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Galosi E, Pirone C, Ceccarelli F, Esposito N, Falco P, Leopizzi M, Di Maio V, Tramontana L, De Stefano G, Di Pietro G, Di Stefano G, Garufi C, Leone C, Natalucci F, Orefice V, Alessandri C, Spinelli FR, Truini A, Conti F. Clinical, histologic, and immunologic signatures of Small Fiber Neuropathy in Systemic Lupus Erythematosus. J Peripher Nerv Syst 2024; 29:315-328. [PMID: 38981675 DOI: 10.1111/jns.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Systemic Lupus Erythematosus (SLE) often causes damage to small nerve fibers, leading to distressing painful and autonomic symptoms. Despite this, Small Fiber Neuropathy (SFN) remains an underrecognized complication for SLE patients. In this cross-sectional study, we aimed to assess SFN in patients with SLE and to explore its correlations with immunologic disease features and clinical manifestations. METHODS We recruited 50 SLE patients (1 male to 12.5 females, aged 20-80 years) reporting painful disturbances. We conducted a comprehensive clinical and neurophysiological evaluation, using Nerve Conduction Studies and Quantitative Sensory Testing. Additionally, we carried out an extensive laboratory assessment of disease-related serological parameters. We also performed a thorough skin biopsy analysis, investigating somatic and autonomic innervation while detecting complement and inflammatory cell infiltrates within the skin. RESULTS Out of 50 patients, 19 were diagnosed with SFN, primarily characterized by a non-length-dependent distribution; 7 had a mixed neuropathy, with both large and small fiber involvement. Patients with SFN were younger than patients with a mixed neuropathy (p = .0143); furthermore, they were more likely to have a history of hypocomplementemia (p = .0058) and to be treated with cyclosporine A (p = .0053) compared to patients without neuropathy. However, there were no significant differences in painful and autonomic symptoms between patients with and without SFN. DISCUSSION This study highlights the relevant frequency of SFN with a non-length-dependent distribution among SLE patients experiencing painful symptoms. Indeed, SFN emerges as an early manifestation of SLE-related neuropathy and is closely associated with hypocomplementemia, suggesting a potential pathogenic role of the complement system. Moreover, SFN may be influenced by disease-modifying therapies. However, the precise role of SFN in shaping painful and autonomic symptoms in patients with SLE remains to be fully elucidated.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carmelo Pirone
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Fulvia Ceccarelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Nicoletta Esposito
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Pietro Falco
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Martina Leopizzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Valeria Di Maio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Lorenzo Tramontana
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Cristina Garufi
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Francesco Natalucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Valeria Orefice
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Cristiano Alessandri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
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Mease P, Reed G, Ogdie A, Pappas DA, Kremer JM. Prevalence of Fibromyalgia and Widespread Pain in Psoriatic Arthritis: Association With Disease Severity Assessment in a Large US Registry. Arthritis Care Res (Hoboken) 2024; 76:1313-1321. [PMID: 38736168 DOI: 10.1002/acr.25358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE The classic conception of pain etiology in rheumatologic disease is nociceptive pain-tissue injury and inflammation signaling through peripheral and central nerve fibers. But this can be mixed with other pain etiologies, including nociplastic, which is augmented pain experience due to central sensitization. The pain of fibromyalgia (FM) is nociplastic, occurs in 10% to 30% of patients with rheumatologic disease, and its presence can influence disease severity assessment. The objective of our study was to (1) ascertain the prevalence of FM and widespread pain (WP) in the CorEvitas psoriatic arthritis (PsA) registry as assessed by the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) questionnaires; (2) characterize the demographic and clinical factors associated with FM and WP; and (3) ascertain the association of FM and WP on the Clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score and other disease activity measures. METHODS PsA registry patients completing the WPI/SSS questionnaires since May 2020, at their most recent visit recorded in the registry, were analyzed. RESULTS The analysis included 1,823 patients with PsA; 11.1% fulfilled the FM definition and 20.6% fulfilled the WP definition. Several factors were associated with the FM definition, including female sex, depression and/or anxiety, impaired function, increased body mass index, and increased number of comorbidities. cDAPSA, patient pain and global assessment, and tender joint count were twice as severe in patients with FM compared to those without. CONCLUSION FM prevalence is elevated in PsA and is associated with elevated disease measures, confounding reliable disease assessment for treat-to-target goals. Identification of FM as an influential contextual factor in disease assessment is recommended.
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Affiliation(s)
- Philip Mease
- Providence Swedish Health and University of Washington, Seattle
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3
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Hügle T, Prétat T, Suter M, Lovejoy C, Ming Azevedo P. Disease Phenotypes in Refractory Musculoskeletal Pain Syndromes Identified by Unsupervised Machine Learning. ACR Open Rheumatol 2024. [PMID: 39210607 DOI: 10.1002/acr2.11699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Overlapping chronic pain syndromes, including fibromyalgia, are heterogeneous and often treatment-resistant entities carrying significant socioeconomic burdens. Individualized treatment approaches from both a somatic and psychological side are necessary to improve patient care. The objective of this study was to identify and visualize patient clusters in refractory musculoskeletal pain syndromes through an extensive set of clinical variables, including immunologic, psychosomatic, wearable, and sleep biomarkers. METHODS Data were collected during a multimodal pain program involving 202 patients. Seventy-eight percent of the patients fulfilled the criteria for fibromyalgia, 77% had a concomitant psychiatric-mediated disorder, and 22% a concomitant rheumatic immune-mediated disorder. Five patient phenotypes were identified by hierarchical agglomerative clustering as a form of unsupervised learning, and a predictive model for the Brief Pain Inventory (BPI) response was generated. Based on the clustering data, digital personas were created with DALL-E (OpenAI). RESULTS The most relevant distinguishing factors among clusters were living alone, body mass index, peripheral joint pain, alexithymia, psychiatric comorbidity, childhood pain, neuroleptic or benzodiazepine medication, and response to virtual reality. Having an immune-mediated disorder was not discriminatory. Three of five clusters responded to the multimodal treatment in terms of pain (BPI intensity), one cluster responded in terms of functional improvement (BPI interference), and one cluster notably responded to the virtual reality intervention. The independent predictive model confirmed strong opioids, trazodone, neuroleptic treatment, and living alone as the most important negative predictive factors for reduced pain after the program. CONCLUSION Our model identified and visualized clinically relevant chronic musculoskeletal pain subtypes and predicted their response to multimodal treatment. Such digital personas and avatars may play a future role in the design of personalized therapeutic modalities and clinical trials.
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Affiliation(s)
- Thomas Hügle
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Tiffany Prétat
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Marc Suter
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Chris Lovejoy
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Pedro Ming Azevedo
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
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Lutaud R, Verger P, Peretti-Watel P, Eldin C. When the patient is making the (wrong?) diagnosis: a biographical approach to patients consulting for presumed Lyme disease. Fam Pract 2024; 41:534-542. [PMID: 36267023 PMCID: PMC9619758 DOI: 10.1093/fampra/cmac116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end. OBJECTIVES To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. METHODS In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach. RESULTS The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. CONCLUSION GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix Marseille University, Marseille, France
- UMR UMR 7268 ADES, EFS, CNRS, Aix-Marseille University, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | - Carole Eldin
- UMR UVE, Aix Marseille University, IRD, Inserm, Marseille, France
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Hamdan AL, Hosri J, Yammine Y, Ghzayel L, Hadi J, Moussawi MA, Romanos M, Nader N, Uthman I. Voice Disorders in Patients with Fibromyalgia: Case Series and Review of the Literature. J Voice 2024:S0892-1997(24)00208-X. [PMID: 39025751 DOI: 10.1016/j.jvoice.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To investigate the prevalence of phonatory disorders and their impact on quality of life in a cohort of patients with fibromyalgia (FMS), and to review the literature. STUDY DESIGN Prospective cohort study. METHODS All adult patients presenting to the rheumatology clinic at a tertiary referral center between January 2024 and April 2024 and diagnosed with FMS were prospectively recruited. The primary outcome measure used to screen for dysphonia was the Voice Handicap Index-10 (VHI-10). All patients were also asked to fill the Fibromyalgia Rapid Screening Tool (FiRST) and the short form of the McGill pain questionnaire (SF-MPQ). RESULTS A total of 70 female patients were included, divided equally into a study and control group (n = 35). The mean FiRST score and the mean SF-MPQ score were significantly higher in the study group compared to the control group (6.20 ± 1.05 vs 1.26 ± 1.65) and (26.14 ± 13.16 vs 2.6 ± 4.23), respectively. There was a statistically significant difference in the mean VHI-10 score between the study group and the control group (8.51 ± 7.66 vs 0.74 ± 0.98; P < 0.001). More than one third of patients in the study group had a VHI-10 score above 11 (37.1%) compared to none in the control group (P < 0.001). There was a strong positive correlation between the VHI-10 score and the FiRST and SF-MPQ scores (r = 0.612; P < 0.001 and r = 0.794; P < 0.001, respectively). CONCLUSION The findings suggest that two out five patients with FMS have vocal complaints that impact their quality of life. Healthcare providers need to recognize these phonatory disorders, that are often masked by other systemic manifestations of the disease.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Hosri
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yara Yammine
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lana Ghzayel
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaafar Hadi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Michael Romanos
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nawfal Nader
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Motyl G, Krupka WM, Maślińska M. The problem of residual pain in the assessment of rheumatoid arthritis activity. Reumatologia 2024; 62:176-186. [PMID: 39055728 PMCID: PMC11267660 DOI: 10.5114/reum/189779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/07/2024] [Indexed: 07/27/2024] Open
Abstract
Residual pain is a major unmet medical need observed in patients suffering from rheumatoid arthritis (RA), which decreases their quality of life, even after achieving remission or low disease activity. The article has two aims: 1) to present mechanisms involved in the pathophysiology of residual pain, both inflammatory and non-inflammatory, i.e. neuropathic and nociplastic pain, as well as secondary pain syndromes, i.e. osteoarthritis and fibromyalgia, which can contribute to residual pain; 2) to show the limitations of current disease activity measures recommended by European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR), which raise the need for a separate assessment of pain, and examples of methods that could be used by medical professionals to assess the pain and make a differential diagnosis. In conclusion, establishing a valid method to assess pain is essential to identify the pathomechanism of residual pain and to create treatments tailored specifically to individual RA patients.
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Affiliation(s)
- Gabriela Motyl
- Medical University of Warsaw, Poland
- Rheumatology Student Research Group at the National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Wiktoria Maria Krupka
- Medical University of Warsaw, Poland
- Rheumatology Student Research Group at the National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Maria Maślińska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Mease PJ. Navigating the complexity of pain in psoriatic arthritis and axial spondyloarthritis. Curr Opin Rheumatol 2024; 36:282-288. [PMID: 38690783 DOI: 10.1097/bor.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE OF REVIEW Pain is the most common and often most troublesome feature of chronic autoimmune diseases such as psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). A predominant concept is that the main source of pain is from disease-induced tissue inflammation and structural damage, activating peripheral nerve fibers which relay to the central nervous system. This mechanism is nociceptive pain and the presumption has been that controlling inflammation will be sufficient to reduce this form of pain. However, despite control of inflammation, patients may still have significant residual pain. RECENT FINDINGS We are learning that there are additional pain mechanisms, neuropathic and nociplastic, that are often operative in patients with rheumatologic conditions, that can significantly influence pain experience, quantitation of disease activity, and may benefit from therapeutic approaches distinct from immunotherapy. Neuropathic pain arises from diseased or damaged nerve tissue and nociplastic pain reflects sensitization of the central nervous system due to multiple genetic, neurobiologic, neural network dysregulation, and psychosocial factors. Pain arising from these mechanisms influence assessment of disease activity and thus needs to be factored into decision-making about immunotherapy efficacy. SUMMARY This review addresses the importance of accurately assessing the complex mechanisms of pain experience in patients with PsA and AxSpA to more appropriately manage immunomodulatory, neuromodulatory, and nonpharmacologic therapies.
