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Posted to Co-Cure Sun, 17 Dec 2000 15:09:20 -0500 by Fred Springfield

Irritant Rhinitis in Allergic, Nonallergic, Control and CFS Populations

Full Title: Irritant Rhinitis in Allergic, Nonallergic, Control and Chronic Fatigue Syndrome Populations
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 3-31
Authors: James N. Baraniuk, MD; Kristina Naranch, BA; Hilda Maibach, MS; Daniel J. Clauw, MD
Affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Lower Level Gorman Building, 3800 Reservoir Road, N.W., Washington, DC 20007-2197. Address correspondence to: James N. Baraniuk at the above address. (E-mail:
Background: Irritation symptoms after exposure to “nonspecific” stimuli are often attributed to nonallergic rhinitis (vasomotor rhinitis). This is a heterogeneous syndrome of exclusion based on nasal symptoms with negative allergy skin tests.

Method: Control (n = 114) and Chronic Fatigue Syndrome (CFS, n = 120) subjects scored the severity of nasal congestion and rhinorrhea sensations that they attributed to 9 irritants. The sum was the “Irritant Rhinitis Score” (IRS, maximum 72). A positive IRS of >/= 19 defined “Irritant Rhinitis.” Demographic, allergy skin test and other assessments were done to characterize the Irritant Rhinitis population.

Results: Irritant Rhinitis was present in 11% of control and 47% of CFS subjects. In multivariate analysis, positive IRS was correlated with a history of rhinitis complaints, systemic complaints such as fatigue, sensations of congestion and rhinorrhea induced by meteorological conditions, tobacco smoke, odors, perfumes, and other volatile materials, and diagnoses of CFS and Multiple Chemical Sensitivity (MCS). Although atopy was not correlated to Irritant Rhinitis, 51% of allergic rhinitis subjects had a positive IRS.

Conclusions: The Irritant Rhinitis Score defined a population with irritant-induced nasal congestion and rhinorrhea who also had significant systemic complaints. Similar neural mechanisms may underlie the spectrum of Irritant Rhinitis, CFS and MCS.

KEYWORDS. Irritant Rhinitis, Vasomotor Rhinitis, Nonallergic Rhinitis, Allergic Rhinitis, Multiple Chemical Sensitivity, Chronic Multisystem Illness, Tobacco Sensitivity

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

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Thu, 21 Dec 2000 15:02:37 -0500

Fibromyalgia in Curr Rheumatol Rep 2000 Apr;2(2)

Six abstracts of articles from Curr Rheumatol Rep 2000 Apr;2(2) dealing directly with fibromyalgia:

Full Title: Musculoskeletal Injury as a Trigger for Fibromyalgia/ Posttraumatic Fibromyalgia.
Journal: Curr Rheumatol Rep 2000 Apr;2(2):104-108
Authors: Buskila D, Neumann L
Affiliation: Rheumatic Disease Unit, Soroka Medical Center, and Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
NLM Citation: PMID: 11123046

The authors conclude:

"Overall data from the current literature are insufficient to indicate whether causal relationships exist between trauma and FM. However, recent reports suggest that soft tissue trauma to the neck can result in an increased incidence of FM compared with other injuries."


Full Title: Pain in Patients with Fibromyalgia Syndrome.
Journal: Curr Rheumatol Rep 2000 Apr;2(2):109-115
Authors: Turk DC, Okifuji A
Affiliation: Department of Anesthesiology, Box 356540, University of Washington, Seattle, WA 98195, USA.
NLM Citation: PMID: 11123047

The authors conclude:

"In this article, we provide methodological guidelines for pain assessment and review recent developments in understanding pain mechanisms and evaluating treatments in FMS. Finally, we demonstrate the heterogeneity of the FMS population and suggest the need for matching treatments to patient characteristics in order to improve clinical outcomes."


Full Title: Sympathetic Nervous System Function in Fibromyalgia.
Journal: Curr Rheumatol Rep 2000 Apr;2(2):116-123
Authors: Petzke F, Clauw DJ
Affiliation: Division of Rheumatology, Immunology, and Allergy, Georgetown University Medical Center, LL Gorman Building, 3800 Reservoir Road NW, Washington, DC 20007.
NLM Citation: PMID: 11123048

The authors state:

"This review focuses on studies of the sympathetic nervous system in fibromyalgia (FM)."


