The Journal of rheumatology. Supplement
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This review summarizes the physiologic and clinical evidence that shows nonrestorative sleep to be associated with chronic fatigue and diffuse myalgia after a flulike illness. Such a febrile illness may trigger alteration in sleep-wake brain and immune functions in patients with fibrositis or chronic fatigue syndromes.
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Review
Confounding features of the fibromyalgia syndrome: a current perspective of differential diagnosis.
Patients eventually diagnosed as having the fibromyalgia syndrome often have symptoms which suggest alternate diagnoses such as peripheral neuropathy, spondylitis, metabolic myopathy, polymyalgia, early rheumatoid arthritis, early systemic lupus erythematosus or a chronic fatigue syndrome. Delay in diagnosis of fibromyalgia often proves costly and frustrating to the patient and may lead to inappropriate therapy.
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Several existing techniques for diagnosing psychiatric illness in the presence of physical complaints are faulty. Psychiatric illness may affect only as few as 30% of patients with fibromyalgia in some series. ⋯ Some fibromyalgia disturbances can arise through insomnia and anxiety. Principles in the classification of fibromyalgia are discussed.
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Increasing recognition of the fibromyalgia syndrome together with concerns about limitations of currently available criteria led most centers engaged in fibromyalgia research in Canada and the United States to undertake a multicenter effort to define epidemiologically correct criteria for the diagnosis of fibromyalgia. Five hundred fifty-eight consecutive patients (293 with fibromyalgia and 265 controls) were recruited from 16 private practice and university centers. The study used training sessions to increase interrater reliability, and included methods to determine reliability of examination and historical data. Standardized definition and methods of data acquisition by independent, blinded assessors were employed.
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Review Case Reports
Treatment of the seronegative spondyloarthropathies with sulfasalazine.
Three patients with reactive arthritis and 2 with ankylosing spondylitis resistant to therapy with nonsteroidal antiinflammatory drugs were treated with enteric coated sulfasalazine in an open trial. Significant toxicity was not observed; 1 patient discontinued sulfasalazine because of gastrointestinal symptoms. As a group, statistically significant improvement was observed in 50 foot walk time, morning stiffness, and hemoglobin concentration. ⋯ Asymptomatic colonic inflammation was found in each of 4 patients examined before beginning therapy. Changes in bowel pathology did not parallel changes in joint symptoms. Sulfasalazine may be a safe and useful therapeutic modality in patients with chronic reactive arthritis or ankylosing spondylitis.