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Affiliation(s)
- Philip J Mease
- Rheumatology Research, Providence Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
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LLedó Boyer A, López-Roig S, Pastor-Mira MÁ, Terol Cantero MC, Martín-Aragón M. Exploring Biopsychosocial Stress Markers in Women With Fibromyalgia. Pain Manag Nurs 2024:S1524-9042(24)00167-X. [PMID: 38862334 DOI: 10.1016/j.pmn.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 04/09/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Identification of fibromyalgia has been a challenge for healthcare professionals due to the lack of a clinical biomarker. A well-supported integrative hypothesis holds that this condition is a chronic pain problem partly caused by long-term dysregulation of stress response. Therefore, stress assessment from a biopsychosocial perspective may be a useful approach to recognizing fibromyalgia. PURPOSE A cross-sectional case-control study was conducted to explore stress markers from a multidimensional perspective, including heart rate variability (as a biomarker of stress) as well as psychological distress and social stress. METHODS Forty-seven women with fibromyalgia were recruited from support groups and another 47 were recruited as matched pain-free controls. Comparison and discriminant function analyses were performed. RESULTS The data support the goodness of biopsychosocial stress markers in women with fibromyalgia, resulting in the identification of between 70% and 74.5% of fibromyalgia cases (sensitivity) and 85%-87% pain-free controls (specificity), with medium-high levels of fit (λ = 0.58 and λ = 0.59; p < .00). Women with fibromyalgia were characterized by high levels of psychological distress, social stress (disorder levels), and autonomic dysregulation. Although distress and social stress had a greater weight in discriminant functions, dysregulation in terms of low parasympathetic activity and high sympathetic activity at rest was also relevant. CONCLUSIONS A biopsychosocial approach to stress with an objective biomarker such as heart rate variability may be a useful tool to identify and manage FM.
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Affiliation(s)
- Ana LLedó Boyer
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain.
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
| | | | | | - Maite Martín-Aragón
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
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Leerling AT, Niesters M, Flendrie M, Tel M, Appelman-Dijkstra NM, Dekkers OM, Winter EM. Neuropathic and Nociplastic Pain Profiles are Common in Adult Chronic Nonbacterial Osteitis (CNO). Calcif Tissue Int 2024; 114:603-613. [PMID: 38627292 PMCID: PMC11090977 DOI: 10.1007/s00223-024-01214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024]
Abstract
Chronic nonbacterial osteitis (CNO) is a rare musculoskeletal disease causing chronic bone pain. It is known that chronic musculoskeletal pain may involve other mechanisms than nociceptive pain only. We investigate the prevalence of neuropathic and nociplastic pain in adult CNO and their association with clinical characteristics and treatment outcomes. Survey study among the Dutch adult CNO cohort (n = 84/195 participated), including PAIN-detect for neuropathic pain, and the Central Sensitization Inventory (CSI), Fibromyalgia Rapid Screening Tool (FiRST), and ACTTION-APS Pain Taxonomy (AAPT) for nociplastic pain. Clinical characteristics and CNO-related bone pain scores were compared between patients with exclusive nociceptive pain and those with nociceptive pain plus neuropathic and/or nociplastic pain (mixed pain). 31% (95% CI 21-41) of patients classified as likely having neuropathic pain according to PAIN-detect. 53% (41-64) of patients displayed central sensitization on CSI, 61% (50-72) screened positive for fibromyalgia on FiRST and 14% (7-23) of patients fulfilled the AAPT criteria, all indicative of nociplastic pain. Mixed pain was associated with longer diagnostic delay (mean difference 2.8 years, 95% CI 0.4-5.2, p = 0.023), lower educational level (72% versus 20%, p < 0.001), and opioid use (37% versus 13%, p = 0.036). Despite comparable disease severity and extent, patients with mixed pain reported significantly higher CNO-related bone pain scores. This study demonstrates the high prevalence of mixed pain in adult CNO, in which neuropathic and nociplastic pain exist alongside nociceptive inflammatory bone pain. Disease burden in CNO may extend beyond inflammatory activity, highlighting the need for a multifaceted management approach.
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Affiliation(s)
- Anne T Leerling
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Niesters
- Department of Anesthesiology and Pain Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel Flendrie
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marije Tel
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Olaf M Dekkers
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth M Winter
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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Sariyildiz A, Coskun Benlidayi I, Yetişir A, Turk I, Zengin Acemoglu SS, Deniz V. Central sensitization significantly deteriorates functionality and the interpretation of self-reported disease activity in primary Sjögren's syndrome. Clin Rheumatol 2024; 43:1949-1958. [PMID: 38691249 DOI: 10.1007/s10067-024-06981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Central sensitization has a major role in health-related parameters in musculoskeletal conditions. There is still a lack of understanding regarding the impact of central sensitization on the interpretation of disease activity and functional disability in primary Sjögren's syndrome (pSS). METHODS The Central Sensitization Inventory (CSI) was used to screen for central sensitization. Disease-related parameters, including objective tests, medication use, the EULAR SS Patient Reported Index (ESSPRI), and the EULAR SS Disease Activity Index (ESSDAI), were assessed. Functionality, quality of life, sleep, and mental health were evaluated by the Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Jenkins Sleep Evaluation Scale (JSS), and Hospital Anxiety and Depression Scale (HADS), respectively. The effect of central sensitization on functionality and disease activity measures was assessed by regression analyses. RESULTS The frequency of central sensitization was 65% in patients with pSS (n = 60). Patients with central sensitization had higher HAQ-DI, ESSPRI, HADS, and JSS and lower SF-36 subdomain scores (p < 0.05 for all). A significant positive correlation was observed between the CSI score and the ESSPRI, JSS, HAQ-DI, and HADS scores (Spearman's rho ranging from 0.342 to 0.739). The multiple regression analysis indicated that CSI was independently associated with HAQ-DI (adjusted R2 = 0.19, B = 0.01) and ESSPRI (adjusted R2 = 0.45, B = 0.08) (p < 0.001 for all). CONCLUSION This study confirms that central sensitization has a major impact on functionality and the interpretation of self-reported disease activity in pSS. When devising strategies for the management of patients with pSS, it is crucial to consider these close relationships. Key Points • The frequency of central sensitization accompanying primary Sjögren's syndrome is considerable. • Central sensitization was independently associated with functionality and self-reported disease activity assessment. • This close association leads to challenges in functionality, evaluating treatment response, and planning or switching between therapies in primary Sjögren's syndrome.
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Affiliation(s)
- Aylin Sariyildiz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayşegül Yetişir
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ipek Turk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Serife Seyda Zengin Acemoglu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tarsus University, Adana, Turkey
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Rios Rodriguez V, Duran TI, Torgutalp M, López-Medina C, Dougados M, Kishimoto M, Ono K, Protopopov M, Haibel H, Rademacher J, Poddubnyy D, Proft F. Comparing clinical profiles in spondyloarthritis with Crohn's disease or ulcerative colitis: insights from the ASAS-PerSpA study. Rheumatol Adv Pract 2024; 8:rkae064. [PMID: 38807853 PMCID: PMC11132819 DOI: 10.1093/rap/rkae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Objectives Assuming SpA manifestations may vary among patients with different inflammatory bowel disease (IBD) subtypes, we explored the clinical characteristics associated with the presence of Crohn's disease (CD) or ulcerative colitis (UC) in patients with spondyloarthritis (SpA). Methods We included 3152 patients of ASAS-PerSpA study diagnosed with either axial SpA or peripheral SpA, according to their treating rheumatologist. Of these, 146 (4.6%) had confirmed IBD by endoscopy and were categorized into CD or UC groups. Demographics, clinical characteristics, treatments and patient-reported outcomes were compared between the two subgroups. Results From 146 patients included in the current analysis, 87 (59.6%) had CD [75 (86.2%) axial SpA and 12 (13.8%) peripheral SpA], and 39 (26.7%) had UC [34 (87.2%) axial SpA and 5 (12.8%) peripheral SpA]. CD and UC groups had similar age with average of 44.9 (13.5) vs 44.0 (13.0) years, respectively, and a slight male predominance in CD (63.2%) compared with UC (51.3%). Diagnostic delay for SpA was 7.0 (6.9) years for CD and 8.8 (8.1) years for UC. Chronic back pain was the most reported symptom present in 95.4% of CD patients and 89.7% of UC patients. Both groups had similar musculoskeletal phenotyping, with higher frequency of psoriasis (15.4%) and uveitis 28.2% in UC; and higher tendency to be HLA-B27 positive in CD (51.9% in CD vs.s 39.4% in UC). Conclusion In our analysis patients with SpA and concurrent CD or UC had mainly similar musculoskeletal phenotypes. However, they differ slightly in extra-musculoskeletal manifestations and HLA-B27 prevalence.
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Affiliation(s)
- Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Department of Rheumatology, Université de Paris., Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, Paris, France
- INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Keisuke Ono
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Daher M, Abbas S, Asaad Z, Khalil K, Jadid G. Prevalence of fibromyalgia and irritable bowel syndrome and its association with studying medicine, a cross-sectional study in Al-Baath University, Syria. Brain Behav 2024; 14:e3445. [PMID: 38468467 PMCID: PMC10928353 DOI: 10.1002/brb3.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/17/2023] [Accepted: 02/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The aim of this study is to assess the prevalence rate of fibromyalgia (FM) and irritable bowel syndrome (IBS) among Al-Baath University students and find out whether studying medicine has an association with a higher prevalence rate. METHODS The participants of this observational cross-sectional study were students aged 18-30 years from Al-Baath University. A structured self-estimated electronic questionnaire developed by Google Forms was distributed using social media platforms from 15 February to 15 March, 2023. We used The American College of Rheumatology (ACR) 2016 and Fibromyalgia Rapid Screening Tool criteria to assess the prevalence rate of FM. We used The ROME IV criteria to asses IBS prevalence rate. RESULTS The final sample size was 800 individuals. The prevalence of IBS in the study population was 26.8%. Overall, IBS-Constipation was the most common subtype, and the prevalence rate was higher among medical students (14%) compared to other colleges (12.8%) (p = .002). The difference in IBS prevalence between males and females was (9.3% vs. 17.5%, p = .283), but this did not reach the statistical significance. The prevalence of FM according to The ACR in the study population was 3.6%. Females had higher prevalence rate than males (3.1% vs. 0.5%, p = .007). The prevalence of FM was also higher in other colleges compared to medicine (2.3% vs. 1.4%, p = .547), but this did not reach statistical significance. CONCLUSION We found an increased prevalence of IBS among medical students. The prevalence of FM did not show any relation to studying medicine. We recommend additional prospective studies to assess whether studying medicine could be a risk factor for these disorders or not.
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Affiliation(s)
| | - Sara Abbas
- Faculty of MedicineDamascus UniversityDamascusSyria
| | - Zainab Asaad
- Faculty of MedicineDamascus UniversityDamascusSyria
| | - Karam Khalil
- Faculty of MedicineDamascus UniversityDamascusSyria
| | - Ghania Jadid
- Scientific Representative at Faculty of MedicineAl‐Baath UniversityHomsSyria
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13
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Hamdan AL, Hosri J, El Hadi N, Ghzayel L, Abou Raji Feghali P, Nawfal N, Barazi R. Risk of Fibromyalgia in Patients with Primary Muscle Tension Dysphonia: A Prospective Pilot Study. J Voice 2024:S0892-1997(24)00004-3. [PMID: 38342645 DOI: 10.1016/j.jvoice.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia. STUDY DESIGN Prospective cohort study. METHODS The medical records and video recordings of all patients presenting to the Voice and Swallowing unit at a tertiary referral center between October 2022 and October 2023 and who were diagnosed with primary MTD were prospectively reviewed. The risk of fibromyalgia was assessed using the "Fibromyalgia Rapid Screening Tool" (FiRST). Demographic data included age, gender, history of smoking, and history of high vocal load. The impact of dysphonia on quality of life was also analyzed using the Voice Handicap Index-10 (VHI-10). RESULTS A total of 42 patients who had filled the FiRST questionnaire were enrolled in this study. These included 20 patients diagnosed with primary MTD and 22 healthy subjects with no history of dysphonia and normal laryngeal examination. Forty percent of the study group tested positive using the FiRST questionnaire as compared to only 9.1% in the control group. The difference between the two groups was statistically significant (P = 0.03). The risk of having fibromyalgia was 6.67 times among patients with primary MTD in comparison to controls (RR=6.67; 95% CI [1.21-36.74]). CONCLUSION The results of this investigation indicate that the risk of fibromyalgia is significantly higher in patients with primary MTD vs controls. A holistic approach in the diagnosis and treatment of MTD is advocated.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jad Hosri
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine El Hadi
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lana Ghzayel
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nader Nawfal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Randa Barazi
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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14
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Bernard J, Barnetche T, Amory C, Despres J, Vandersmissen M, Landrin J, Gaujoux-Viala C, Lukas C, Ruyssen-Witrand A, Truchetet ME, Vergne-Salle P, Mathieu S, Tournadre A. Frequency of irritable bowel syndrome in spondyloarthritis: a multicentric cross-sectional study and meta-analysis. RMD Open 2024; 10:e003836. [PMID: 38216286 PMCID: PMC10806458 DOI: 10.1136/rmdopen-2023-003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA). METHODS In a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in five rheumatology departments were asked for IBS Rome IV criteria. Demographic data, lifestyle behaviours and disease characteristics were recorded. Second, a systematic literature review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Of the 500 patients with ax-SpA included, 124 reported IBS symptoms (25%). Female gender, unemployment, higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse Bath Ankylosing Spondylitis Functional Index scores, multiple lines of biologics, fibromyalgia, anxiety, depression and lower physical activity were associated with IBS symptoms. In multivariate model, the risk of IBS was associated with anxiety and physical inactivity. From the literature review, the prevalence of IBS in patients with SpA was 15.4% (8.8% to 23.3%). Meta-analysis of the five studies comparing the presence of IBS in patients with SpA (323/7292) and healthy controls (484/35587) showed a significant increase of IBS in patients with SpA (OR=1.59 (1.05 to 2.40)). CONCLUSION The prevalence of IBS symptoms was high in the ax-SpA population and should therefore be considered in the presence of gastrointestinal disorders. The presence of IBS symptoms was associated with anxiety and low physical activity in multivariate analysis. Patients with IBS symptoms tended to have more difficult to manage disease characterised by higher activity, worse functional score and multiple lines of treatment in univariate analysis.