Full Title: Sleep and Circadian Rhythm Disorders in Fibromyalgia.
Journal: Curr Rheumatol Rep 2000 Apr;2(2):124-130
Author: Korszun A
Affiliation: Department of Psychological Medicine, University of Wales College of Medicine, Heath Park Cardiff CF4 4XN, UK.
NLM Citation: PMID: 11123049

The authors conclude:

"This review focuses on the role of sleep and circadian rhythm disorders in FM and, in the absence of any specific treatment for FM, presents a pragmatic therapeutic approach aimed at identifying and treating comorbid sleep and depressive disorders, optimizing sleep habits, and judicious use of pharmacologic agents.


Full Title: Evidence for Metabolic Abnormalities in the Muscles of Patients with Fibromyalgia.
Journal: Curr Rheumatol Rep 2000 Apr;2(2):131-140
Authors: Park JH, Niermann KJ, Olsen N
Affiliation: Vanderbilt University School of Medicine, Department of Radiology, Division of Rheumatology and Immunology, Department of Medicine, 3219 Medical Center North, Vanderbilt University, Nashville, TN 37232-2681, USA.
NLM Citation: PMID: 11123050

The authors conclude:

"The accurate assignment of intrinsic or extrinsic factors has been substantially clarified by a recent surge of experimental findings. Irrespective of the multifaceted causes of muscle dysfunction and pain, an in-depth understanding of the muscle defects may provide ideas for characterization of the underlying pathogenesis and development of new therapeutic approaches for fibromyalgia syndrome.


Full Title: Use of Neuroimaging to Understand Abnormal Pain Sensitivity in Fibromyalgia.
Authors: Bradley LA, McKendree-Smith NL, Alberts KR, Alarcon GS, Mountz JM, Deutsch G
Affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, BDB 475, 1808 7th Ave S, Birmingham, Alabama 35294-0012.
NLM Citation: PMID: 11123051

The authors conclude:

"We anticipate that future neuroimaging studies will enhance our understanding of abnormal pain sensitivity and of pain management interventions aimed at altering central nervous system function in patients with fibromyalgia."


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Posted to Co-Cure Fri, 22 Dec 2000 15:29:15 +1100 by Moira A. Smith

Regional Cerebral Blood Flow in Fibromyalgia:...

Full Title: Regional Cerebral Blood Flow in Fibromyalgia: Single-Photon-Emission Computed Tomography Evidence of Reduction in the Pontine Tegmentum and Thalami

Journal: Arthritis Rheum 2000 Dec;43(12);2823-2833

Authors and Affiliations: Richard Kwiatek, MBBS, FRACP, Leighton Barnden, PhD, Jenni Chew, BAppSc, Christopher Rowe, MD, FRACP, Kevin Pile, MD, FRACP: The Queen Elizabeth Hospital, Adelaide, Australia; Raymond Tedman, PhD, Richard Jarrett, PhD: The University of Adelaide, Adelaide, Australia.

Submitted for publication February 22, 2000;
accepted in revised form August 21, 2000.

Address reprint requests to Richard Kwiatek, MBBS, FRACP, Department of Rheumatology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia.

Objective. To determine whether regional cerebral blood flow (rCBF) is abnormal in any cerebral structure of women with fibromyalgia (FM), following a report that rCBF is reduced in the thalami and heads of caudate nuclei in FM.

Methods. Seventeen women with FM and 22 healthy women had a resting single-photon-emission computed tomography (SPECT) brain scan to assess rCBF and a T1-weighted magnetic resonance imaging (MRI) scan to enable precise anatomic localization. Additionally, all participants underwent 2 manual tender point examinations and completed a set of questionnaires evaluating clinical features. SPECT scans were analyzed for differences in rCBF between groups using statistical parametric mapping (SPM) and regions of interest (ROIs) manually drawn on coregistered MRI.

Results. Compared with control subjects, the rCBF in FM patients was significantly reduced in the right thalamus (P = 0.006), but not in the left thalamus or head of either caudate nucleus. SPM analysis indicated a statistically significant reduction in rCBF in the inferior pontine tegmentum (corrected P = 0.006 at the cluster level and corrected P = 0.023 for voxel of maximal significance), with consistent findings from ROI analysis (P = 0.003). SPM also detected a reduction in rCBF on the perimeter of the right lentiform nucleus. No correlations were found with clinical features or indices of pain threshold.

Conclusion. Our finding of a reduction in thalamic rCBF is consistent with findings of functional brain imaging studies of other chronic clinical pain syndromes, while our finding of reduced pontine tegmental rCBF is new. The pathophysiologic significance of these changes in FM remains to be elucidated.

