Medium-/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia.

OBJECTIVE: To propose a rehabilitation protocol able to produce immediate and long-term beneficial effects on level of disability and overall performance in ADLs. MATERIALS AND METHODS: Forty-one FM patients were randomized to an exercise and educational-behavioral programme group (experimental group, EG = 21) or to a control group (CG = 20). Each subject was evaluated before, at the end (T1), and after 6 months (T6) from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ), the visual analogue scale (VAS), the Health Assessment Questionnaire (HAQ), the fatigue severity scale (FSS), the 6-minute walking test (6MWT), tender points count (TPC), and spinal active range of motion. The exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine flexibility, and aerobic exercises, which patients were subsequently educated to perform at home. RESULTS: The two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and significant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04). The positive results were maintained at the follow-up. CONCLUSION: The proposed programme was well tolerated and produced immediate and medium-term beneficial effects improving function and strain endurance. This trial is registered with DRKS00005071 on DRKS.

Commercial blot assays in the diagnosis of systemic rheumatic diseases.

Commercial blot assays are advanced applications of immunoblotting or dot immunobinding methodologies for the detection of specific autoantibodies in autoimmune diseases. Line(Dot) blots in particular have cost-effectively optimized a sort of multiparametric assay for simultaneous determination of several autoantibody reactivities. Efficient and wide-spectrum potentialities of recombinant DNA technology and proteomics are fruitfully employed by manufacturers in order to obtain highly purified antigens or novel targets to be spotted on blot matrices thus continuously implementing their multianalytic platforms. At present most widely used commercial blot assays for the diagnosis of connective tissue diseases can detect autoantibodies to several Extractable Nuclear Antigens or myositis and/or scleroderma associated autoantigens. They actually represent an important step-forward in the methodological panorama designed for the autoimmunity laboratory. However continuous effort in order to validate and improve clinical reliability of commercially available blot assays should be carried out. In this short review, our preliminary contribution on the validation of a commercial line blot assay for the laboratory diagnosis of autoimmune myositis is briefly reported.

Th2 immune deviation induced by pregnancy: the two faces of autoimmune rheumatic diseases.

One of the most important immunological modifications during pregnancy is the Th1/Th2 shift, due to the progressive increase of progesterone and estrogens during pregnancy, which reach their peak-level in the third trimester of gestation. At high levels, estrogens seem mainly to suppress Th1 cytokines and stimulate Th2-mediated immunological responses as well as antibody production. For this reason Th1-mediated diseases, like rheumatoid arthritis (RA), tend to improve and Th2-mediated disease, like systemic lupus erythematosus (SLE), tend to worsen during pregnancy. SLE is the autoimmune rheumatic disease in which pregnancy most frequently occurs because it predominantly affects young females in their childbearing age. Other autoimmune rheumatic diseases, including RA, are less frequently observed during pregnancy due to their low female-to-male ratio and peak onset after the age of 40. This review is focused on the disease course, gestational outcome and management of patients with SLE and RA during pregnancy.