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Affiliation(s)
- Jessika Bernard
- Rheumatology, Clermont-Ferrand University Hospital, Rheumatology Department, UNH-UMR 1019, INRAe and University Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas Barnetche
- Rheumatology, Bordeaux University Hospital FHU ACRONIM, Bordeaux, France
| | - Charlotte Amory
- Rheumatology, University Hospital Lapeyronie, Montpellier, France
| | - Jerome Despres
- Rheumatology, Toulouse University Hospital, Rheumatology Centre, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS » University of Toulouse 3, Toulouse, France
| | - Maxime Vandersmissen
- Rheumatology, Limoges University Hospital, team CAPtuR, UMR Inserm 1308, University of Limoges, France, Limoges, France
| | - Justine Landrin
- Rheumatology, Bordeaux University Hospital FHU ACRONIM, Bordeaux, France
| | - Cecile Gaujoux-Viala
- Rheumatology, Nîmes University Hospital, Nîmes, France
- UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, University of Montpellier, INSERM, Montpellier, France
| | - Cédric Lukas
- Rheumatology, University Hospital Lapeyronie, Montpellier, France
- UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, University of Montpellier, INSERM, Montpellier, France
| | - Adeline Ruyssen-Witrand
- Rheumatology, Toulouse University Hospital, Rheumatology Centre, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS » University of Toulouse 3, Toulouse, France
| | | | - Pascale Vergne-Salle
- Rheumatology, Limoges University Hospital, team CAPtuR, UMR Inserm 1308, University of Limoges, France, Limoges, France
| | - Sylvain Mathieu
- Rheumatology, Clermont-Ferrand University Hospital, Rheumatology Department, UNH-UMR 1019, INRAe and University Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Tournadre
- Rheumatology, Clermont-Ferrand University Hospital, Rheumatology Department, UNH-UMR 1019, INRAe and University Clermont Auvergne, Clermont-Ferrand, France
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15
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Kawka L, Sarmiento-Monroy JC, Mertz P, Pijnenburg L, Rinagel M, Ugarte-Gil MF, Geneton S, Blaess J, Piga M, Arnaud L. Assessment and personalised advice for fatigue in systemic lupus erythematosus using an innovative digital tool: the Lupus Expert system for the Assessment of Fatigue (LEAF) study. RMD Open 2023; 9:e003476. [PMID: 38056917 PMCID: PMC10711918 DOI: 10.1136/rmdopen-2023-003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Fatigue is reported as the most prevalent symptom by patients with systemic lupus erythematosus (SLE). Fatigue management is complex due to its multifactorial nature. The aim of the study was to assess the usefulness of an innovative digital tool to manage fatigue in SLE, in a completely automated manner. METHODS The «Lupus Expert System for Assessment of Fatigue» (LEAF) is free digital tool which measures the intensity and characteristics of fatigue and assesses disease activity, pain, insomnia, anxiety, depression, stress, fibromyalgia and physical activity using validated patient-reported instruments. Then, LEAF automatically provides personalised feedback and recommendations to cope with fatigue. RESULTS Between May and November 2022, 1250 participants with SLE were included (95.2% women, median age 43yo (IQR: 34-51)). Significant fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue <34) was reported by 78.9% of patients. In univariate analysis, SLE participants with fatigue were more likely to be women (p=0.01), perceived their disease as more active (p<0.0001), had higher levels of pain (p<0.0001), anxiety (p<0.0001), depression (p<0.0001), insomnia (p<0.0001), stress (p<0.0001) and were more likely to screen for fibromyalgia (p<0.0001), compared with patients without significant fatigue. In multivariable analysis, parameters independently associated with fatigue were insomnia (p=0.0003), pain (p=0.002), fibromyalgia (p=0.008), self-reported active SLE (p=0.02) and stress (p=0.045). 93.2% of the participants found LEAF helpful and 92.3% would recommend it to another patient with SLE. CONCLUSION Fatigue is commonly severe in SLE, and associated with insomnia, pain, fibromyalgia and active disease according to patients' perspective. Our study shows the usefulness of an automated digital tool to manage fatigue in SLE.
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Affiliation(s)
- Lou Kawka
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Philippe Mertz
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Luc Pijnenburg
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marina Rinagel
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Manuel Francisco Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Sophie Geneton
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Blaess
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matteo Piga
- Department of Medical Sciences and Public health, University of Cagliari, Cagliari, Italy
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Immuno-rhumatologie moléculaire, Strasbourg, France
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16
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Gramont B, Goutte J, Féasson L, Millet G, Hupin D, Cathébras P. [Chronic fatigue: What investigations? And what for?]. Rev Med Interne 2023; 44:662-669. [PMID: 37248110 DOI: 10.1016/j.revmed.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Chronic fatigue is a frequent complaint, expressed at all levels of the healthcare system. It is perceived as disabling in a high proportion of cases, and internists are frequently called upon to find "the" cause. The etiological diagnostic approach of an unexplained state of fatigue relies on the careful search for more specific clues by questioning and clinical examination. It is necessary to recognize the limited place of complementary examinations apart from the basic biological parameters. Simple rating scales can be useful in the etiological and differential diagnosis of fatigue. Chronic fatigue syndrome (CFS), in the current state of knowledge, cannot be considered as a specific pathological entity distinct from idiopathic chronic fatigue states, and does not have validated biomarkers. It is important to know that a state of chronic asthenia often results from several intricated etiological factors (biological, psychological and social), to be classified as predisposing, precipitating and perpetuating. The metabolic and cardiorespiratory exercise test has a major place in the assessment and management of fatigue, as a prerequisite for personalized retraining or adapted physical activity (APA), which are the treatments of choice for chronic fatigue.
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Affiliation(s)
- B Gramont
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France.
| | - J Goutte
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
| | - L Féasson
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - G Millet
- STAPS, IRMIS, université Jean-Monnet, Saint-Étienne, France
| | - D Hupin
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
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17
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Pontes-Silva A, Dibai-Filho AV, de Melo TS, Santos LM, de Souza MC, DeSantana JM, Avila MA. Effects of progressive intensity resistance training on the impact of fibromyalgia: protocol for a blinded randomized controlled trial. BMC Musculoskelet Disord 2023; 24:816. [PMID: 37838712 PMCID: PMC10576880 DOI: 10.1186/s12891-023-06952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population. OBJECTIVE To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity. METHODS A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain. DISCUSSION The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients' lives. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.
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Affiliation(s)
- André Pontes-Silva
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Physical Education Postgraduate Program, Physical Education Department, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Thayná Soares de Melo
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Josimari Melo DeSantana
- Laboratory of Research on Neuroscience (LAPENE), Physical Therapy Department, Graduate Program in Health Science, Graduate Program in Physiological Science, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - Mariana Arias Avila
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil.
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18
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Hackshaw KV, Yao S, Bao H, de Lamo Castellvi S, Aziz R, Nuguri SM, Yu L, Osuna-Diaz MM, Brode WM, Sebastian KR, Giusti MM, Rodriguez-Saona L. Metabolic Fingerprinting for the Diagnosis of Clinically Similar Long COVID and Fibromyalgia Using a Portable FT-MIR Spectroscopic Combined with Chemometrics. Biomedicines 2023; 11:2704. [PMID: 37893078 PMCID: PMC10604557 DOI: 10.3390/biomedicines11102704] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Post Acute Sequelae of SARS-CoV-2 infection (PASC or Long COVID) is characterized by lingering symptomatology post-initial COVID-19 illness that is often debilitating. It is seen in up to 30-40% of individuals post-infection. Patients with Long COVID (LC) suffer from dysautonomia, malaise, fatigue, and pain, amongst a multitude of other symptoms. Fibromyalgia (FM) is a chronic musculoskeletal pain disorder that often leads to functional disability and severe impairment of quality of life. LC and FM share several clinical features, including pain that often makes them indistinguishable. The aim of this study is to develop a metabolic fingerprinting approach using portable Fourier-transform mid-infrared (FT-MIR) spectroscopic techniques to diagnose clinically similar LC and FM. Blood samples were obtained from LC (n = 50) and FM (n = 50) patients and stored on conventional bloodspot protein saver cards. A semi-permeable membrane filtration approach was used to extract the blood samples, and spectral data were collected using a portable FT-MIR spectrometer. Through the deconvolution analysis of the spectral data, a distinct spectral marker at 1565 cm-1 was identified based on a statistically significant analysis, only present in FM patients. This IR band has been linked to the presence of side chains of glutamate. An OPLS-DA algorithm created using the spectral region 1500 to 1700 cm-1 enabled the classification of the spectra into their corresponding classes (Rcv > 0.96) with 100% accuracy and specificity. This high-throughput approach allows unique metabolic signatures associated with LC and FM to be identified, allowing these conditions to be distinguished and implemented for in-clinic diagnostics, which is crucial to guide future therapeutic approaches.
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Affiliation(s)
- Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1601 Trinity St., Austin, TX 78712, USA
| | - Siyu Yao
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
| | - Haona Bao
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
| | - Silvia de Lamo Castellvi
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
- Campus Sescelades, Departament d’Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Spain
| | - Rija Aziz
- Department of Internal Medicine, Dell Medical School, The University of Texas, 1601 Trinity St., Austin, TX 78712, USA; (R.A.); (M.M.O.-D.); (W.M.B.); (K.R.S.)
| | - Shreya Madhav Nuguri
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
| | - Lianbo Yu
- Center of Biostatistics and Bioinformatics, The Ohio State University, Columbus, OH 43210, USA;
| | - Michelle M. Osuna-Diaz
- Department of Internal Medicine, Dell Medical School, The University of Texas, 1601 Trinity St., Austin, TX 78712, USA; (R.A.); (M.M.O.-D.); (W.M.B.); (K.R.S.)
| | - W. Michael Brode
- Department of Internal Medicine, Dell Medical School, The University of Texas, 1601 Trinity St., Austin, TX 78712, USA; (R.A.); (M.M.O.-D.); (W.M.B.); (K.R.S.)
| | - Katherine R. Sebastian
- Department of Internal Medicine, Dell Medical School, The University of Texas, 1601 Trinity St., Austin, TX 78712, USA; (R.A.); (M.M.O.-D.); (W.M.B.); (K.R.S.)
| | - M. Monica Giusti
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, The Ohio State University, Columbus, OH 43210, USA; (S.Y.); (H.B.); (S.d.L.C.); (S.M.N.); (M.M.G.); (L.R.-S.)
