid extraction (LLE) combined with radioimmunoassay. It was applied to study the recovery and level of some opioid peptides (Met-enkephalin-Arg(6)-Phe(7) and Leu-enkephalin-Arg(6)), substance P and the substance P(1-7) fragment, which are all compounds known to be present in human CSF.

The results indicated that the use of LLE highly improved the recovery of these peptides compared to current liquid-solid-phase extraction methods by using silica gel cartridges or mini-columns for ion-exchange chromatography. Peptides added to CSF in concentrations down to 10 fmol/ml were recovered in yields exceeding 80%. The mean recovery of synthetic peptides as recorded by radioimmunoassay in the LLE procedure was significantly improved when HCl was added to the sample. In contrast, when the (125)I-labeled analogues of the peptides were added to CSF samples, the mean recovery of the four labeled peptides using the LLE procedure was markedly reduced in acidified samples. We also found that the inclusion of HCl effectively improved the removal of proteins present in the samples.

As an application the levels of substance P and Met-enkephalin-Arg(6)-Phe(7) in CSF samples from patients with chronic pain (fibromyalgia syndrome) were measured using the new procedure. It was possible to confirm a significant difference in the CSF levels of both peptides when comparing patients and controls.

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Posted to Co-Cure Fri, 25 Aug 2000 18:52:07 +0200 by Dr. Marc-Alexander Fluks

Strength and physiological response to exercise in patients with CFS

Strength and physiological response to exercise in patients with chronic fatigue syndrome
Kathy Y Fulcher(a), Peter D White(b)
    (a) National Sports Medicine Institute, St Bartholomew's and the Royal London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK,
    (b) Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London EC1A 7BE, UK
Correspondence to: Dr PD White E-Mail: p.d.white@mds.qmw.ac.uk
Received 12 January 1999 and in revised form 7 January 2000;
Accepted 21 January 2000

Abstract
OBJECTIVE - To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder.

METHODS - Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity.

RESULTS - Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise.

CONCLUSIONS - Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function.

Keywords: chronic fatigue syndrome; exercise; incapacity; muscle strength; fitness

Full Article

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Posted to Co-Cure Fri, 25 Aug 2000 00:47:27 -0400 by Kimberly Hare

Measuring the epidemiology of distress: the rheumatology distress index

Measuring the epidemiology of distress: the rheumatology distress index.
J Rheumatol 2000 Aug;27(8):2000-9
Wolfe F, Skevington SM
National Data Bank for Rheumatic Diseases, Arthritis Reserach Center Foundation, and University of Kansas School of Medicine, Wichita 67214, USA. E-Mail: fwolfe@arthritis-research.org
PMID: 10955344, UI: 20410311

OBJECTIVES: (1) To examine clinical and psychological variables to determine which are associated with psychologic and psychosocial severity or "distress"; (2) to investigate whether patients with the 2 major rheumatic disorders, rheumatoid arthritis (RA) and osteoarthritis (OA), differ in distress variables and distress; and (3) to develop and validate a simple, clinically acceptable index of distress suitable for routine care and research purposes.

METHODS: A total of 2,403 patients were evaluated in 2 data sets (N = 1,399 and N = 1,490). The first data set was evaluated in the clinic by a routine clinical examination and administration of the Clinical Health Assessment Questionnaire (CLINHAQ). This instrument includes measures of pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. The second data set was evaluated by a mailed questionnaire that included the CLINHAQ, but also coping scales, the Beliefs in Pain Control Questionnaire, the Self Performance Scale, and the Arthritis Helplessness Index.

RESULTS: RA and OA groups had similar scores for the variables associated with distress: pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. Patients with fibromyalgia (FM) had more abnormal scores for every variable, reflecting overall distress. Using patients with FM as a "gold standard" of distress, we developed an index in data set 2. the Rheumatology Distress Index (RDI), made up of 5 variables, anxiety, depression, global severity, fatigue, and sleep disturbance, that best identified patients with FM compared to other patients. We then validated the instrument on the distress severity clusters formed in data set 1. The correlation between RDI and distress severity cluster was 0.874 with all patients considered and 0.867 with FM patients excluded. In addition, RDI predicted 1,174 of 1,399 (83.9%) cluster memberships correctly. Compared with a battery of psychological and clinical tests that classified 74% of FM and non-FM patients correctly, the RDI and is only slightly less effective, classifying 70.3% correctly.

