ABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A literature search for systematic reviews of randomized, controlled trials on physiotherapy, occupational therapy and physical therapy from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Low to moderate intensity endurance and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial magnetic stimulation are not recommended.
Subject(s)
Fibromyalgia/therapy , Occupational Therapy , Physical Therapy Modalities , Practice Guidelines as Topic , Combined Modality Therapy , Exercise , Fibromyalgia/diagnosis , Humans , Patient Care Team , Societies, MedicalABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A literature search for systematic reviews of randomized controlled drug trials from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Amitriptyline and duloxetine are recommended in the case of comorbid depressive disorders or generalized anxiety disorder and pregabalin in the case of generalized anxiety disorder. Off-label use of duloxetine and pregabalin can be considered if there are no comorbid mental disorders or no generalized anxiety disorder. Strong opioids are not recommended.
Subject(s)
Fibromyalgia/drug therapy , Practice Guidelines as Topic , Amitriptyline/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Duloxetine Hydrochloride/therapeutic use , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Germany , Humans , Pregabalin/therapeutic use , Randomized Controlled Trials as Topic , Societies, MedicalABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized, controlled trials on patient education and shared decision-making from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences, clinical and practical applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The diagnosis of fibromyalgia syndrome should be explicitly communicated to the affected individual. Shared decision-making with the patient on the therapeutic options based on individual preferences of the patient, comorbidities and the success of previous treatment is recommended. A step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.
Subject(s)
Fibromyalgia/diagnosis , Fibromyalgia/therapy , Interdisciplinary Communication , Intersectoral Collaboration , Patient Education as Topic/methods , Practice Guidelines as Topic , Decision Making , Fibromyalgia/classification , Germany , Humans , Societies, MedicalABSTRACT
BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: A diagnosis of FMS should be explicitly communicated with the afflicted individual. A step-wise treatment, depending on the severity of FMS and the responses to therapeutic measures, is recommended. Therapy should only be continued if the positive effects outweigh the side effects. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Cooperative Behavior , Fibromyalgia/rehabilitation , Interdisciplinary Communication , Patient Care Team , Patient Education as Topic , Adult , Combined Modality Therapy , Communication , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Humans , Pain, Intractable/diagnosis , Pain, Intractable/psychology , Pain, Intractable/rehabilitation , Patient Admission , Patient-Centered Care , Rehabilitation Centers , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: The use of a multicomponent therapy (the combination of aerobic exercise with at least one psychological therapy) for a minimum of 24 h is strongly recommended for patients with severe FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Cooperative Behavior , Fibromyalgia/rehabilitation , Interdisciplinary Communication , Patient Care Team , Adult , Combined Modality Therapy/methods , Evidence-Based Medicine , Exercise , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Follow-Up Studies , Humans , Patient Admission , Psychotherapy , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
To date, the long-term course of fibromyalgia (FM) generally shows little improvement and many patients have problems managing their private, social and professional lives, if at all. Health workers in various specialties, and even in the same specialty, have differing concepts on etiology, diagnosis and treatment of FM. In its work spanning 2 years, an interdisciplinary working group made up from 10 scientific associations reviewed the literature and developed an S3-level consensus guideline. Various etiopathogenetic concepts converge from the perspective of a biopsychosocial model. A stepwise treatment approach with patient education, endurance training, multi-modal therapy and promotion of significant resources is recommended. Of the psychotherapeutic methods, cognitive behavioural training has proved the most relevant. Only a handful of drug therapies have undergone controlled trials, most however only over a period of a few weeks.
Subject(s)
Fibromyalgia/diagnosis , Fibromyalgia/therapy , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Rheumatology/standards , GermanyABSTRACT
BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Patient's information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS: The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.
Subject(s)
Fibromyalgia/rehabilitation , Patient Care Team , Patient Education as Topic , Algorithms , Combined Modality Therapy , Cooperative Behavior , Disease Management , Evidence-Based Medicine , Fibromyalgia/diagnosis , Follow-Up Studies , Germany , Humans , Self-Help Groups , Societies, MedicalABSTRACT
BACKGROUND: An interdisciplinary guideline for the treatment of fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) was developed in cooperation with ten German medical and psychological associations and two patients' self-help organizations. METHODS: Using the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/ 2006) a systematic literature search was performed, which included all randomised controlled trials (RCT) evaluating multicomponent therapy in FMS and CWP. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of recommendation was graded according to the German program for disease management guidelines. Consensus was achieved using a multi-step nominal group procedure. RESULTS: The short-term use of amitriptyline is strongly recommended (grade A) and the short-term use of fluoxetine und duloxetine is recommended (grade B). CONCLUSIONS: The recommendations regarding pharmacological treatment of FMS are limited by the short duration of the RCT, the lack of follow-ups and absence of cost-effectiveness studies.