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19
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Hamitouche F, Lopez-Medina C, Gossec L, Perrot S, Dougados M, Moltó A. Evaluation of the agreement between the ACR 1990 fibromyalgia tender points and an enthesitis score in patients with axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:2757-2764. [PMID: 36573318 DOI: 10.1093/rheumatology/keac683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/24/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSION These results suggest a significant overlap between both scores in patients with axSpA, including in those without concomitant FM. TRIAL REGISTRATION clinicaltrials.gov, https://clinicaltrials.gov, NCT03039088.
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Affiliation(s)
- Faten Hamitouche
- Rheumatology Department, Cochin Hospital, AP-HP. Centre, Paris, France
| | - Clementina Lopez-Medina
- INSERM U1153, CRESS, Université Paris-Cité, Paris, France
- Rheumatology Department, Reina Sofia Hospital, IMIBIC, University of Cordoba, Spain
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, AP-HP. Centre, Paris, France
- INSERM U1153, CRESS, Université Paris-Cité, Paris, France
| | - Anna Moltó
- Rheumatology Department, Cochin Hospital, AP-HP. Centre, Paris, France
- INSERM U1153, CRESS, Université Paris-Cité, Paris, France
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20
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Upadhyaya SK, Malgutte DR, Handa R, Gupta S, Kumar A, Budumuru S. Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic. BMJ Open 2023; 13:e069014. [PMID: 37321814 PMCID: PMC10276963 DOI: 10.1136/bmjopen-2022-069014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This study evaluated the prevalence of fibromyalgia (FM), anxiety and depression in patients with rheumatoid arthritis (RA) and their effects on the clinical parameters of RA during the COVID-19 pandemic. DESIGN Cross-sectional, outpatient clinic, observational, non-interventional. SETTING Single-centre, tertiary care, multispecialty, service and research hospital, north-central India. PARTICIPANTS Adult patients with RA, controls. RESULTS This cross-sectional study included 200 patients with RA diagnosed with the American College of Rheumatology/European League Against Rheumatism 2010 (ACR) criteria and 200 controls. FM was diagnosed using the revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in patients with RA were assessed using multiple Disease Activity Scores. The presence of depression and anxiety was determined using the Hospital Anxiety and Depression Scale. FM was present in 31% of patients with RA compared with 4% of controls in our study. Patients with RA with FM were older, predominantly females with longer disease duration, and more likely to be on steroids. Patients with RA with FM had a higher disease activity, and none of our RA with FM patients were in remission. The multivariable analysis found FM to be an independent predictor of the Simplified Disease Activity Index for RA. Patients with RA with FM had worse functional ability and poorer quality of life. The prevalence of anxiety and depression was 12.5% and 30%, significantly higher in RA with FM patients. CONCLUSION During the COVID-19 pandemic, around one-third of our study patients had FM and depression, significantly higher than pre-COVID-19 times. Thus, mental health assessment should be incorporated into the routine management of patients with RA.
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Affiliation(s)
| | | | - Rohini Handa
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sirinder Gupta
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil Kumar
- Rheumatology, Indraprastha Apollo Hospital, New Delhi, India
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21
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Aicha BT, Lobna BA, Yosra Z, Siwar BD, Ines C, Selma B, Leila R, Rawdha T, Olfa S, Ines M, Leila A. Assessment of self-esteem and community integration in spondyloarthritis. REUMATOLOGIA CLINICA 2023; 19:299-305. [PMID: 37286265 DOI: 10.1016/j.reumae.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/17/2022] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. METHODS This study was a cross-sectional study including SpA patients (ASAS criteria) aged 18-50 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. RESULTS A total of 72 patients were enrolled (sex-ratio=1.88), with median (IQR) age of 39 years (28.25-46). Median (IQR) disease duration was 10 (6-14) years. Median (IQR) BASDAI and ASDAS were 3 (2.1-4.7) and 2.7 (1.9-3.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.25-34), and 83 (53.25-93.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. CONCLUSION Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters.
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Affiliation(s)
- Ben Tekaya Aicha
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Ben Ammar Lobna
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Zgueb Yosra
- Department of Psychiatry A, Razi Hospital, La Manouba, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ben Dhia Siwar
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Cherif Ines
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Bouden Selma
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rouached Leila
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Tekaya Rawdha
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Saidane Olfa
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mahmoud Ines
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Abdelmoula Leila
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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22
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Gossec L, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, Korotaeva TV, Lavie F, Noël W, Nurmohamed MT, Sfikakis PP, Sharaf M, Theander E, Smolen JS. Long-term effectiveness and persistence of ustekinumab and TNF inhibitors in patients with psoriatic arthritis: final 3-year results from the PsABio real-world study. Ann Rheum Dis 2023; 82:496-506. [PMID: 36600178 PMCID: PMC10086293 DOI: 10.1136/ard-2022-222879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate real-world persistence and effectiveness of the IL-12/23 inhibitor, ustekinumab or a tumour necrosis factor inhibitor (TNFi) for psoriatic arthritis over 3 years. METHODS PsABio (NCT02627768), a prospective, observational study, followed patients with PsA prescribed first-line to third-line ustekinumab or a TNFi. Persistence and effectiveness (achievement of clinical Disease Activity for PSA (cDAPSA) low disease activity (LDA)/remission and minimal disease activity/very LDA (MDA/VLDA)) were assessed every 6 months. Safety data were collected over 3 years. Analyses to compare the modes of action were adjusted on baseline differences by propensity scores (PS). RESULTS In 895 patients (mean age 49.8 years, 44.7% males), at 3 years, the proportion of patients still on their initial treatments was similar with ustekinumab (49.9%) and TNFi (47.8%). No difference was seen in the risk of stopping/switching; PS-adjusted hazard ratio (95% CI) for stopping/switching ustekinumab versus TNFi was 0.87 (0.68 to 1.11). In the overall population, cDAPSA LDA/remission was achieved in 58.6%/31.4% ustekinumab-treated and 69.8%/45.0% TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.89 (0.63 to 1.26) for cDAPSA LDA; 0.72 (0.50 to 1.05) for remission. MDA/VLDA was achieved in 41.4%/19.2% of ustekinumab-treated and 54.2%/26.9% of TNFi-treated patients with overlapping PS-adjusted ORs. A greater percentage of TNFi-treated patients achieved effectiveness outcomes. Both treatments exhibited good long-term safety profiles, although ustekinumab-treated patients had a lower rate of adverse events (AEs) versus TNFi. CONCLUSION At 3 years, there was generally comparable persistence after ustekinumab or TNFi treatment, but AE rates were lower with ustekinumab.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | | | - Elisa Gremese
- Fondazione Policlinico A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Frederic Lavie
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Paris, France
| | - Wim Noël
- Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Petros P Sfikakis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
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23
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AlAujan SS, Almalag HM, Assiri GA, Alodaibi FA, Omair MA. Fibromyalgia Rapid Screening Tool (FiRST): Arabic Translation and Cross-Cultural Adaptation and Validation. Healthcare (Basel) 2023; 11:healthcare11070961. [PMID: 37046889 PMCID: PMC10094652 DOI: 10.3390/healthcare11070961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Fibromyalgia (FM), a complex neurological disorder, has multiple consequences for the patient. To diagnose patients, healthcare practitioners use multiple diagnostic questionnaires. However, Arabic translated or validated tools are lacking. This study aimed to translate and validate the Fibromyalgia Rapid Screening Tool (FiRST) into the Arabic language. Methods: Forward and backward translations of the FiRST were conducted by two Arabic translators and two English-certified translators. The survey was piloted (n = 5) and subjected to cognitive interviews and psychometric analysis. Patients were recruited from a university hospital in Riyadh and an FM support group in Saudi Arabia. The internal consistency, factor analysis, and test–retest correlations were evaluated. Results: This study included 46 patients. The stepwise translation process resulted in minor edits related to the use of synonyms to the survey items. The translated survey had a good internal consistency and test–retest correlation, with a Cronbach’s alpha of 0.7 and Pearson’s correlation coefficient of 0.79 (p-value < 0.001), respectively. The survey was factorable into two themes: generalized symptoms and more specific sensations. Conclusions: The Arabic FiRST is a simple, valid, and reliable tool to diagnose patients with FM in different settings.
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Affiliation(s)
- Shiekha S. AlAujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh 11362, Saudi Arabia
- Correspondence: ; Tel.: +966118054327
| | - Haya M. Almalag
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ghadah A. Assiri
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh 11362, Saudi Arabia
| | - Faris A. Alodaibi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
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24
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Trouvin AP, Simunek A, Coste J, Medkour T, Carvès S, Bouhassira D, Perrot S. Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation. Pain 2023; 164:605-612. [PMID: 35984362 DOI: 10.1097/j.pain.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.
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Affiliation(s)
- Anne-Priscille Trouvin
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Arielle Simunek
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Joël Coste
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Terkia Medkour
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Sandrine Carvès
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Didier Bouhassira
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
- Pain Medicine Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Serge Perrot
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
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25
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Makowka S, Mory LN, Mouthon M, Mancini C, Guggisberg AG, Chabwine JN. EEG Beta functional connectivity decrease in the left amygdala correlates with the affective pain in fibromyalgia: A pilot study. PLoS One 2023; 18:e0281986. [PMID: 36802404 PMCID: PMC9943002 DOI: 10.1371/journal.pone.0281986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
Fibromyalgia (FM) is a major chronic pain disease with prominent affective disturbances, and pain-associated changes in neurotransmitters activity and in brain connectivity. However, correlates of affective pain dimension lack. The primary goal of this correlational cross-sectional case-control pilot study was to find electrophysiological correlates of the affective pain component in FM. We examined the resting-state EEG spectral power and imaginary coherence in the beta (β) band (supposedly indexing the GABAergic neurotransmission) in 16 female patients with FM and 11 age-adjusted female controls. FM patients displayed lower functional connectivity in the High β (Hβ, 20-30 Hz) sub-band than controls (p = 0.039) in the left basolateral complex of the amygdala (p = 0.039) within the left mesiotemporal area, in particular, in correlation with a higher affective pain component level (r = 0.50, p = 0.049). Patients showed higher Low β (Lβ, 13-20 Hz) relative power than controls in the left prefrontal cortex (p = 0.001), correlated with ongoing pain intensity (r = 0.54, p = 0.032). For the first time, GABA-related connectivity changes correlated with the affective pain component are shown in the amygdala, a region highly involved in the affective regulation of pain. The β power increase in the prefrontal cortex could be compensatory to pain-related GABAergic dysfunction.
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Affiliation(s)
- Soline Makowka
- Faculty of Science and Medicine, Department of Neuroscience and Movement Science, Laboratory for Neurorehabilitation Science, Medicine Section, University of Fribourg, Fribourg, Switzerland
| | - Lliure-Naima Mory
- Faculty of Science and Medicine, Department of Neuroscience and Movement Science, Laboratory for Neurorehabilitation Science, Medicine Section, University of Fribourg, Fribourg, Switzerland
- Neurorehabilitation Division, Fribourg Hospital Meyriez/Murten, Fribourg, Switzerland
| | - Michael Mouthon
- Faculty of Science and Medicine, Department of Neuroscience and Movement Science, Laboratory for Neurorehabilitation Science, Medicine Section, University of Fribourg, Fribourg, Switzerland
| | - Christian Mancini
- Faculty of Science and Medicine, Department of Neuroscience and Movement Science, Laboratory for Neurorehabilitation Science, Medicine Section, University of Fribourg, Fribourg, Switzerland
| | - Adrian G. Guggisberg
- Department of Clinical Neuroscience, Division of Neurorehabilitation, Geneva University Hospital, Geneva, Switzerland
| | - Joelle Nsimire Chabwine
- Faculty of Science and Medicine, Department of Neuroscience and Movement Science, Laboratory for Neurorehabilitation Science, Medicine Section, University of Fribourg, Fribourg, Switzerland
- Neurorehabilitation Division, Fribourg Hospital Meyriez/Murten, Fribourg, Switzerland
- * E-mail:
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26
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Cengiz G, Nas K, Keskin Y, Kılıç E, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cüzdan Balta N, Gezer İA, Keskin D, Mülkoğlu C, Reşorlu H, Ataman Ş, Bal A, Baykul M, Duruöz MT, Küçükakkaş O, Yurdakul OV, Alkan Melikoğlu M, Ayhan FF, Bodur H, Çaliş M, Çapkin E, Devrimsel G, Gök K, Hizmetli S, Kamanlı A, Ecesoy H, Kutluk Ö, Şen N, Şendur ÖF, Tekeoğlu İ, Toprak M, Tolu S, Tuncer T. The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study. Int J Rheum Dis 2023; 26:43-50. [PMID: 36165674 DOI: 10.1111/1756-185x.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
AIM Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). METHOD This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. RESULTS In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). CONCLUSION We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.