CONCLUSION: Distress is a patient rather than a disease phenomenon. A simple, easy to administer self-report questionnaire can be used to classify patients according to their level of distress. The resulting index, the RDI, accurately identifies distressed and non-distressed patients. Such an index should be useful for patient care and research.

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Posted to Co-Cure Fri, 25 Aug 2000 00:38:25 -0400 by Kimberly Hare

The impact of life events in female patients with fibromyalgia and in female healthy controls

The impact of life events in female patients with fibromyalgia and in female healthy controls.
Eur Psychiatry 2000 Aug;15(5):295-301
Anderberg UM, Marteinsdottir I, Theorell T, von Knorring L
Dept. of Neuroscience, Psychiatry, University Hospital, SE-75185 Uppsala, Sweden.
PMID: 10954873

The aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women.

A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study.

During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01). Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

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Posted to Co-Cure Fri, 25 Aug 2000 00:42:56 -0400 by Kimberly Hare

The assessment of functional impairment in fibromyalgia ...

The assessment of functional impairment in fibromyalgia (FM): Rasch analyses of 5 functional scales and the development of the FM Health Assessment Questionnaire.
J Rheumatol 2000 Aug;27(8):1989-99
Wolfe F, Hawley DJ, Goldenberg DL, Russell IJ, Buskila D, Neumann L
University of Kansas School of Medicine, Wichita, USA.
PMID: 10955343, UI: 20410310

OBJECTIVE: Functional assessment by self-report questionnaire plays an important role in most rheumatic conditions, but psychometric properties of questionnaires have not been studied in fibromyalgia (FM), particularly by Rasch analysis, which allows for examining adequacy of the questionnaire scale. To assess currently used instruments, we examined the Fibromyalgia Impact Scale (FIQ), 4 versions of the Health Assessment Questionnaire (HAQ), and the Medical Outcome Survey Short Form (SF-36).

METHODS: More than 2,500 patients from 4 sites (3 US, 1 Israel) completed the FIQ. The HAQ questionnaires were completed by 1438 patients participating in the US National Data Bank for Rheumatic Diseases. Seven hundred sixty patients from Wichita, Kansas, completed the SF-36. Rasch analysis was applied separately to each of these data sets.

RESULTS: The FIQ systematically underestimated functional impairment by its handling of activities not usually performed. All questionnaires had problems with non-unidimensionality and ambiguous items when applied to patients with FM. In addition, scales were found to be non-linear. Because of these findings we used the 20 item HAQ questionnaire as an item bank to develop a new questionnaire more suitable for use in FM, the fibromyalgia HAQ (FHAQ). This questionnaire fits the Rasch model well, is relevant, is linear, and has a long, well spaced scale.

CONCLUSION: No available functional assessment questionnaire works well in FM. A new questionnaire, the FHAQ, was developed. It has appropriate metric properties and should function well in this condition. Since the FHAQ is a subset of the larger HAQ questionnaire, a new questionnaire is not required; only a different method of scoring is needed. Additional studies regarding sensitivity to change are required to fully validate the FHAQ.

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Posted to Co-Cure Thu, 24 Aug 2000 02:27:49 -0400 by Ray Colliton

CDC Testing Methods for Detecting HHV-6 Questionable

CDC Testing Methods for Detecting HHV-6 Questionable
by Tamara Schuit
ImmuneSupport.com

08-21-2000 - (Last week, we published a test conducted by the CDC that stated “there is no evidence that HHV-6A, 6B, 7 or any combination is associated with CFS.” The following takes another view of HHV-6 and CFS--editor)

Contrary to findings from the Center for Disease Control (the CDC), HHV-6 can indeed account for the clinical symptoms of CFS, according to research conducted by Konnie Knox, M.D., and Donald Carrigan, M.D., of ViraCor Diagnostic Labs.

The problem with the CDC testing, say Knox and Carrigan, is that it tested both patient and control groups using serum samples, lymphocytes and three polymerase chain reaction methods. According the two researchers, these tests are not an accurate means of detecting active HHV-6 infection.

