Reports from National Arthritis Meeting

Dr. Shiel Gives Perspectives of Interest on Fibromyalgia From
2004 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 Treatment

Duloxetine (Cymbalta) was shown by researchers at the University of Cincinnati to be effective and safe in treating fibromyalgia.

Dr. Shiel's Perspective: This one could be big. Cymbalta has been demonstrated by previous studies as possibly effective in fibromyalgia. It is currently marketed for relieving nerve pain from diabetes. Early studies had suggested its potential as a treatment for fibromyalgia. It is classified as an antidepression medication. It is a potent inhibitor of the brain chemicals serotonin and norepinephrine. Interestingly, in this study, it worked whether or not the patients with fibromyalgia had depression.

Herbal Treatment

St. John's wort (Hypericum perforatum) was reported as effective for the treatment of fibromyalgia.

Dr. Shiel's Perspective: The researchers hypothesized that the herb might work by affecting non-REM sleep as it alters brain transmitter chemicals (increases serotonin and noradrenaline re-uptake). It was interesting that patients taking St. John's wort did not have improvement in depression.

Sleep Apnea Association

Researchers from Philadelphia reported that in 135 patients with fibromyalgia there was a significantly higher incidence of sleep apnea .

Dr. Shiel's Perspective: It is well known that patients with fibromyalgia frequently have disturbed sleep. It is even suspected that inadequate non-REM sleep may play a key role in causing the condition. Sleep apnea also impairs non-REM sleep. It will be important for patients with persisting symptoms of fibromyalgia to consider a thorough sleep study evaluation.

Acupuncture

Researchers from Germany, University of Michigan, and Georgetown University reported findings that indicate that patients with fibromyalgia who had high tenderness and low levels of depression had better results with acupuncture treatments.

Dr. Shiel's Perspective: This is interesting because it seems to demonstrate that there may be different subgroups of fibromyalgia patients. It would be helpful to know which patients might benefit from acupuncture as not all do.

For more information, please visit the Fibromyalgia Index.

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Last Editorial Review: 12/28/2004