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Affiliation(s)
- Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kemal Nas
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Yaşar Keskin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kılıç
- Rheumatology Clinic, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Betül Sargin
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Sevtap Acer Kasman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Nilay Sahin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Nihan Cüzdan Balta
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, School of Medicine, Selcuk University, Konya, Turkey
| | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Reşorlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merve Baykul
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Meltem Alkan Melikoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Atılım University, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mustafa Çaliş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erhan Çapkin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Kevser Gök
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Sami Hizmetli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation. School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Hilal Ecesoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Öznur Kutluk
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Ömer Faruk Şendur
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - İbrahim Tekeoğlu
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Murat Toprak
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Medipol University, Istanbul, Turkey
| | - Tiraje Tuncer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
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Clinical and functional impact of central sensitization on patients with familial Mediterranean fever: a cross-sectional study. Rheumatol Int 2023; 43:125-136. [PMID: 35960338 DOI: 10.1007/s00296-022-05181-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
This study aimed to investigate the frequency of CS and its clinical and functional effects on familial Mediterranean fever (FMF). A hundred FMF patients were included in this study. The presence of CS was investigated by the central sensitization inventory (CSI). In addition to the detailed clinical features of patients and genetic mutations, quality of life, disability, sleep disorders, depression, anxiety, and fibromyalgia frequency were examined to evaluate the negative effects of CS on the individual. Patients were divided into groups according to the presence and severity of CS, and their results were compared. Correlation and multivariate regression analysis were performed to investigate the association of CS with selected demographic and clinical parameters. The mean CSI was 37.72 (SD: 19.35), and thirty-eight (38%) patients had CS. Sacroiliitis occurred in 11 patients (11%), amyloidosis in 3 (3%), and erysipelas-like erythema in 11 (11%). The most prevalent genetic mutation was M694/any compound heterogeneous (35.7%), followed by M69V homogeneous (30%). Regarding comparing the patients with and without CS, the number of attacks, disease activity, daily colchicine dose, and all investigated comorbidities were significantly higher in the patients with CS (p < 0.05). In regression analysis, gender, colchicine dose and sleep disturbance were detected as related parameters with CS (OR (95% CI): 6.05 (1.39; 26.32), p: 0.017, OR (95% CI): 6.69 (1.65; 27.18), p: 0.008, OR (95% CI): 1.35 (1.35; 1.59), p: 0.001, respectively). Concomitant pain sensitization appears to be related to FMF patients' clinical and functional characteristics. These results suggest taking into consideration CS in the management of FMF patients.
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Comparative characteristics of ACR 1990, mACR 2010, ACR 2016 and AAPT 2019 criteria for diagnosing fibromyalgia in patients with ankylosing spondylitis. Rheumatol Int 2023; 43:69-77. [PMID: 35869993 DOI: 10.1007/s00296-022-05168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/25/2022] [Indexed: 02/02/2023]
Abstract
Despite many approaches, diagnosis of fibromyalgia (FM) remains a difficult clinical task, especially in the case of comorbidity of FM with other rheumatic diseases, such as ankylosing spondylitis (AS). The prevalence of FM among the population is 2.9-4.7%; whereas in patients with AS, it increases to 12.6-28.5%. The aim of the study was to evaluate the prevalence of FM in AS patients according to different criteria and to characterize them. 143 patients with AS, according to the modified New York Criteria, were examined. The FiRST used for screening of a possible FM. The FM was detected using the ACR 1990 criteria, mARC 2010, ACR 2016 and AAPT 2019 diagnostic criteria. All data were analyzed using IBM Statistics SPSS 22 software. The study was carried out in compliance with bioethical standards. According to ACR 1990, mACR 2010, ACR 2016, and AAPT 2019, the prevalence of FM in patients with AS ranged from 21.0% to 35.7%. The strongest correlation was observed in the mACR 2010 and ACR 2016 criteria (Cohen's κ = 0.871, p < 0.001); ACR 1990 and mACR 2010 as well as ACR 2016 criteria also demonstrated quite a strong level of agreement (Cohen's κ = 0.675 and 0.684, p < 0.001). Our results showed a high prevalence of FM in AS patients. mACR 2010 and ACR 2016 criteria are optimal for clinical practice to diagnose FM in AS patients.
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Izci Duran T, Torgutalp M, Rios Rodriguez V, Proft F, López-Medina C, Dougados M, Poddubnyy D. The impact of psoriasis on the clinical characteristics, disease burden and treatment patterns of peripheral spondyloarthritis. Rheumatology (Oxford) 2022; 62:135-146. [PMID: 35451472 DOI: 10.1093/rheumatology/keac235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, disease burden, and treatment patterns of peripheral spondyloarthritis (pSpA) patients with and without psoriasis using data from the ASAS-perSpA study. METHODS We included 433 patients who had a diagnosis of pSpA according to the rheumatologist's diagnosis from the ASAS-PerSpA study. The presence of a personal history of psoriasis was defined as the presence of signs of psoriasis at physical examination or the presence of psoriatic nail dystrophy, including onycholysis, pitting and hyperkeratosis, or a history of psoriasis diagnosed by a physician. Clinical characteristics, patient-reported outcomes and treatment pattern were compared between subgroups with and without psoriasis. RESULTS A total of 83 patients (19.2%) had a personal history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years), a higher frequency of dactylitis (36.1 vs 20.0%) and enthesitis (65.1 vs 55.4%) than patients without psoriasis. A longer diagnostic delay (odds ratio [OR] = 1.06 [95% CI 1.01, 1.11]), lower odds for HLA-B27 positivity (OR = 0.31 [95% CI 0.15, 0.65]) and higher odds for enthesitis (OR = 2.39 [95% CI 1.16, 4.93]) were associated with the presence of psoriasis in a multivariable regression analysis. While patient-reported outcomes were comparable between groups, a higher use of biologic DMARDs was observed in patients with vs without psoriasis. CONCLUSION The presence of psoriasis has an impact on clinical characteristics of pSpA. pSpA patients without psoriasis were less frequently treated with biologic DMARDs despite similar disease burden as compared with patients with psoriasis.
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Affiliation(s)
- Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clementina López-Medina
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Can Exercise Affect the Pain Characteristics in Patients with Fibromyalgia? A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10122426. [PMID: 36553951 PMCID: PMC9778432 DOI: 10.3390/healthcare10122426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Exercise is often recommended for fibromyalgia. The aim of this study was to investigate the possible influence and change in the pain characteristics of fibromyalgia patients when breathing exercises were added to their exercise program. A total of 106 patients were included and randomly divided into two groups. Τhe first group of patients followed a program of active exercises up to the limits of pain, lasting 30 min with a repetition of two times a week. Patients of the second group followed the same program with the addition of diaphragmatic breaths when they reached the pain limit. The patients completed three questionnaires: the Fibromyalgia Rapid Screening Tool (FiRST), the Brief Pain Inventory (BPI), and the Pain Quality Assessment Scale (PQAS)-once at the beginning, once again after three weeks of exercise, and again 3 months since the beginning of the program. Independent t-tests for the mean total change scores in pain scales demonstrated that for the second group there was a greater improvement in all pain scales, except for the PQAS Deep Pain subscale (p = 0.38). In conclusion, both groups showed significant improvement in all characteristics of the pain scales; however, the improvement of the second group was significantly higher.
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31
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Fitzgerald GE, Maguire S, Lopez-Medina C, Dougados M, O'Shea FD, Haroon N. Tender to touch-Prevalence and impact of concomitant fibromyalgia and enthesitis in spondyloarthritis: An ancillary analysis of the ASAS PerSpA study. Joint Bone Spine 2022; 89:105420. [PMID: 35636706 DOI: 10.1016/j.jbspin.2022.105420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The primary objective was to evaluate the co-existence of fibromyalgia (FM) & enthesitis in individuals with spondyloarthritis (SpA). Secondary objectives were to identify clinical features associated with the presence of FM in enthesitis and analyse sex-specific differences. METHODS This was an ancillary analysis of the Assessment of SpondyloArthritis International Society Peripheral Involvement in SpA (PerSpA) study. Enthesitis was defined as the presence of enthesitis ever. Clinical FM was defined as the rheumatologist's confirmation of the presence of FM. A score of≥5/6 on the Fibromyalgia Rapid Screening Test (FiRST) defined a positive screening test for FM. RESULTS Enthesitis ever and FM (EFM) co-existed in 10.3% (n=425) of the cohort using FiRST criteria and 5.3% using clinical diagnosis of FM. More individuals with FM by clinical diagnosis had imaging-confirmed enthesitis ever than by FiRST criteria. More females had EFM than males, defined clinically (76.9% vs 23.1%) or by FiRST criteria (62.6% vs 37.4%). Individuals with EFM had more severe disease across all measures compared to those with enthesitis only, with no significant difference between sexes. EFM was significantly associated with age, female sex, BMI, BASDAI and region. CONCLUSION FM is an important comorbidity in the setting of enthesitis in SpA. While EFM is more common in females, it is not a rare condition in males. EFM is associated with worse disease severity measures in SpA in both males and females. Recognition of FM in the setting of enthesitis is essential to prevent overtreatment and optimise patient outcomes.
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Affiliation(s)
- Gillian E Fitzgerald
- School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
| | - Sinead Maguire
- School of Medicine, Trinity College Dublin, Dublin, Ireland; Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Clementina Lopez-Medina
- University of Paris, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, INSERM (U1153), Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, France; Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- University of Paris, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, INSERM (U1153), Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, France
| | - Finbar D O'Shea
- School of Medicine, Trinity College Dublin, Dublin, Ireland; Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Nigil Haroon
- Schroeder Arthritis Institute, University Health Network, M5T 0S8 Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, M5T 0S8 Toronto, Ontario, Canada; Division of Rheumatology, Toronto Western Hospital, University Health Network, M5T 2S8 Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, M5S 1A8 Toronto, Ontario, Canada
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32
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Nociplastic pain concept, a mechanistic basis for pragmatic approach to fibromyalgia. Clin Rheumatol 2022; 41:2939-2947. [PMID: 35701625 DOI: 10.1007/s10067-022-06229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
Nociplastic pain (NP), as a mechanistic term, denotes pain arising from altered nociception without clear evidence of tissue or somatosensory damage. Fibromyalgia (FM), a prototypical NP condition, incorporates a broad continuum of phenotypes with a distinct neurobiological signature and shared NP attributes. The nociplastic concept may provide a new opportunity for early diagnosis of FM by identifying the characteristic NP features before a state of pain generalization and symptoms clustering. In this approach, even individual symptoms associated with NP features are worthy of attention to denote FM. It may provide a timely diagnosis of FM before clinical progression to a severe and hard-to-manage condition. Furthermore, collecting all various FM phenotypes under the nociplastic concept and not delimiting FM to the only typical presentation allows investigators to identify FM subgroups reflecting potentially distinct pathophysiologic mechanisms and biomarkers. This viewpoint can be served in future studies to develop individualized management. In this review, we postulate a novel approach to early FM diagnosis and management based on NP conceptualization and phenotype recognition. Key Points • FM as a NP condition represents overlapping clinical phenotypes and incomplete presentations especially in early stage of illness. • The mechanistic approach based on the NP features of FM can be implicated in the timely diagnosis and management of FM. • The NP-based approach to FM provides a broader viewpoint beyond FM delimitation to pain generalization and polysymptomatic complaints.
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The Affective Dimension of Pain Appears to Be Determinant within a Pain-Insomnia-Anxiety Pathological Loop in Fibromyalgia: A Case-Control Study. J Clin Med 2022; 11:jcm11123296. [PMID: 35743367 PMCID: PMC9225613 DOI: 10.3390/jcm11123296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Fibromyalgia (FM) is a chronic pain disease characterized by multiple symptoms whose interactions and implications in the disease pathology are still unclear. This study aimed at investigating how pain, sleep, and mood disorders influence each other in FM, while discriminating between the sensory and affective pain dimensions. Methods: Sixteen female FM patients were evaluated regarding their pain, while they underwent—along with 11 healthy sex- and age-adjusted controls—assessment of mood and sleep disorders. Analysis of variance and correlations were performed in order to assess group differences and investigate the interactions between pain, mood, and sleep descriptors. Results: FM patients reported the typical widespread pain, with similar sensory and affective inputs. Contrary to controls, they displayed moderate anxiety, depression, and insomnia. Affective pain (but neither the sensory pain nor pain intensity) was the only pain indicator that tendentially correlated with anxiety and insomnia, which were mutually associated. An affective pain–insomnia–anxiety loop was thus completed. High ongoing pain strengthened this vicious circle, to which it included depression and sensory pain. Conclusions: Discriminating between the sensory and affective pain components in FM patients disclosed a pathological loop, with a key role of affective pain; high ongoing pain acted as an amplifier of symptoms interaction. This unraveled the interplay between three of most cardinal FM symptoms; these results contribute to better understand FM determinants and pathology and could help in orienting therapeutic strategies.