Subject(s)
Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antidepressive Agents/therapeutic use , Fibromyalgia/drug therapy , Anti-Anxiety Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Evidence-Based Medicine , Fibromyalgia/diagnosis , Humans , Hypnotics and Sedatives/therapeutic use , Patient Care Team , Randomized Controlled Trials as Topic , Societies, MedicalABSTRACT
BACKGROUND: A guideline for the treatment of fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating multicomponent therapy (MT) was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: MT is superior to control groups or routine treatment (evidence level 1A) and should be offered to FMS patients (recommendation strength A). CONCLUSIONS: Future studies should consider medication, other co-therapies and comorbidities. MT programs tailored to FMS subgroups should be tested.
Subject(s)
Fibromyalgia/rehabilitation , Patient Care Team , Combined Modality Therapy , Evidence-Based Medicine , Fibromyalgia/diagnosis , Germany , Humans , Self-Help Groups , Societies, MedicalABSTRACT
Fibromyalgia is a common syndrome of unknown etiology characterized by chronic widespread pain and poly-symptomatic autonomic disturbances and often mental features. The American College of Rheumatology's classification criteria define fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a diagnosis of exclusion as long as stand none laboratory or technical tests. The major role in pathogenesis appears to be central and involves the subcortical pain modulation, psychical stress especially in early childhood, endocrinological and genetic factors. There is no evidence of abnormalities in muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical function and sleep disturbance. Actual evidence of effects of pharmacological and nonpharmacological interventions are summarized. Tricyclic agents, aerobic exercises, patient education and combined therapies can reduce effectively symptoms and disability.
Subject(s)
Analgesics/therapeutic use , Exercise Therapy/methods , Fibromyalgia/diagnosis , Fibromyalgia/therapy , Pain/prevention & control , Practice Patterns, Physicians'/trends , Sleep Wake Disorders/prevention & control , Exercise Therapy/trends , Fibromyalgia/complications , Humans , Pain/diagnosis , Pain/etiology , Patient Education as Topic/methods , Patient Education as Topic/trends , Practice Guidelines as Topic , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/etiologyABSTRACT
Fibromyalgia is a frequent disorder of the middle aged, particularly in women characterized by diffuse and widespread pain, and tenderness on palpation at characteristic sites, called tender points. Additional characteristic symptoms of fibromyalgia are fatigue, sleep disturbances, irritable bowel and bladder syndrome, chronic headaches, paresthesia, hearing and vestibular dysfunction. The etiology remains poorly understood. Diagnosis is based on characteristic symptoms, presence of tender points and exclusion of similar confounding conditions. Because of the unknown etiology, all therapies are symptomatic. Interdisciplinary combined treatments can relief the pain in about 50% of the patients.
Subject(s)
Fibromyalgia/diagnosis , Combined Modality Therapy , Diagnosis, Differential , Female , Fibromyalgia/etiology , Fibromyalgia/therapy , Humans , Male , Middle Aged , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/etiology , Myofascial Pain Syndromes/therapy , Patient Care Team , SyndromeABSTRACT
We investigated the efficacy and tolerability of short-term treatment with tropisetron, a selective, competitive 5-HT3-receptor antagonist in fibromyalgia. The trial was designed as a prospective, multicenter, double-blind, parallel-group, dose-finding study. We randomly assigned 418 patients suffering from primary fibromyalgia to receive either placebo, 5 mg, 10 mg or 15 mg tropisetron once daily for 10 days. Clinical response was measured by changes in pain score, visual analog scale, tender point count and ancillary symptoms. Responders were prospectively defined as patients showing a 35% or higher reduction in pain score. Treatment with 5 mg tropisetron resulted in a significantly higher response rate (39.2%) than placebo (26.2%) (p < 0.05). In the visual analog scale, the group administered 5 mg tropisetron showed a significant improvement (p < 0.05) and the group administered 10 mg tropisetron showed a nonsignificant clinical benefit. The number of painful tender points was significantly reduced (p = 0.002) in the 5 mg tropisetron group. Regarding ancillary symptoms, the 5 mg tropisetron group showed a significant improvement (p < 0.05) in sleep and dizziness. The patients' overall assessment of efficacy was significantly higher for 5 mg (p = 0.016) and 10 mg (p = 0.002) tropisetron than for placebo. The safety and tolerability of tropisetron was good; gastrointestinal tract symptoms were the most frequently reported adverse events. Short-term treatment of fibromyalgia patients with 5 mg tropisetron for 10 days proved to be efficacious and well tolerated. In this study a bell-shaped dose-response curve was seen.
