Preparing patients for biologic medications for dermatologic and rheumatic diseases.

Psoriasis, psoriatic arthritis, and rheumatoid arthritis are prevalent conditions that often require a team of primary care and specialist healthcare professionals for the most optimum patient outcomes. Primary care providers can facilitate referrals to dermatology and rheumatology specialists by obtaining the needed screening workup for patients who need treatment with immunosuppressive therapies. This article reviews tuberculosis screening, hepatitis screening, and vaccinations to be administered before patients begin biologic medications.

Effects of Class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia.

OBJECTIVES: This study evaluated the effects of Class IV laser therapy on pain, Fibromyalgia (FM) impact, and physical function in women diagnosed with FM. DESIGN: The study was a double-blind, randomized control trial. SETTING: Testing was completed at the university and Rheumatologist office and treatment was completed at a chiropractic clinic. PARTICIPANTS: Thirty-eight (38) women (52±11 years; mean±standard deviation) with FM were randomly assigned to one of two treatment groups, laser heat therapy (LHT; n=20) or sham heat therapy (SHT; n=18). INTERVENTION: Both groups received treatment twice a week for 4 weeks. Treatment consisted of application of LHT or SHT over seven tender points located across the neck, shoulders, and back. Treatment was blinded to women and was administered by a chiropractic physician for 7 minutes. OUTCOME MEASURES: Participants were evaluated before and after treatment for number and sensitivity of tender points, completed the FM Impact Questionnaire (FIQ) and the pain question of the FIQ, and were measured for function using the continuous scale physical functional performance (CS-PFP) test. Data were evaluated using repeated-measures analysis of variance with significance accepted at p≤0.05. RESULTS: There were significant interactions for pain measured by the FIQ (LHT: 7.1±2.3 to 6.2±2.1 units; SHT: 5.8±1.3 to 6.1±1.4 units) and for upper body flexibility measured by the CS-PFP (LHT: 71±17 to 78±12 units; SHT: 77±12 to 77±11 units) with the LHT improving significantly compared to SHT. There was a time effect for the measure of FM impact measured by the FIQ, indicating that FM impact significantly improved from pre- to post-treatment in LHT (63±20 to 57±18 units), while no change was observed in the SHT (57±11 to 55±12 units). CONCLUSIONS: This study provides evidence that LHT may be a beneficial modality for women with FM in order to improve pain and upper body range of motion, ultimately reducing the impact of FM.

Resistance exercise training does not affect postexercise hypotension and wave reflection in women with fibromyalgia.

The purpose of this study was to assess the effects of resistance exercise training (RET) on aortic wave reflection and hemodynamics during recovery from acute resistance exercise in women with fibromyalgia (FM) and healthy women (HW). Nine women with FM (aged 42 ± 5 years; mean ± SD) and 14 HW (aged 45 ± 5 years) completed testing at baseline and after 12 weeks of whole-body RET that consisted of 3 sets of 5 exercises. Heart rate (HR), digital blood pressure (BP, plethysmography), aortic BP, and wave reflection (radial tonometry) were assessed before and 20 min after acute leg resistance exercise. Aortic and digital diastolic blood pressure (DBP) were significantly decreased (p < 0.05) and aortic and digital pulse pressures (PP) were significantly increased (p < 0.05) after acute exercise before RET. Acute resistance exercise had no effect on HR, wave reflection (augmentation index and reflection time), digital, or aortic systolic BP. RET improved muscle strength without affecting acute DBP and PP responses. Acute resistance exercise produces postexercise diastolic hypotension without affecting systolic blood pressure, HR, and wave reflection responses in women with and without FM. RET does not alter resting and postexercise hemodynamics and aortic wave reflection in premenopausal women.

The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.

OBJECTIVE: To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs). DESIGN: Before-after trial. SETTING: Testing and training occurred in a university setting. PARTICIPANTS: Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y). INTERVENTION: Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises. MAIN OUTCOME MEASURES: Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise. RESULTS: There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise. CONCLUSIONS: These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate.