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Goebel A, Andersson D, Barker C, Basu N, Bullock C, Bevan S, Bashford-Rogers RJM, Choy E, Clauw D, Dulake D, Dulake R, Flor H, Glanvill M, Helyes Z, Irani S, Kosek E, Laird J, MacFarlane G, McCullough H, Marshall A, Moots R, Perrot S, Shenker N, Sher E, Sommer C, Svensson CI, Williams A, Wood G, Dorris ER. Research Recommendations Following the Discovery of Pain Sensitizing IgG Autoantibodies in Fibromyalgia Syndrome. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1084-1094. [PMID: 34850195 PMCID: PMC9157149 DOI: 10.1093/pm/pnab338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is the most common chronic widespread pain condition in rheumatology. Until recently, no clear pathophysiological mechanism for fibromyalgia had been established, resulting in management challenges. Recent research has indicated that serum immunoglobulin Gs (IgGs) may play a role in FMS. We undertook a research prioritisation exercise to identify the most pertinent research approaches that may lead to clinically implementable outputs. METHODS Research priority setting was conducted in five phases: situation analysis; design; expert group consultation; interim recommendations; consultation and revision. A dialogue model was used, and an international multi-stakeholder expert group was invited. Clinical, patient, industry, funder, and scientific expertise was represented throughout. Recommendation-consensus was determined via a voluntary closed eSurvey. Reporting guideline for priority setting of health research were employed to support implementation and maximise impact. RESULTS Arising from the expert group consultation (n = 29 participants), 39 interim recommendations were defined. A response rate of 81.5% was achieved in the consensus survey. Six recommendations were identified as high priority- and 15 as medium level priority. The recommendations range from aspects of fibromyalgia features that should be considered in future autoantibody research, to specific immunological investigations, suggestions for trial design in FMS, and therapeutic interventions that should be assessed in trials. CONCLUSIONS By applying the principles of strategic priority setting we directed research towards that which is implementable, thereby expediating the benefit to the FMS patient population. These recommendations are intended for patients, international professionals and grant-giving bodies concerned with research into causes and management of patients with fibromyalgia syndrome.
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Affiliation(s)
- Andreas Goebel
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Andersson
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | - Chris Barker
- Lancashire and South Cumbria NHS Foundation Trust, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Craig Bullock
- Versus Arthritis, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, UK
| | - Stuart Bevan
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, UK
| | - David Clauw
- Anesthesiology, Medicine (Rheumatology) and Psychiatry University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School & Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Laird
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | | | - Hayley McCullough
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robert Moots
- Faculty of Health Social Care and Medicine, Edge Hill University, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Nick Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Emanuele Sher
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Germany
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Williams
- Health Psychology, UCL Research Department of Clinical, Educational & Health Psychology, University College London, UK
| | - Geoff Wood
- Cambridge Institute for Medical Research, Cambridge, UK
| | - Emma R Dorris
- School of Medicine, University College Dublin, Ireland
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Macian N, Dualé C, Voute M, Leray V, Courrent M, Bodé P, Giron F, Sonneville S, Bernard L, Joanny F, Menard K, Ducheix G, Pereira B, Pickering G. Short-Term Magnesium Therapy Alleviates Moderate Stress in Patients with Fibromyalgia: A Randomized Double-Blind Clinical Trial. Nutrients 2022; 14:2088. [PMID: 35631229 PMCID: PMC9145501 DOI: 10.3390/nu14102088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
Patients suffering from fibromyalgia often report stress and pain, with both often refractory to usual drug treatment. Magnesium supplementation seems to improve fibromyalgia symptoms, but the level of evidence is still poor. This study is a randomized, controlled, double-blind trial in fibromyalgia patients that compared once a day oral magnesium 100 mg (Chronomag®, magnesium chloride technology formula) to placebo, for 1 month. The primary endpoint was the level of stress on the DASS-42 scale, and secondary endpoints were pain, sleep, quality of life, fatigue, catastrophism, social vulnerability, and magnesium blood concentrations. After 1 month of treatment, the DASS-42 score decreased in the magnesium and placebo groups but not significantly (21.8 ± 9.6 vs. 21.6 ± 10.8, respectively, p = 0.930). Magnesium supplementation significantly reduced the mild/moderate stress subgroup (DASS-42 stress score: 22.1 ± 2.8 to 12.3 ± 7.0 in magnesium vs. 21.9 ± 11.9 to 22.9 ± 11.9 in placebo, p = 0.003). Pain severity diminished significantly (p = 0.029) with magnesium while the other parameters were not significantly different between both groups. These findings show, for the first time, that magnesium improves mild/moderate stress and reduces the pain experience in fibromyalgia patients. This suggests that daily magnesium could be a useful treatment to improve the burden of disease of fibromyalgia patients and calls for a larger clinical trial.
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Affiliation(s)
- Nicolas Macian
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Christian Dualé
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
- INSERM 1107, University Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Marion Voute
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Vincent Leray
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Marion Courrent
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Paula Bodé
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Fatiha Giron
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Sylvie Sonneville
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Lise Bernard
- Clinical Research/Temporary Authorization Department, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
| | - Fabienne Joanny
- FJ Recherche et Developpement, Research Organization, 230 Rue du Faubourg Saint-Honoré, F-75008 Paris, France;
| | - Katell Menard
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Gilles Ducheix
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
| | - Bruno Pereira
- Clinical Research and Innovation Department, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
| | - Gisèle Pickering
- Platform of Clinical Investigation Department, INSERM CIC 1405, University Hospital Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.D.); (M.V.); (V.L.); (M.C.); (P.B.); (F.G.); (S.S.); (K.M.); (G.D.); (G.P.)
- INSERM 1107, University Clermont Auvergne, F-63000 Clermont-Ferrand, France
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Ziade N, Rassi J, Elzorkany B, Lopez-Medina C, Gamal SM, Hlais S, Dougados M, Baraliakos X. What is peripheral spondyloarthritis? Identifying proportion, phenotype and burden in post hoc analysis of the ASAS-PerSpA study. Semin Arthritis Rheum 2022; 55:152012. [PMID: 35489171 DOI: 10.1016/j.semarthrit.2022.152012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the prevalence, phenotype, and burden of peripheral spondyloarthritis (pSpA). The objective of the study is to compare the phenotype and burden of disease of pure pSpA to that of pure psoriatic arthritis (PsA), pure axial SpA (axSpA), and combined forms of SpA. METHODS This is a post hoc analysis of 4,185 patients from the cross-sectional ASAS-Peripheral involvement in SpA (PerSpA) study. Patients were approached in 2 ways: the first approach was based on the rheumatologist's diagnosis (diagnostic approach) and the second one was based on the fulfillment of ASAS or CASPAR classification criteria (classification criteria approach). Demographics, disease phenotype, and burden were compared among pure pSpA, PsA, axSpA, and the combined forms. FINDINGS The proportion of pSpA was 31.5% of SpA using the classification criteria approach and 10.3% using the diagnostic approach. pSpA was pure (i.e. without axSpA or PsA) in 16.8% of pSpA using the criteria, and in 62.3% using the diagnostic approach. Using classification criteria and diagnostic approach, respectively, pure pSpA patients had a high prevalence of peripheral joint disease (86 and 96%), synovitis (76 and 91%), and enthesitis (57 and 55%), a positive HLA-B27 in 65 and 59%, a high C-Reactive Protein level in 51% and inflammatory back pain in 52 and 42%. However, compared to pure PsA and pure axSpA, they had a significantly higher disease burden, but lower use of biologics using both approaches. INTERPRETATION The proportion of pSpA varies when using the classification criteria or the diagnostic approach. pSpA occurred in a pure form less frequently than PsA and axSpA and had intermediate features but a higher disease burden. FUNDING The PerSpA main study has been conducted under the umbrella of ASAS thanks to unrestricted grants from PFIZER, LILLY, ABBVIE, NOVARTIS, UCB, JANSSEN, MERCK.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Joe Rassi
- Surgery Department, Saint-Joseph University, Beirut, Lebanon; Orthopedic Surgery Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Bassel Elzorkany
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Clementina Lopez-Medina
- Rheumatology Department, Cochin Hospital, Paris, France; Rheumatology Department, Reina Sofia University Hospital / IMIBIC/ University of Cordoba, Cordoba, Spain.
| | - Sherif M Gamal
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Sani Hlais
- Family Medicine Department, Saint-Joseph University, Beirut, Lebanon; Family Medicine Department, American University of Beirut, Lebanon.
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Therapeutic Patient Education for Fibromyalgia during Spa Therapy: The FiETT Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084613. [PMID: 35457480 PMCID: PMC9030628 DOI: 10.3390/ijerph19084613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
Spa therapy is known to improve quality of life and diminish pain. We assessed the efficacy (Fibromyalgia Impact Questionnaire-FIQ) and safety at 6 months of a fibromyalgia-specific therapeutic patient education (TPE) program added to fibromyalgia-specific standardized spa therapy (SST), compared to SST alone, in a controlled randomized trial. We enrolled 157 patients, mostly women, attending spa centers in Southwest France in 2015–2016, and randomized them to SST + TPE (79) or SST (78). The intention-to-treat with “missing as failure” analysis showed a tendency toward a higher, though non-significant, benefit with TPE than without for FIQ (−9 vs. −3; p = 0.053) or pain intensity (−0.9 vs. −1.1; p = 0.58). In addition, pain relief (+3.2 vs. +4.3; p = 0.03) and fatigue (−1.6 vs. −3.7; p = 0.02) were significantly improved, and 87% patients in the SST + TPE arm still regularly practiced the physical exercises taught to them at 6 months. We suspect significant and lasting improvement from spa therapy, as well as our already well-informed and well-managed participants, to have prevented the demonstration of a significant benefit of TPE on FIQ.
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Morin M, St-Gelais R, Ketounou KÉ, d'Assomption RML, Ezzaidi H, Fernandes KBP, da Silva RA, Ngomo S. tDCS Task-Oriented Approach Improves Function in Individuals With Fibromyalgia Pain. A Pilot Study. FRONTIERS IN PAIN RESEARCH 2022; 2:692250. [PMID: 35295530 PMCID: PMC8915725 DOI: 10.3389/fpain.2021.692250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia (FM) is a complex pain syndrome accompanied by physical disability and loss of daily life activities. Evidences suggest that modulation of the primary motor cortex (M1) by transcranial direct current stimulation (tDCS) improves functional physical capacity in chronic pain conditions. However, the gain on physical function in people living with FM receiving tDCS is still unclear. This study aimed to evaluate whether the tDCS task-oriented approach improves function and reduces pain in a single cohort of 10 FM. A total of 10 women with FM (60.4 ± 15.37 years old) were enrolled in an intervention including anodal tDCS delivered on M1 (2 mA from a constant stimulator for 20 min); simultaneously they performed a functional task. The anode was placed on the contralateral hemisphere of the dominant hand. Outcome assessments were done before the stimulation, immediately after stimulation and 30 min after the end of tDCS. The same protocol was applied in subsequent sessions. A total of five consecutive days of tDCS were completed. The main outcomes were the number of repetitions achieved and time in active practice to evaluate functional physical task performance such as intensity of the pain (visual analog scale) and level of fatigue (Borg scale). After 5 days of tDCS, the number of repetitions achieved significantly increased by 49% (p = 0.012). No change was observed in active practice time. No increase in pain was observed despite the mobility of the painful parts of the body. These results are encouraging since an increase in pain due to the mobilization of painful body parts could have been observed at the end of the 5th day of the experiment. These results support the use of tDCS in task-based rehabilitation.