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Posted to Co-Cure Tue, 19 Dec 2000 11:43:56 -0500 by Fred Springfield

Specific oxidative alterations in vastus lateralis muscle of CFS patients

Full Title: Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome.
Journal: Free Radic Biol Med 2000 Dec 15;29(12):1252-1259
Authors: Fulle S, Mecocci P, Fano G, Vecchiet I, Vecchini A, Racciotti D, Cherubini A, Pizzigallo E, Vecchiet L, Senin U, Beal MF
Affiliation: Lab. Interuniversitario di Miologia, Dip. Biologia Cellulare e Molecolare, Universita di Perugia, Perugia, Italy
NLM Citation: PMID: 11118815

Chronic fatigue syndrome (CFS) is a poorly understood disease characterized by mental and physical fatigue, most often observed in young white females. Muscle pain at rest, exacerbated by exercise, is a common symptom.

Although a specific defect in muscle metabolism has not been clearly defined, yet several studies report altered oxidative metabolism. In this study, we detected oxidative damage to DNA and lipids in muscle specimens of CFS patients as compared to age-matched controls, as well as increased activity of the antioxidant enzymes catalase, glutathione peroxidase, and transferase, and increases in total glutathione plasma levels.

From these results we hypothesize that in CFS there is oxidative stress in muscle, which results in an increase in antioxidant defenses. Furthermore, in muscle membranes, fluidity and fatty acid composition are significantly different in specimens from CFS patients as compared to controls and to patients suffering from fibromyalgia.

These data support an organic origin of CFS, in which muscle suffers oxidative damage.

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Posted to Co-Cure Thu, 21 Dec 2000 14:01:42 -0500

The Sympathetic Nerve - An Integrative Interface between Two Supersystems: The Brain and the Immune System

Full Title: The Sympathetic Nerve - An Integrative Interface between Two Supersystems: The Brain and the Immune System.
Journal: Pharmacol Rev 2000 Dec;52(4):595-638
Authors: Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES
Affiliation: Inflammatory Joint Diseases Section, Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland.
NLM Citation: PMID: 11121511

The brain and the immune system are the two major adaptive systems of the body. During an immune response the brain and the immune system "talk to each other" and this process is essential for maintaining homeostasis. Two major pathway systems are involved in this cross-talk: the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). This overview focuses on the role of SNS in neuroimmune interactions, an area that has received much less attention than the role of HPA axis.

Evidence accumulated over the last 20 years suggests that norepinephrine (NE) fulfills the criteria for neurotransmitter/neuromodulator in lymphoid organs. Thus, primary and secondary lymphoid organs receive extensive sympathetic/noradrenergic innervation. Under stimulation, NE is released from the sympathetic nerve terminals in these organs, and the target immune cells express adrenoreceptors. Through stimulation of these receptors, locally released NE, or circulating catecholamines such as epinephrine, affect lymphocyte traffic, circulation, and proliferation, and modulate cytokine production and the functional activity of different lymphoid cells.

Although there exists substantial sympathetic innervation in the bone marrow, and particularly in the thymus and mucosal tissues, our knowledge about the effect of the sympathetic neural input on hematopoiesis, thymocyte development, and mucosal immunity is extremely modest. In addition, recent evidence is discussed that NE and epinephrine, through stimulation of the beta(2)-adrenoreceptor-cAMP-protein kinase A pathway, inhibit the production of type 1/proinflammatory cytokines, such as interleukin (IL-12), tumor necrosis factor-alpha, and interferon-gamma by antigen-presenting cells and T helper (Th) 1 cells, whereas they stimulate the production of type 2/anti-inflammatory cytokines such as IL-10 and transforming growth factor-beta.

Through this mechanism, systemically, endogenous catecholamines may cause a selective suppression of Th1 responses and cellular immunity, and a Th2 shift toward dominance of humoral immunity. On the other hand, in certain local responses, and under certain conditions, catecholamines may actually boost regional immune responses, through induction of IL-1, tumor necrosis factor-alpha, and primarily IL-8 production.

Thus, the activation of SNS during an immune response might be aimed to localize the inflammatory response, through induction of neutrophil accumulation and stimulation of more specific humoral immune responses, although systemically it may suppress Th1 responses, and, thus protect the organism from the detrimental effects of proinflammatory cytokines and other products of activated macrophages.