Subject(s)
Fibromyalgia/therapy , Indoles/therapeutic use , Receptors, Serotonin/drug effects , Serotonin Antagonists/therapeutic use , Adolescent , Adult , Aged , Double-Blind Method , Female , Fibromyalgia/blood , Half-Life , Humans , Indoles/adverse effects , Male , Middle Aged , Pain Measurement , Prospective Studies , Receptors, Serotonin, 5-HT3 , Serotonin Antagonists/adverse effects , TropisetronABSTRACT
OBJECTIVE: Based on a potential role for serotonin receptors in fibromyalgia, we investigated the efficacy and tolerability of treatment with tropisetron, a highly selective, competitive inhibitor of the 5-HT3 receptor. METHODS: In this prospective, multicenter, double-blind, parallel-group, dose-finding study, 418 patients suffering from primary fibromyalgia (ACR criteria) were randomly assigned to receive either placebo, 5 mg, 10 mg or 15 mg tropisetron once daily, respectively. The duration of treatment was 10 days. The clinical response was measured by changes in pain-score, visual analog scale (VAS), and the number of painful tender-points. RESULTS: Treatment with 5 mg tropisetron resulted in a significantly higher response rate (39.2%) when compared with placebo (26.2%) (p=0.033). The absolute reduction in pain-score was -13.5% for 5 mg tropisetron, -13.0% for 10 mg tropisetron, and -6.3% for placebo (p<0.05). The effects of 15 mg tropisetron were similar to placebo, thus suggesting a bell-shaped dose-response curve. Compared with placebo, treatment with 5 mg tropisetron led to a significant improvement (p<0.05) in VAS, while a clear trend in terms of clinical benefit was seen with 10 mg tropisetron. The number of painful tender-points was also reduced significantly (p=0.002) in the 5 mg tropisetron group. Of interest, during the 12-month follow-up period, pain intensity of responders on 5 mg and 10 mg tropisetron was still markedly below baseline. The treatment was well tolerated, with gastro-intestinal complaints being the most frequently reported side effects, in keeping with the known safety profile for 5-HT3 receptor antagonists. CONCLUSIONS: This study demonstrates the efficacy of short-term treatment with 5 mg tropisetron once daily in primary fibromyalgia. Treatment was well tolerated and prolonged clinical benefits were seen.
Subject(s)
Fibromyalgia/drug therapy , Indoles/therapeutic use , Receptors, Serotonin/physiology , Serotonin Antagonists/therapeutic use , Adolescent , Adult , Aged , Double-Blind Method , Female , Fibromyalgia/physiopathology , Follow-Up Studies , Humans , Indoles/adverse effects , Male , Middle Aged , Pain Measurement , Placebos , Prospective Studies , Receptors, Serotonin/drug effects , Receptors, Serotonin, 5-HT3 , Serotonin Antagonists/adverse effects , TropisetronABSTRACT
OBJECTIVE: To translate the Health Assessment Questionnaire Disability Index (HAQ) into a German version, to validate and to compare its properties with two different versions of the Hannover Functional Ability Questionnaire (HFAQ) in a German speaking population. METHODS: The test-retest reliability was tested by Pearson correlation in 32 outpatients of the Department of Rheumatology of the Medizinische Hochschule Hannover. For retesting, the questionnaire was mailed to them 1 week later. To validate the questionnaire it was administered to 110 inpatients in three different hospitals. All patients fulfilled the American College of Rheumatology 1987 revised criteria of rheumatoid arthritis (RA) or the Rome criteria of definitive inactive RA. The internal consistency was measured by Cronbach's coefficient alpha (CCA). To assess criterion validity we compared the HAQ and the two versions of the HFAQ with Keitel's test (KT) and the modified Steinbrocker classification (mSC). Construct validity was assessed by comparing these instruments with different clinical and laboratory variables. A multivariate analysis was used to identify the most important factors that are influencing the HAQ- and HFAQ-scores. RESULTS: Test-retest reliability of the HAQ was r = 0.94. CCA was 0.91 (HAQ), 0.90 (HFAQ-P) and 0.93 (HFAQ-PR). The KT Pearson correlation coefficients reached r = -0.73 (HAQ), r = +0.74 (HFAQ-P) and r = +0.71 (HFAQ-PR). The mSC correlated r = +0.75 (HAQ), r = -0.72 (HFAQ-P) and r = -0.70 (HFAQ-PR). The correlation coefficients of HAQ/HFAQ-P was r = -0.87 and of HAQ/HFAQ-PR r = -0.88. The correlations between other clinical and laboratory variables reached from r = +/-0.58 (pain/HAQ) to r = +/-0.11 (number of swollen joints/HFAQ-PR). In backward multiple regression analysis 59-64% of the variance of disability measured by the questionnaires was explained predominantly by pain (32-33%) and by range of motion (16-21%). CONCLUSION: The German version of the HAQ presented here and the two versions of the HFAQ are reliable and valid instruments for measuring functional disability in a German-speaking population with RA. The construct measured by the HAQ and both versions of the HFAQ showed a high degree of correspondence.
