Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Fibromyalgia From
2001 Annual Scientific Meeting Of The American College Of Rheumatology

Below are perspectives on key reports presented at the recent national meeting of the American College of Rheumatology:

Introduction

Fibromyalgia (formerly known as fibrositis) is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression, and disturbances in bowel function. While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity. Fibromyalgia also does not cause damage to internal body organs. Therefore, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness, and tenderness of the joints, tendons, and muscles, and leads to joint deformity and damage to the internal organs or muscles. Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Medicine Treatments

Prozac(fluoxetine)

At this meeting, Prozac (fluoxetine) was demonstrated to be effective in relieving the symptoms of fibromyalgia in a study from the University of Cincinnati Medical Center. It seemed to significantly help the pain, fatigue as well as associated depression. Patients studied were all female and were 18 years of age or older. 

Dr. Shiel's Perspective: In speaking with the presenter of this paper she told me that on average patients seemed to require higher than the starting doses of Prozac for best results. She adjusted up the doses at 2 week intervals. Prozac has been reported to be beneficial in the past when taken together with Elavil. This study documents that some patients will find Prozac helpful if taken alone.

Ultracet

Ulracet was effective and well tolerated in relieving the pain symptoms of fibromyalgia. 313 patients were studied and 94% were female. 

Dr. Shiel's Perspective: I am not surprised by this study that was performed by one of the national experts in fibromyalgia from Oregon. I have been using Ultram for some time and finding it helpful for many, but not all, patients with fibromyalgia. Ultracet is a combination pill that contains both the main ingredient in Ultram and acetaminophen (Tylenol).

Supplements

Fibromyalgia patients were reported to have lower than average DHEA levels. 

Dr. Shiel's Perspective: DHEA is available as a food supplement. It is a sex (male) steroid. It has been used to reduce fatigue in patients with immune diseases such as lupus. This study might suggest that hormones play a role in fibromyalgia and perhaps studies should get underway to determine if the supplement could be helpful as a treatment.

Acupuncture

Acupuncture was found to be effective in some patients with fibromyalgia. 60 patients were studied. Of these, 20 received acupuncture for 4 months, 20 had "sham" acupuncture (went in and got pushed on without needles insertions) for 4 months, and 20 took Elavil (traditional treatment), 25 mg at bedtime for 4 months. The acupuncture group fared statistically the best. 

Dr. Shiel's Perspective: This study will encourage me to consider acupuncture for some patients with fibromyalgia.

Exercise

Muscle strengthening exercises over one year maintained significant symptom improvements as compared with flexibility exercises. 

Dr. Shiel's Perspective: This is a very interesting study. Traditionally, aerobic forms of exercises have been recommended for the treatment of fibromyalgia. This is because they seem to be associated with improvement in the deficient non-Rapid Eye Movement sleep in these patients. This study emphasizes that some form of strengthening exercises, such as weight lifting, could also be helpful. I would suggest that each patient be evaluated individually in this regard, but that a "cross-training" mix of aerobic exercise with strengthening exercise might be optimal for many affected by fibromyalgia.

For more, please see MedicineNet.com' s Fibromyalgia article.

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Last Editorial Review: 12/28/2004