Cardiovascular autonomic modulation after acute resistance exercise in women with fibromyalgia.

OBJECTIVE: To test the hypothesis that autonomic modulation after resistance exercise (RE) would be reduced in women with fibromyalgia (FM) compared with controls. DESIGN: Before-after trial. SETTING: Testing occurred in a university setting. PARTICIPANTS: Women with FM (n=9) and healthy controls (n=9) underwent testing before (pre) and 20 minutes after (post) RE. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Normalized low-frequency (LFnu) and normalized high-frequency (HFnu) oscillations and the LFnu/HFnu ratio were indicative of sympathetic modulation, parasympathetic modulation, and sympathovagal balance, respectively. Baroreceptor reflex sensitivity (BRS) was also measured. RESULTS: Variables were similar in both groups at rest. HFnu decreased in controls (pre, 55.0+/-4.2%; post, 35.0+/-4.7%; P<.05) and increased in women with FM (pre, 57.0+/-5.7%; post, 63.2+/-4.6%; P<.05). LFnu increased in controls (pre, 43.3+/-4.4%; post, 63.2+/-4.8%; P<.05) and decreased in women with FM (pre, 41.8+/-5.6%; post, 35.6+/-4.7%; P<.05). The LFnu/HFnu ratio increased in controls (pre, 0.89+/-0.17; post, 2.43+/-0.64; P<.05) with no change in women with FM (pre, 0.90+/-0.22; post, 0.64+/-0.13; P=.13). BRS decreased in controls (pre, 8.78+/-1.42 ms/mmHg; post, 5.49+/-0.66 ms/mmHg; P<.05), but not in women with FM (pre, 5.91+/-1.22 ms/mmHg; post, 9.23+/-2.4 ms/mmHg; P=.16). CONCLUSIONS: After acute RE, women with FM responded differently from controls, demonstrated by lower sympathetic and higher vagal modulation without altering BRS. These postexercise responses may be attributed to the altered autonomic responsiveness to physiologic stress that characterizes FM.

Effects of resistance training and chiropractic treatment in women with fibromyalgia.

OBJECTIVE: The objective of this study was to evaluate resistance training (RES) and RES combined with chiropractic treatment (RES-C) on fibromyalgia (FM) impact and functionality in women with FM. DESIGN: The design of the study was a randomized control trial. SETTING: Testing and training were completed at the university and chiropractic treatment was completed at chiropractic clinics. PARTICIPANTS: Participants (48 +/- 9 years; mean +/- standard deviation) were randomly assigned to RES (n = 10) or RES-C (n = 11). INTERVENTION: Both groups completed 16 weeks of RES consisting of 10 exercises performed two times per week. RES-C received RES plus chiropractic treatment two times per week. OUTCOME MEASURES: Strength was assessed using one repetition maximum for the chest press and leg extension. FM impact was measured using the FM impact questionnaire, myalgic score, and the number of active tender points. Functionality was assessed using the 10-item Continuous Scale Physical Functional Performance test. Analyses of variance with repeated measures compared groups before and after the intervention. RESULTS: Six (6) participants discontinued the study: 5 from RES and 1 from RES-C. Adherence to training was significantly higher in RES-C (92.0 +/- 7.5%) than in RES (82.8 +/- 7.5%). Both groups increased (p < or = 0.05) upper and lower body strength. There were similar improvements in FM impact in both groups. There were no group interactions for the functionality measures. Both groups improved in the strength domains; however, only RES-C significantly improved in the pre- to postfunctional domains of flexibility, balance and coordination, and endurance. CONCLUSIONS: In women with FM, resistance training improves strength, FM impact, and strength domains of functionality. The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality.

Resistance exercise training improves heart rate variability in women with fibromyalgia.