Subject(s)
Activities of Daily Living/classification , Arthritis, Rheumatoid/diagnosis , Health Status , Adult , Aged , Arthritis, Rheumatoid/classification , Female , Humans , Male , Middle Aged , Motor Skills/physiology , Patient Admission , Range of Motion, Articular/physiology , Reproducibility of ResultsABSTRACT
Muscle tissue oxygen tension was measured by a polarographic oxygen fine-needle probe, and inorganic phosphate and creatine phosphate spectra were recorded using magnetic resonance spectroscopy in patients with chronic low back pain and in patients with fibromyalgia. Results were compared with healthy controls. The tissue oxygen tension was markedly higher in those with tense muscles than in normal subjects. Magnetic resonance spectra for inorganic phosphate were higher in patients demonstrating muscle contraction, and intracellular pH was shifted in the alkaline direction in cases with increased muscle tension. Results show that hypoxia is not the result of increased muscle tension, as was thought previously, but results from oversupply of oxygen demanded by the muscle, leading to increased capillary perfusion and rising oxygen tension.
Subject(s)
Energy Metabolism , Fibromyalgia/metabolism , Low Back Pain/metabolism , Muscle Rigidity/metabolism , Muscle, Skeletal/metabolism , Oxygen Consumption , Adult , Aged , Female , Humans , Hydrogen-Ion Concentration , Magnetic Resonance Spectroscopy/methods , Male , Middle Aged , Muscle Contraction , Phosphorus IsotopesABSTRACT
Forty-two patients with psoriatic arthritis were included in a multicenter, double-blind trial comparing auranofin and gold sodium thiomalate (GST) for 6 months, followed by a 6-month open treatment. Fifty-two percent of the patients on auranofin and 33% on GST were able to complete the 1-year course of therapy. As a result of the study we conclude that both gold compounds are effective agents in the treatment of psoriatic arthritis. Degree of improvement of arthritis was better in the GST group, but the number of improved patients was greater in the auranofin group. Two patients on auranofin were withdrawn for side effects (one diarrhoea, one worsening of psoriasis) and 5 on GST (rash 2, total loss of appetite 1, exacerbation of psoriasis 2). Comparing the side effects of both compounds, auranofin is less likely to aggravate the psoriatic condition or result in withdrawal of patients for adverse reactions.
Subject(s)
Arthritis, Psoriatic/drug therapy , Auranofin/therapeutic use , Gold Sodium Thiomalate/therapeutic use , Adult , Aged , Arthritis, Psoriatic/physiopathology , Auranofin/adverse effects , Double-Blind Method , Female , Gold Sodium Thiomalate/adverse effects , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Still's disease was diagnosed in a 40-year-old patient as a cause of psycho-organic syndrome with complete disorientation and stupor, sensory and motor aphasia. There were no signs of a tumour, cerebrovascular accident, bacterial or viral infection. The patient recovered quickly from the cerebral disturbances under treatment with corticosteroids. Similar symptoms in adult patients with Still's disease are seldom found in the literature.
Subject(s)
Meningoencephalitis/etiology , Still's Disease, Adult-Onset/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Female , Humans , Meningoencephalitis/drug therapyABSTRACT
Generalised tendomyopathy (fibromyalgia) is characterised by diffuse localized pain involving the locomotory system, tenderness in the regions of the tendon insertions and muscles, loss of muscular power, sleep disorders and other vegetative functional and psychological disorders. In many cases, the diagnosis is delayed, often being made only after comprehensive superfluous diagnostic procedures, sometimes invasive, and inappropriate treatment. Age at disease onset is about 35 years, and initially involves, usually localized, the cervical or lumbar region of the spine. The condition is usually progressive over years. Pathogenesis is multifactorial; for generalization and persistence of the disease, psychosocial factors and civilization-related phenomena appear to play a decisive role. Treatment of generalized tendomyopathy is, for the most part, symptomatic and, overall, unsatisfactory. By way of medical treatment, only antidepressants seem to have a certain positive effect in some of the patients. Of importance is a good doctor--patient relationship and successful motivation of the patient to undergo active physiotherapeutic--in some cases also psychotherapeutic--treatment. With an eye to instituting more successful therapeutic measures and avoiding unnecessary diagnostic and therapeutic procedures, and, last but not least, for socioeconomic reasons, early diagnosis is of great importance.