Read the complete article

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Posted to Co-Cure Wed, 23 Aug 2000 18:36:01 -0400 by Kimberly Hare

Is Fibromyalgia a Distinct Clinical Syndrome?

Is Fibromyalgia a Distinct Clinical Syndrome?
Curr Rev Pain 2000;4(4):287-294
Rau Cl, Russell IJ
Department of Medicine, Division of Clinical Immunology, Mail Code 7868, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. E-Mail: russell@uthscsa.edu
PMID: 10953276

The validity of the fibromyalgia syndrome (FMS) as a distinct clinical entity has been challenged for several reasons. Many skeptics express concern about the subjective nature of chronic pain, the subjectivity of the tender point (TeP) examination, the lack of a gold standard laboratory test, and the absence of a clear pathogenic mechanism by which to define FMS. Another expressed concern has been the relative nature of the pain-distress relationship in the rheumatology clinic.

The apparently continuous relationship between TePs and somatic distress across a variety of clinical disorders is said to argue against FMS as a separate clinical disorder. The most aggressive challenges of the FMS concept have been from legal defenses of insurance carriers motivated by economic concerns. Other forms of critique have presented as psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of nociceptive physiology, and occasionally have resulted from honest misunderstanding.

It is not likely that a few paragraphs of data and logic will cause an unbeliever to change an ingrained opinion. Therefore, this review describes the clinical manifestations of FMS, responds to some of the theoretic arguments against it, and discusses some possible pathophysiologic mechanisms by which FMS may develop and persist as a unique syndrome.

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Posted to Co-Cure Wed, 23 Aug 2000 18:32:40 -0400 by Kimberly Hare

Psychological Determinants of Fibromyalgia and Related Syndromes

Psychological Determinants of Fibromyalgia and Related Syndromes.
Curr Rev Pain 2000;4(4):276-286
Winfield JB
Thurston Arthritis Research Center, 3330 C Thurston Building, Campus box # 7280, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. E-Mail: john_winfield@med.unc.edu
PMID: 10953275

Fibromyalgia and other chronic pain and fatigue syndromes constitute an increasingly greater societal burden that currently is not being approached effectively by traditional Western medicine.

Although the hallmarks of fibromyalgia--chronic widespread pain, fatigue, and multiple other somatic symptoms--have neurophysiologic and endocrinologic underpinnings, these biological aspects derive primarily from psychological variables.

Female gender, adverse experiences during childhood, psychological vulnerability to stress, and a stressful, often frightening environment and culture are important antecedents of fibromyalgia. To understand fibromyalgia and related syndromes and to provide optimum care requires a biopsychosocial, not a biomedical, viewpoint.

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Posted to Co-Cure Wed, 23 Aug 2000 18:37:56 -0400 by Kimberly Hare

Fibromyalgia Following Trauma: Psychology or Biology?

Fibromyalgia Following Trauma: Psychology or Biology?
Curr Rev Pain 2000;4(4):295-300
Gardner GC
Division of Rheumatology, Box 356428, University of Washington, Seattle, WA 98195, USA.
PMID: 10953277

The concept that fibromyalgia may follow trauma is currently an area of intense debate within the medical field and is driven to a large extent by social and legal issues. This article questions whether the current literature supports the notion that trauma may cause fibromyalgia and explores the relative contribution of biology and psychology in the development of and sense of disability from fibromyalgia.

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Posted to Co-Cure Tue, 22 Aug 2000 21:03:04 -0400 by Kimberly Hare

Insights into muscle diseases gained by phosphorus magnetic resonance spectroscopy

Insights into muscle diseases gained by phosphorus magnetic resonance spectroscopy.
Muscle Nerve 2000 Sep;23(9):1316-1334
Argov Z, Lofberg M, Arnold DL
Magnetic Resonance Spectroscopy Unit, Montreal Neurological Institute, 3801 University Street, Montreal, Quebec H3A 2B4, Canada.
PMID: 10951434

Phosphorus magnetic resonance spectroscopy (P-MRS) has now been used in the investigation of muscle energy metabolism in health and disease for over 15 years.

The present review describes the basics of the metabolic observations made by P-MRS including the assumptions and problems associated with the use of this technique. Extramuscular factors, which may affect the P-MRS results, are detailed.