The above-mentioned immunomodulatory effects of catecholamines and the role of SNS are also discussed in the context of their clinical implication in certain infections, major injury and sepsis, autoimmunity, chronic pain and fatigue syndromes, and tumor growth.

Finally, the pharmacological manipulation of the sympathetic-immune interface is reviewed with focus on new therapeutic strategies using selective alpha(2)- and beta(2)-adrenoreceptor agonists and antagonists and inhibitors of phosphodiesterase type IV in the treatment of experimental models of autoimmune diseases, fibromyalgia, and chronic fatigue syndrome.


Note: This is U.S. Government work not protected by U.S. copyright. The full article in PDF format may be read at

[PDF-formatted documents require an Acrobat text reader in order to read them, but most newer computers come with Acrobat already bundled with the computer's system software. If you need to obtain a free Acrobat reader, see .]

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Posted to Co-Cure Fri, 15 Dec 2000 13:03:02 -0500 by Kimberly Hare

Strength training induced adaptations in neuromuscular function of premenopausal women with FM

Full Title: Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women.
Journal: Ann Rheum Dis 2001 Jan;60(1):21-26
Authors: Hakkinen A, Hakkinen K, Hannonen P, Alen M
Affiliation: Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland.
NLM Citation: PMID: 11114277

OBJECTIVE: To investigate the effects of 21 weeks' progressive strength training on neuromuscular function and subjectively perceived symptoms in premenopausal women with fibromyalgia (FM).

METHODS: Twenty one women with FM were randomly assigned to experimental (FM(T)) or control (FM(C)) groups. Twelve healthy women served as training controls (H(T)). The FM(T) and H(T) groups carried out progressive strength training twice a week for 21 weeks. The major outcome measures were muscle strength and electromyographic (EMG) recordings. Secondary outcome measures were pain, sleep, fatigue, physical function capacity (Stanford Health Assessment Questionnaire), and mood (short version of Beck's depression index).

RESULTS: Female FM(T) subjects increased their maximal and explosive strength and EMG activity to the same extent as the H(T) group. Moreover, the progressive strength training showed immediate benefits on subjectively perceived fatigue, depression, and neck pain of training patients with FM.

CONCLUSIONS: The strength training data indicate comparable trainability of the neuromuscular system of women with FM and healthy women. Progressive strength training can safely be used in the treatment of FM to decrease the impact of the syndrome on the neuromuscular system, perceived symptoms, and functional capacity. These results confirm the opinion that FM syndrome has a central rather than a peripheral or muscular basis.

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Posted to Co-Cure Tue, 12 Dec 2000 11:40:14 -0500 by Fred Springfield

Results of Isoproterenol Tilt Table Testing in Monozygotic Twins Discordant for CFS

Full Title: Results of Isoproterenol Tilt Table Testing in Monozygotic Twins Discordant for Chronic Fatigue Syndrome.
Journal: Arch Intern Med 2000 Dec 11/25;160(22):3461-3468
Authors: Poole J, Herrell R, Ashton S, Goldberg J, Buchwald D
Affiliation: Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98104.
NLM Citation: PMID: 11112240

BACKGROUND: The pathogenesis of chronic fatigue syndrome (CFS) is unknown. Neurally mediated hypotension (NMH) has been suggested as a common comorbid condition or a potential underlying cause.

METHODS: We conducted a cotwin control study of 21 monozygotic twins who were discordant for CFS. One twin met the 1994 Centers for Disease Control and Prevention criteria for CFS, and the other twin was healthy and denied chronic fatigue. The twins were selected from a volunteer twin registry in which at least 1 member reported persistent fatigue. As part of a 7-day clinical evaluation, all 21 twin pairs were evaluated with a 3-stage tilt table test with isoproterenol hydrochloride for the assessment of NMH. The presence of NMH was defined as syncope or presyncope associated with a decrease of 25 mm Hg in blood pressure and no associated increase in heart rate.

RESULTS: A positive tilt table test result was observed in 4 twins with CFS (19%) and in 4 healthy twins (19%). This difference was not statistically significant (matched pair odds ratio, 1.0; 95% confidence interval, 0.2-5.4; P>.90). Compared with the healthy twins, the twins with CFS reported more severe symptoms of CFS and NMH both in the week before and during the tilt table test.

CONCLUSIONS: These results do not support a major role for NMH in CFS. They highlight the importance of selecting well-matched control subjects, as well as the unique value of the monozygotic cotwin control design in the study of this illness.

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

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