Current rheumatology reports
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Review
The role of quantitative sensory testing in the evaluation of musculoskeletal pain conditions.
Quantitative sensory testing (QST) is a noninvasive method of assessing sensory and pain perception that has been used in the past 30 years primarily for analysis of cutaneous and mucosal perception. In recent years, several published studies have demonstrated that QST may be useful in the analysis of painful musculoskeletal disorders as well. ⋯ This review analyzes published studies on this subject and summarizes current information on altered sensory and pain perception available for some of the most common musculoskeletal disorders. At present, QST remains primarily a research tool but may be useful in differential diagnosis in indicating the presence of central sensitization and for clinical monitoring of disease progression or treatment response.
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Hyperimmunoglobulinemia D and periodic fever syndrome, an autoinflammatory syndrome, is caused by mutations in the gene coding for mevalonate kinase. The disease is clinically characterized by recurrent attacks of fever accompanied by an array of inflammatory symptoms including lymphadenopathy, rash, arthritis, and gastrointestinal complaints. ⋯ Frequent fever attacks impair quality of life and the achievement of educational milestones. Recent reports show promising results with anakinra and etanercept to treat the attacks.
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This article considers four broad classes of psychological techniques and their effects on fibromyalgia (FM) pain. A literature search identified 14 randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT), five relaxation RCTs, five biofeedback RCTs, five hypnotherapy RCTs, and two writing intervention RCTs. For psychoanalytic therapy in FM, no RCTs have been published. ⋯ Relaxation as a single treatment has not been proven useful. Hypnotherapy and writing intervention have demonstrated mild treatment effects, whereas psychological treatment is effective in FM pain. Considering the heterogeneity of FM, the promising effects of matched interventions such as CBT and OBT with pharmacotherapy, exercise, and other treatment domains require further research.
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Chronic widespread pain (CWP) is very prevalent in the general population (5%-10%) and is characterized by pain in all four body quadrants, the neck, and back. CWP differs from localized pain not only in its distribution but also in the way it affects lives. Multiple pain sites are associated with higher pain intensity, longer pain duration, and greater disability. ⋯ FM has been found in 2% to 4% of community subjects and represents the extreme of CWP. This article compares pain characteristics, quality of life, consequences for daily living, and psychosocial status between FM patients and individuals with CWP. Available evidence shows that FM is associated with more severe symptoms and consequences for daily life and higher pain-severity compared with CWP.
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Hypocomplementemic urticarial vasculitis syndrome (HUVS) is an uncommon immune complex-mediated entity characterized by urticaria with persistent acquired hypocomplementemia. First described in 1973, HUVS is associated with several systemic findings including leukocytoclastic vasculitis, severe angioedema, laryngeal edema, pulmonary involvement, arthritis, arthralgia, glomerulonephritis, and uveitis. These manifestations should be present for at least 6 months. ⋯ The disease marker is the serum presence of anti-C1q antibodies. Treatment, based on disease severity, involves corticosteroids and other immunosuppressive agents that have demonstrated some success. Patients may have significant morbidity and mortality, most commonly caused by chronic obstructive pulmonary disease and acute laryngeal edema.