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Affiliation(s)
- Marika Morin
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Raphaël St-Gelais
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Kossi Épiphane Ketounou
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Régis M-L d'Assomption
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Hassan Ezzaidi
- Department of Applied Sciences, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | | | - Rubens A da Silva
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Suzy Ngomo
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
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Kerckhove N, Delage N, Cambier S, Cantagrel N, Serra E, Marcaillou F, Maindet C, Picard P, Martiné G, Deleens R, Trouvin AP, Fourel L, Espagne-Dubreuilh G, Douay L, Foulon S, Dufraisse B, Gov C, Viel E, Jedryka F, Pouplin S, Lestrade C, Combe E, Perrot S, Perocheau D, De Brisson V, Vergne-Salle P, Mertens P, Pereira B, Djiberou Mahamadou AJ, Antoine V, Corteval A, Eschalier A, Dualé C, Attal N, Authier N. eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study. JMIR Form Res 2022; 6:e30052. [PMID: 35234654 PMCID: PMC8928045 DOI: 10.2196/30052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. TRIAL REGISTRATION ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Cambier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric Serra
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Fabienne Marcaillou
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Maindet
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pascale Picard
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaelle Martiné
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Rodrigue Deleens
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Anne-Priscille Trouvin
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Lauriane Fourel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Gaelle Espagne-Dubreuilh
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Ludovic Douay
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Stéphane Foulon
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Bénédicte Dufraisse
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Christian Gov
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Eric Viel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - François Jedryka
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Sophie Pouplin
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Combe
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Perrot
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Dominique Perocheau
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Valentine De Brisson
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Pascale Vergne-Salle
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Patrick Mertens
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Bruno Pereira
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Violaine Antoine
- Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Université Clermont Auvergne, Aubière, France
| | | | | | - Christian Dualé
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadine Attal
- Institut National de la Santé et de la Recherche Médicale, Unité 987 - Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Ambroise Paré, Paris, France
| | - Nicolas Authier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Ghavidel‐Parsa B, Bidari A, Atrkarroushan Z, Khosousi M. Implication of the Nociplastic Features for Clinical Diagnosis of Fibromyalgia: Development of the Preliminary Nociplastic-Based Fibromyalgia Features (NFF) Tool. ACR Open Rheumatol 2022; 4:260-268. [PMID: 34936234 PMCID: PMC8916565 DOI: 10.1002/acr2.11390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Nociplastic concept incorporates a broad continuum of pain phenotypes shared with clinical peculiarity. This study aimed to develop and validate a diagnostic tool, the preliminary Nociplastic-based Fibromyalgia Features (NFF), to detect fibromyalgia (FM) in patients with chronic pain. METHODS Items requiring yes or no responses and relating to the most relevant clinical nociplastic pain (NP) features of FM were compiled by a group of expert rheumatologists. The provisional list was tested in a prospective study on 185 consecutive patients with chronic pain (126 patients with FM and 59 patients with non-FM non-inflammatory chronic pain) diagnosed based on expert decision. Identification of the most discriminant combinations of items for FM and the calculation of their sensitivity and specificity were based on both univariate and multivariate (stepwise logistic regression) analyses. All participants were investigated through the final NFF, the 2011 American College of Rheumatology (ACR) criteria, and the 2016 ACR criteria. NFF performance was assessed with receiver operating characteristic curve analysis. RESULTS Based on multivariate analyses, we retained only seven items in the final version of the NFF. A cut-off score of 4 (corresponding to the number of positive items) gave the highest rate of correct identification of patients (85%), with a sensitivity of 82% and a specificity of 91%. The NFF showed the highest concordance rate with expert diagnosis (85%) and the lowest value (77%) with the ACR 2016 criteria. CONCLUSION The preliminary NFF with respect to the various aspects of NP showed good performance for detection of the FM in the clinical setting. This tool may provide a more pragmatic approach to the timely diagnosis of FM.
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Affiliation(s)
| | - Ali Bidari
- Iran University of Medical SciencesTehranIran
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Settembre C, D’Antonio E, Moscato P, Loi G, Santonicola A, Iovino P. Association among Disorders of Gut-Brain Interaction (DGBI) and Fibromyalgia: A Prospective Study. J Clin Med 2022; 11:jcm11030809. [PMID: 35160260 PMCID: PMC8836992 DOI: 10.3390/jcm11030809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
The disorders of gut-brain interaction (DGBI) have been associated with Fibromyalgia (FM). However, there are no data about the relationship between FM and DGBI using Rome IV criteria. This study aimed to evaluate the prevalence of FM in patients with Irritable Bowel Syndrome (IBS) and/or Functional Dyspepsia (FD) and the prevalence of IBS and FD in FM patients using Rome IV criteria. DGBI patients and FM patients were recruited from two outpatient clinics devoted to DGBI and FM. All patients underwent a standardized gastrointestinal (GI) symptoms questionnaire. FM symptoms in DGBI patients were assessed through Fibromyalgia Rapid Screening Tool (FiRST) and Fibromyalgia Impact Questionnaire. Thereafter, the rheumatologists evaluated them. 49.0% of FM patients fulfilled the diagnostic criteria for IBS, 81.6% for FD with an overlap for both IBS/FD in 44.9%. IBS-C was the most prevalent IBS-subtype in DGBI patients, whereas IBS-M was the most prevalent in FM patients (p = 0.01). 45.3% of DGBI patients reported pathological FiRST scores. DGBI patients with FM showed the highest score at the standardized GI questionnaire followed by FM patients with DGBI and DGBI without FM. In conclusion DGBI are common in FM patients and vice versa. The presence of FD is extremely frequent in FM patients. A multidisciplinary approach should be routinely used for the management of these patients.
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Affiliation(s)
- Carmela Settembre
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (C.S.); (E.D.)
| | - Elvira D’Antonio
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (C.S.); (E.D.)
| | - Paolo Moscato
- Rheumatology Unit, AOU San Giovanni di Dio e Ruggi d’Aragona, 84125 Salerno, Italy; (P.M.); (G.L.)
| | - Gabriella Loi
- Rheumatology Unit, AOU San Giovanni di Dio e Ruggi d’Aragona, 84125 Salerno, Italy; (P.M.); (G.L.)
| | - Antonella Santonicola
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (C.S.); (E.D.)
- Correspondence: (A.S.); (P.I.)
| | - Paola Iovino
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (C.S.); (E.D.)
- Correspondence: (A.S.); (P.I.)
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de Sousa AP, de Arruda GT, Pontes-Silva A, de Souza MC, Driusso P, Avila MA. Measurement properties of the Brazilian online version of the Fibromyalgia Rapid Screening Tool (FiRST). Adv Rheumatol 2022; 62:39. [PMID: 36316763 PMCID: PMC9628418 DOI: 10.1186/s42358-022-00271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The Fibromyalgia Rapid Screening Tool (FiRST) was developed to screen people with chronic pain for Fibromyalgia (FM), especially in primary health care settings. This study aimed to translate the FiRST into Brazilian Portuguese and evaluate its measurement properties for an online application. METHODS After the process of translation and backtranslation, the FiRST was applied online in 483 adults with chronic pain (FM group n = 395; Chronic pain group n = 88), along with the Numerical Rating Scale for pain and fatigue, the Brief Pain Inventory, and the Fibromyalgia Impact Questionnaire-Revised. A Receiver Operating Characteristics (ROC) curve was computed and the area under the curve (AUC) was used to determine the sensibility, specificity, and cut-off score for the FiRST. The Mann-Whitney test was used for quantitative variables and the Chi-square and the Fisher's exact test, for the categorical variables with level of significance of 5%. Fleiss' Kappa, Gwet's AC1 and percentage of agreement were also calculated between test and retest. RESULTS For all the questionnaires, the FM group presented higher scores, which mean a worst condition. The FiRST presented a sensitivity of 92.3%, and a specificity of 61.6% with 5 as the cut-off score. AUC, Fleiss' Kappa, Gwet's AC1 and percentage of agreement were, respectively, 0.82, 0.38, 0.63 and 71.8%. CONCLUSION The FiRST was translated into Brazilian Portuguese and the online version presented a good content validity and adequate measurement errors that allow FM patients to be screened among people with chronic pain.
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Affiliation(s)
- Ana Paula de Sousa
- grid.411247.50000 0001 2163 588XPhysical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil ,grid.411247.50000 0001 2163 588XStudy Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil
| | - Guilherme Tavares de Arruda
- grid.411247.50000 0001 2163 588XPhysical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil ,grid.411247.50000 0001 2163 588XStudy Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil
| | - André Pontes-Silva
- grid.411247.50000 0001 2163 588XPhysical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil ,grid.411247.50000 0001 2163 588XStudy Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil
| | - Marcelo Cardoso de Souza
- grid.411233.60000 0000 9687 399XPostgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN Brazil
| | - Patricia Driusso
- grid.411247.50000 0001 2163 588XLaboratory of Research on Women’s Health (LAMU), Physical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil
| | - Mariana Arias Avila
- grid.411247.50000 0001 2163 588XPhysical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil ,grid.411247.50000 0001 2163 588XStudy Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, Jardim Guanabara, ZIP Code 13565-905, São Carlos, SP Brazil
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Magrey MN, Thomas C, Khan MA. The American College of Rheumatology Fibromyalgia Criteria Are Useful in the Evaluation of Fibromyalgia Symptoms in Patients With Ankylosing Spondylitis: A Cross-Sectional Study. J Clin Rheumatol 2021; 27:e399-e403. [PMID: 32701537 DOI: 10.1097/rhu.0000000000001490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is common among patients with ankylosing spondylitis (AS), and its coexistence is believed to interfere with the measurement of patient-reported outcomes of disease activity and function in AS because of overlapping symptoms between the 2 diseases. This can confound clinical assessment and treatment decisions. AIMS The aim of this study was to assess the relationship between the Fibromyalgia Symptom Scale (FSS) and its components, the Widespread Pain Index (WPI), and System Severity Scale with measures of disease activity, function, and patient-reported outcomes in AS. METHODS We recruited 63 AS patients (aged ≥18 years) meeting the modified New York criteria, and Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein, Routine Assessment of Patient Index Data 3, and Bath Ankylosing Spondylitis Functional Index questionnaires were administered to them. The presence of FM was determined using validated 2010 American College of Rheumatology diagnostic criteria for FM. RESULTS Twenty-eight of 63 patients (44.4%) with AS and FM had higher disease activity and greater impairment of functional ability compared with AS patients without FM. Using multiple linear regression estimates, there was no significant relationship of FSS scores with Bath Ankylosing Spondylitis Disease Activity Index (p = 0.36), Routine Assessment of Patient Index Data 3 (p = 0.50), Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (p = 0.24), Bath Ankylosing Spondylitis Functional Index (p = 0.42) scores, or erythrocyte sedimentation rate (p = 0.82) and C-reactive protein (p = 0.75). CONCLUSIONS Despite a high prevalence of FM in our patients with the diagnosis of AS, there was no relationship between FSS and measures of disease activity or function in AS, suggesting that FSS and its components could be a useful tool to assess FM in AS patients. Also, FM impairs functional ability in patients with AS.