Fibromyalgia (FM) is characterized by generalized muscle pain, low muscle strength and autonomic dysfunction. Heart rate (HR) variability (HRV) is reduced in individuals with FM increasing their risk for cardiovascular morbidity and mortality. We tested the hypothesis that resistance exercise training (RET) improves HRV, baroreflex sensitivity (BRS) and muscle strength in women with FM. Women with FM (n = 10) and healthy controls (n = 9), aged 27-60 years, were compared at baseline. Only women with FM underwent supervised RET 2 days per week for 16 weeks. Baseline and post-training measurements included HRV and spontaneous baroreflex sensitivity (BRS, alpha index) from continuous electrocardiogram and blood pressure (BP) recorded with finger plethysmography during 5 min in the supine position. RR interval, total power, log transformed (Ln) squared root of the standard deviation of RR interval (RMSSD), low-frequency power and BRS were lower (P<0.05), and HR and pulse pressure were higher (P<0.05) in women with FM than in healthy controls. After RET, mean (SEM) total power increased (387 +/- 170 ms(2), P<0.05), RMSSD increased (0.18 +/- 0.08 Ln ms, P<0.05) and Ln of high-frequency power increased (0.54 +/- 0.27 Ln ms(2), P = 0.08) in women with FM. Upper and lower body muscle strength increased by 63% and 49% (P<0.001), and pain perception decreased by 39% in women with FM. There were no changes in BRS, HR and BP after RET. Our study demonstrates that RET improves total power, cardiac parasympathetic tone, pain perception and muscle strength in women with FM who had autonomic dysfunction before the exercise programme.

A comparison of physical functional performance and strength in women with fibromyalgia, age- and weight-matched controls, and older women who are healthy.

BACKGROUND AND PURPOSE: The purpose of this study was to compare functionality and strength among women with fibromyalgia (FM), women without FM, and older women. SUBJECTS: Twenty-nine women with FM (age [X+/-SD]=46+/-7 years), 12 age- and weight-matched women without FM (age=44+/-8 years), and 38 older women who were healthy (age=71+/-7 years) participated. METHODS: The Continuous Scale-Physical Functional Performance Test (CS-PFP) was used to assess functionality. Isokinetic leg strength was measured at 60 degrees/s, and handgrip strength was measured using a handgrip dynamometer. RESULTS: The women without FM had significantly higher functionality scores compared with women with FM and older women. There were no differences in functionality between women with FM and older women. Strength measures for the leg were higher in women without FM compared with women with FM and older women, and both women with and without FM had higher grip strengths compared with older women. DISCUSSION AND CONCLUSION: This study demonstrated that women with FM and older women who are healthy have similar lower-body strength and functionality, potentially enhancing the risk for premature age-associated disability.

The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia.

OBJECTIVE: To determine whether women with fibromyalgia benefit from strength training. DESIGN: Randomized controlled trial. SETTING: Testing was completed at the university and training was completed at a local community wellness facility. PARTICIPANTS: Twenty-nine women (age range, 18-54 y) with fibromyalgia participated. Subjects were randomly assigned to a control (n=14; wait-listed for exercise) or strength (n=15) group. After the first 4 weeks, 7 (47%) women dropped from the strength group. INTERVENTION: Subjects underwent 12 weeks of training on 11 exercises, 2 times a week, performing 1 set of 8 to 12 repetitions at 40% to 60% of their maximal lifts and were progressed to 60% to 80%. MAIN OUTCOME MEASURES: Subjects were measured for strength, functionality, tender point sensitivity, and fibromyalgia impact. RESULTS: The strength group significantly (P< or =.05) improved upper- (strength, 39+/-11 to 42+/-12 kg; control, 38+/-13 to 38+/-12 kg) and lower- (strength, 68+/-28 to 82+/-25 kg; control, 61+/-25 to 61+/-26 kg) body strength. Upper-body functionality measured by the Continuous-Scale Physical Functional Performance test improved significantly (strength, 44+/-11 to 50+/-16U; control, 51+/-11 to 49+/-13U) after training. Tender point sensitivity and fibromyalgia impact did not change. CONCLUSIONS: Strength training improved strength and some functionality in women with fibromyalgia. Interventions with resistance have important implications on independence and quality of life issues for women with fibromyalgia.