The important P-MRS observations in patients with mitochondrial myopathies, including the monitoring of experimental therapies, are emphasized. The findings in other metabolic myopathies (those associated with glycolytic defects or endocrine disturbances) and in the destructive myopathies (the dystrophies and the inflammatory myopathies) are also described.

Observations made in normal and abnormal fatigue, fibromyalgia, and malignant hyperthermia are considered. Finally, a summary of the possible diagnostic use of P-MRS in exercise intolerance is provided.

Copyright 2000 John Wiley & Sons, Inc.

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Posted to Co-Cure Tue, 22 Aug 2000 20:59:31 -0400 by Kimberly Hare

Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia

Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia.
Rheumatology (Oxford) 2000 Aug;39(8):917-921
Jeschonneck M, Grohmann G, Hein G, Sprott H
Department of Internal Medicine IV and. Department of Internal Medicine III, Friedrich Schiller University, Jena, Germany and. Department of Rheumatology and Institute of Physical Medicine, University Hospital, Zurich, Switzerland.
PMID: 10952750

OBJECTIVE: Skin temperature and skin blood flow were studied above different tender points in 20 patients with fibromyalgia (FM) and 20 healthy controls.

METHODS: Blood flow was measured by laser Doppler flowmetry and skin temperature was measured with an infrared thermometer.

RESULTS: In the skin above the five tender points examined in each subject, we found an increased concentration of erythrocytes, decreased erythrocyte velocity and a consequent decrease in the flux of erythrocytes. A decrease in temperature was recorded above four of the five tender points.

CONCLUSION: Vasoconstriction occurs in the skin above tender points in FM patients, supporting the hypothesis that FM is related to local hypoxia in the skin above tender points.

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Posted to Co-Cure Tue, 22 Aug 2000 20:44:36 -0400 by Fred Springfield

A Comparison of Self-Estimated Symptoms and Impact of Disease in FMS and RA

A Comparison of Self-Estimated Symptoms and Impact of Disease in Fibromyalgia and Rheumatoid Arthritis
Journal of Musculoskeletal Pain, Vol. 8(3) 2000
Jorma Viitanen, M.D.; Sisko Ronni, M.D.; Sirkku Ala-Peijari; Kirsti Uoti-Reilama, M.D.; Hannu Kautiainen

ABSTRACT.
Objective: To investigate self-assessed impairments and impact of fibromyalgia [FMS] in 86 patients and to compare the results with those from the 74 rheumatoid patients [RA] who attended a three- week inpatient course.

Methods: Self-estimated symptoms as elicited using a multivariant questionnaire together with the Epworth Sleepiness Scale, the Rimons’ Brief Depression Scale, and Arthritis Impact Measurement Scales were compared between the two cohorts.

Results: Fibromyalgia patients identified significantly more pain, sleep disorders, daytime dozing, and difficulties in social activities, and were subjectively more depressive and anxious than RA patients. However, assessments of global health and ability to work in the two groups did not differ significantly, while RA patients’ fitness and “functional ability” were assessed as slightly poorer.

Conclusion: Fibromyalgia patients experienced more psychosocial problems and felt impairments equally or even more than RA patients. The role of these symptoms in the disability of FMS patients would also be reliably assessed in outcome measures.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com .]

KEYWORDS. Fibromyalgia, rheumatoid arthritis, comparison, quality of life


Jorma Viitanen, MD, is Rheumatologist and Chief Physician, Sisko Ronni, MD, is Specialist in Physical Therapy and Rehabilitation, Sirkku Ala-Peijari is Physiotherapist, and Kirsti Uoti-Reilama, MD, is Rheumatologist, Rehabilitation Institute of the Finnish Rheumatism Association, Kangasala, Finland.

Hannu Kautiainen is Statistician, Rheumatism Foundation Hospital, Heinola, Finland.

Address correspondence to: Jorma Viitanen, MD, Reumaliiton Kuntoutumislaitos, FIN-36200 Kangasala, Finland.

The authors thank the Institutes’ personnel for invaluable work in the collection of material.

Submitted: March 26, 1999.
Revision accepted: August 22, 1999.

Journal of Musculoskeletal Pain, Vol. 8(3) 2000
© 2000 by The Haworth Press, Inc. All rights reserved.

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Note: All abstract summaries, unless otherwise noted, were prepared by Margaret Bailey.


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