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Affiliation(s)
- Marina N Magrey
- From the Case Western Reserve University School of Medicine at MetroHealth Medical Center
| | | | - Muhammad Asim Khan
- From the Case Western Reserve University School of Medicine at MetroHealth Medical Center
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López-Medina C, Chevret S, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compan V, Luo SF, Biglia A, Tae-Jong K, Kishimoto M, Pimentel-Santos FM, Gu J, Muntean L, van Gaalen FA, Geher P, Magrey M, Ibáñez-Vodnizza SE, Bautista-Molano W, Maksymowych W, Machado PM, Landewé R, van der Heijde D, Dougados M. Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study. RMD Open 2021; 7:rmdopen-2021-001728. [PMID: 34750246 PMCID: PMC8576480 DOI: 10.1136/rmdopen-2021-001728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
Objective To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. Methods Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. Results The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist‘s diagnosis as well as with the classification criteria was found. Conclusion These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France .,Rheumatology, Reina Sofia University Hospital, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Sylvie Chevret
- CRESS, Université de Paris, INSERM U-1153, Paris, France
| | - Anna Molto
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,CRESS, Université de Paris, INSERM U-1153, Paris, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Tuncay Duruöz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Rheumatology, Ruhr University Bochum, Bochum, Germany
| | | | | | - Ruben Burgos-Vargas
- Rheumatology, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
| | - José Maldonado-Cocco
- Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Nelly Ziade
- Rheumatology, Saint Joseph University, Beirut, Lebanon.,Rheumatology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Meghna Gavali
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Alessandro Biglia
- Rheumatology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Kim Tae-Jong
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | | | | | - Jieruo Gu
- Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Laura Muntean
- Rheumatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.,Rheumatology, County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Geher
- Rheumatology, Semmelweis University, Budapest, Hungary
| | - Marina Magrey
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Wilson Bautista-Molano
- Rheumatology, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,CRESS, Université de Paris, INSERM U-1153, Paris, France
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Jouini S, Milleron O, Eliahou L, Jondeau G, Vitiello D. Effects of a personalized home-based training program among patients suffering from Marfan syndrome: a pilot randomized and controlled study. Intractable Rare Dis Res 2021; 10:263-268. [PMID: 34877238 PMCID: PMC8630458 DOI: 10.5582/irdr.2021.01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Marfan syndrome (MFS) is an autosomal hereditary pathology affecting 1:5000 peoples. Alteration of the fibrillin 1 gene (FBN1) results in haplo-insufficiency of the FBN1 protein mainly altering the vascular system. International recommendations have gradually allowed MFS patients to perform training programs because of its potential benefits. However, to date, there are no data on the effect of a long training period in these patients. The aim of the present study is to investigate the effect of a 3-month personalized home-based training on quality of life (QoL) of patients suffering from MFS. At least 50 MFS patients were included in the study. They were randomly placed into 4 groups: control group; endurance; resistance and endurance + resistance training groups. The training program lasted 3 months and is performed at patients' home. There were 2 training sessions per week telemonitored by a specialist of physical activity and cardiology. Pre and post-training evaluations were performed at the Bichat-Paris Hospital, France. They consisted of assessing psychometrics based on self-administered questionnaires (FiRST, GPAQ, ISP-25, MOS SF-36) and physiological parameters such as the peak oxygen consumption, aorta diameter, cardiac ventricle function and skeletal muscle power at rest and during exercise. Our preliminary results showed an improvement of 50% in QoL, cardiorespiratory fitness and skeletal muscle power in a patient who completed the combined training program. This experimental approach might be a new alternative way for MFS patients' care that may improve their QoL, cardiorespiratory fitness and skeletal muscle power.
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Affiliation(s)
- Steeve Jouini
- Institute of Sport and Health Sciences of Paris, Université de Paris, Paris, France
| | - Olivier Milleron
- Laboratory for Vascular Translational Science, Hôpital Bichat-Claude-Bernard, Université de Paris, Paris, France
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Ludivine Eliahou
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Guillaume Jondeau
- Laboratory for Vascular Translational Science, Hôpital Bichat-Claude-Bernard, Université de Paris, Paris, France
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Damien Vitiello
- Institute of Sport and Health Sciences of Paris, Université de Paris, Paris, France
- Address correspondence to:Damien Vitiello, URP 3625-Institute of Sport and Health Sciences of Paris (I3SP), Université de Paris, Paris 75015, France. E-mail:
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AlEnzi F, Alhamal S, Alramadhan M, Altaroti A, Siddiqui I, Aljanobi G. Fibromyalgia in Health Care Worker During COVID-19 Outbreak in Saudi Arabia. Front Public Health 2021; 9:693159. [PMID: 34568254 PMCID: PMC8461016 DOI: 10.3389/fpubh.2021.693159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background: In the face of the contemporary COVID-19 pandemic, health service providers have emerged as the most at-risk individuals who are likely to contract the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aim: To measure the prevalence of fibromyalgia (FM) during COVID outbreak among health workers in Saudi Arabia using FiRST and LFESSQ tool. Methods: The study employed a cross-sectional methodology to explore the prevalence of Fibromyalgia among health workers at different health care settings in Saudi Arabia. The assessment of the prevalence of fibromyalgia among health worker was determined by using the Fibromyalgia Rapid Screening Tool (FiRST) and London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) questionnaires. Descriptive statistics were used to summarize the data. Results: The sample size included 992 participants. The prevalence of fibromyalgia using FiRST and LFESSQ was 12.6 and 19.8%, respectively. In this study, the prevalence of fibromyalgia was higher in females when compared to males. Most of the respondents have Vitamin D deficiency. The relationship of fibromyalgia was significantly associated with the participants who worked during an outbreak, who covered COVID-19 inpatient, covered in-hospital on call and in area quarantine. Conclusion: The study's findings demonstrate that the prevalence of Fibromyalgia among health service providers during the current COVID-19 pandemic is considerably higher and that there are potential interventions that may be employed to mitigate the prevalence of the infection during the COVID-19 crisis.
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Affiliation(s)
- Fahidah AlEnzi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sara Alhamal
- Department of Internal Medicine, Rheumatology Section, Qatif Central Hospital, Al Qatif, Saudi Arabia
| | - Maryam Alramadhan
- Department of Internal Medicine, Rheumatology Section, Qatif Central Hospital, Al Qatif, Saudi Arabia
| | - Ahmed Altaroti
- Department of Internal Medicine, Rheumatology Section, Qatif Central Hospital, Al Qatif, Saudi Arabia
| | - Intisar Siddiqui
- Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ghada Aljanobi
- Department of Internal Medicine, Rheumatology Section, Qatif Central Hospital, Al Qatif, Saudi Arabia
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Keramiotou K, Anagnostou C, Konstantonis G, Kataxaki E, Sfikakis PP, Tektonidou MG. Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS). Rheumatol Adv Pract 2021; 5:rkab029. [PMID: 34557620 PMCID: PMC8450930 DOI: 10.1093/rap/rkab029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/21/2021] [Indexed: 12/20/2022] Open
Abstract
Objective The aim was to examine hand function and performance in activities of daily living (ADL) in patients with SLE vs healthy controls, and any associations with demographic and disease-related characteristics. Methods Hand function (grip strength, pinch strength and dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and biological sex-matched healthy controls. Grip strength, pinch strength and dexterity were measured by Jamar dynamometer, pinch gauge and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by disabilities of the arm, shoulder and hand (DASH) and HAQ. Regression analysis was performed to assess the determinants of hand dysfunction. Results All hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS; n = 157) compared with healthy subjects (P < 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ, and use of immunosuppressives with DASH, HAQ and grip strength. Likewise, in patients in LLDAS, painful joints were correlated with DASH and HAQ, age with grip strength and Purdue (P < 0.001), gender with grip strength, and immunosuppressives with HAQ and grip strength. Conclusion Hand function and performance of daily activities are significantly impaired in SLE, even in patients who achieve LLDAS, suggesting the need for their evaluation and management in clinical practice.
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Affiliation(s)
- Kyriaki Keramiotou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens.,Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | | | - George Konstantonis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
| | - Evangelia Kataxaki
- Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
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Daskalakis I, Sperelakis I, Sidiropoulou B, Kontakis G, Tosounidis T. Patient-Reported Outcome Measures (PROMs) Relevant to Musculoskeletal Conditions Translated and Validated in the Greek Language: A COSMIN-Based Systematic Review of Measurement Properties. Mediterr J Rheumatol 2021; 32:200-217. [PMID: 34964024 PMCID: PMC8693298 DOI: 10.31138/mjr.32.3.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The use of patient-reported outcome measures (PROMs) constitutes a valuable tool in evaluating the quality of care offered in orthopaedic surgery. The aim of this review is to identify the PROMs that have been translated into and validated in the Greek language, summarise their measurement properties, and evaluate their methodological quality according to the COSMIN Risk of Bias Checklist. METHODS A structured literature search was conducted using the databases PubMED/MEDLINE, Embase, Scopus, and the Cochrane Library in order to identify PROMs relevant to musculoskeletal conditions translated and validated in the Greek language. The methodological quality of the studies was assessed according to the COSMIN Risk of Bias Checklist, and the quality of measurement properties according to the COMSIN criteria. RESULTS Literature search yielded 6743 articles. After removal of duplicates and screening of the articles, 32 studies including PROMs related to musculoskeletal conditions were identified. The studies included 31 PROMs and reported 171 measurement properties. Methodological quality was adequate for 81 of them (47.3%). The most commonly reported measurement properties were internal consistency, reliability, construct validity and responsiveness. CONCLUSION The majority of PROMs translated into Greek involves the lower extremity and especially knee pathologies. The search revealed that there are areas of Musculoskeletal Medicine such as skeletal trauma, musculoskeletal oncology, and paediatric orthopaedics in which patient reported-outcome measures have not been translated into Greek. Translation and validation of new outcome measures is encouraged, using studies designed in compliance with the COSMIN guidelines, and further validation of the translated instruments.
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Affiliation(s)
- Ioannis Daskalakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Ioannis Sperelakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Georgios Kontakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Theodoros Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
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López-Medina C, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compan V, Luo SF, Monti S, Tae-Jong K, Kishimoto M, Pimentel-Santos FM, Gu J, Schiotis R, van Gaalen FA, Geher P, Magrey M, Ibáñez Vodnizza SE, Bautista-Molano W, Maksymowych W, Machado PM, Landewé R, van der Heijde D, Dougados M. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 2021; 7:rmdopen-2020-001450. [PMID: 33462157 PMCID: PMC7816910 DOI: 10.1136/rmdopen-2020-001450] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. METHODS Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. RESULTS A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). CONCLUSION These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France .,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany
| | - Tuncay Duruöz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Najia Hajjaj-Hassouni
- Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Ruben Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
| | - José Maldonado-Cocco
- Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon
| | - Meghna Gavali
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Sara Monti
- Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy
| | - Kim Tae-Jong
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - F M Pimentel-Santos
- Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Jieruo Gu
- Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruxandra Schiotis
- Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Rheumatology Department, SCBI, Cluj-Napoca, Romania
| | - Floris A van Gaalen
- Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Geher
- Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary
| | - Marina Magrey
- Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Wilson Bautista-Molano
- Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Robert Landewé
- Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.,Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology, Université de Paris Descartes, Paris, France
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50
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Ursini F, Ciaffi J, Mancarella L, Lisi L, Brusi V, Cavallari C, D'Onghia M, Mari A, Borlandelli E, Faranda Cordella J, La Regina M, Viola P, Ruscitti P, Miceli M, De Giorgio R, Baldini N, Borghi C, Gasbarrini A, Iagnocco A, Giacomelli R, Faldini C, Landini MP, Meliconi R. Fibromyalgia: a new facet of the post-COVID-19 syndrome spectrum? Results from a web-based survey. RMD Open 2021; 7:rmdopen-2021-001735. [PMID: 34426540 PMCID: PMC8384499 DOI: 10.1136/rmdopen-2021-001735] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Postacute COVID-19 syndrome (PACS) is an emerging entity characterised by a large array of manifestations, including musculoskeletal complaints, fatigue and cognitive or sleep disturbances. Since similar symptoms are present also in patients with fibromyalgia (FM), we decided to perform a web-based cross-sectional survey aimed at investigating the prevalence and predictors of FM in patients who recovered from COVID-19. Methods Data were anonymously collected between 5 and 18 April 2021. The collection form consisted of 28 questions gathering demographic information, features and duration of acute COVID-19, comorbid diseases, and other individual’s attributes such as height and weight. The American College of Rheumatology (ACR) Survey Criteria and the Italian version of the Fibromyalgia Impact Questionnaire completed the survey. Results A final sample of 616 individuals (77.4% women) filled the form 6±3 months after the COVID-19 diagnosis. Of these, 189 (30.7%) satisfied the ACR survey criteria for FM (56.6% women). A multivariate logistic regression model including demographic and clinical factors showed that male gender (OR: 9.95, 95% CI 6.02 to 16.43, p<0.0001) and obesity (OR: 41.20, 95% CI 18.00 to 98.88, p<0.0001) were the strongest predictors of being classified as having post-COVID-19 FM. Hospital admission rate was significantly higher in men (15.8% vs 9.2%, p=0.001) and obese (19.2 vs 10.8%, p=0.016) respondents. Conclusion Our data suggest that clinical features of FM are common in patients who recovered from COVID-19 and that obesity and male gender affect the risk of developing post-COVID-19 FM.
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Affiliation(s)
- Francesco Ursini
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy .,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luana Mancarella
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Lisi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Carlotta Cavallari
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Martina D'Onghia
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Mari
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Borlandelli
- Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | | | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto De Giorgio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Baldini
- Biomedical Science and Technology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Riccardo Meliconi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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