Fibromyalgia: chronobiological aspects

Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial

OBJECTIVES

To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia (FM) and to determine exercise adherence levels.

DESIGN

A randomized controlled trial.

SETTING

Testing and training were completed at the university.

PARTICIPANTS

Middle-aged women with FM (n=60) and healthy women (n=25).

INTERVENTION

A 16-week aquatic training program, including strength training, aerobic training, and relaxation exercises.

MAIN OUTCOME MEASURES

Tender point count (syringe calibrated), health status (Fibromyalgia Impact Questionnaire); sleep quality (Pittsburgh Sleep Quality Index); physical (endurance strength to low loads tests), psychologic (State Anxiety Inventory), and cognitive function (Paced Auditory Serial Addition Task); and adherence 12 months after the completion of the study.

RESULTS

For all the measurements, the patients showed significant deficiencies compared with the healthy subjects. Efficacy analysis (n=29) and intent-to-treat analysis (n=34) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality, cognitive function, and physical function. Anxiety remained unchanged during the follow-up. The exercise group had a significant improvement of health status, not associated exclusively with the exercise intervention. There were no changes in the control group. Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program.

CONCLUSIONS

An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology. The therapeutic intervention's effects can be assessed through applicable tests in the clinical practice.

A link between lunar phase and medically unexplained stroke symptoms: an unearthly influence?

OBJECTIVE

Lunar effects on human behaviour and health have been postulated for centuries; associations between phase of the moon and both vascular and psychiatric disease have been reported. We hypothesised that admission with medically unexplained stroke symptoms would be influenced by lunar cycle.

METHODS

All admissions to the Western Infirmary Acute Stroke Unit are recorded in a comprehensive database. We analysed admissions between January 1, 1993, and September 30, 2006 (inclusive). Association between admission rate, phase of the moon, and a series of other culturally significant dates was calculated using chi-square testing.

RESULTS

There were 7219 admissions during the study period, comprising 167 complete lunar cycles. Stroke admissions were evenly spread throughout lunar phases (P=.72). Admission with medically unexplained stroke symptoms was significantly increased during full moon phases (P=.023). There was no variation in admission rates during other significant dates.

CONCLUSION

There was a statistically significant association between admission to the acute stroke unit with a diagnosis of medically unexplained stroke symptoms and lunar phase. The reasons for this observed variation remain elusive; our data do not support a convincing biological or psychosocial aetiology.

Seasonal variation in the onset of acute microcrystalline arthritis

OBJECTIVE

To determine whether acute attacks of uric acid and calcium pyrophosphate microcrystalline arthritis show a seasonal variation and, if so, to verify whether the distribution of single episodes shows a rhythmic circannual pattern.

METHOD

All suspected cases of microcrystalline acute arthritis observed at the General Hospital of Ferrara during an 8 yr period (January 1990-December 1997) were considered. Diagnosis was made on the basis of history, physical examination and analysis of synovial fluid by means of polarized light microscopy. Month and day of each event were categorized both into four 3-month periods (by seasons) and 12 monthly intervals. Two different statistical methods have been utilized: chi(2) test for goodness of fit and partial Fourier series.

RESULTS

During the period considered, 210 episodes of acute gout were observed [196 in males (93.3%) and 14 in females (6.7%)] in 179 different subjects, and 179 episodes of acute pseudogout [58 in males (32.4%) and 121 in females (67.6%)] in 165 different subjects. Gout attacks showed a higher frequency peak in spring [76 cases (36. 2%), P<0.001]. Analysis of distribution of events by gender confirmed the clear spring pattern in males (36.2%), whereas the paucity of cases in females did not allow any valid statistical analysis. Pseudogout attacks showed a higher frequency peak in autumn [52 cases (29.1%)], without reaching a statistically significant level either for the total sample or for subgroups divided by gender. Analysis of the seasonal distribution of gout or pseudogout events was significantly different (chi(2) 15.7, P=0.001). Chronobiological evaluation by means of Fourier analysis showed a circannual pattern for gout attacks, both for the total sample (P=0.006) and the male subgroup (P=0.003), characterized by a peak in April and a trough in October. Again, as for pseudogout events, no seasonal variation was found, either for the total sample or subgroups by gender.

CONCLUSIONS

The present study gives further confirmation that acute gout attacks exhibit a circannual distribution in their occurrence, being more frequent in April, whereas pseudogout attacks do not. Moreover, the seasonal distribution of gout and pseudogout acute events is significantly different.