Metal-induced oxidative stress level in patients with fibromyalgia syndrome and its contribution to the severity of the disease: A correlational study.

BACKGROUND: Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease characterised by widespread chronic musculoskeletal pain. Metal-induced oxidative stress contributes to the severity of FMS. AIMS: First, this study evaluated the association between plasma levels of toxic heavy metals and essential metals with oxidative stress (OS) markers. Second, the OS markers and metal contents were correlated with the disease severity by assessing the Fibromyalgia Impact Questioner Revised (FIQR) and tender points (TP). METHOD: A total of 105 FMS patients and 105 healthy controls of similar age and sex were recruited. OS parameter such as lipid peroxidation (LPO), protein carbonyl group (PCG), nitric oxide (NO) and essential metals such as zinc (Zn), magnesium (Mg), manganese (Mn), copper (Cu) and toxic heavy metals such as aluminium (Al), arsenic (As), lead (Pb) were estimated. RESULTS: Levels of LPO, PCG, NO (p< 0.001) and Cu, Mn, and Al (p< 0.001), were significantly higher, and Mg (p< 0.001) and Zn (p< 0.001) were significantly lower in patients compared to controls. A positive association was observed between OS parameters, FIQR and TP with Cu, Al and Mn. A significant negative association was observed between Zn and Mg with FIQR, TP and OS parameters. CONCLUSION: Heavy metals such as Al induce OS parameters and decrease the levels of essential trace elements such as Mg and Zn, which may be responsible for the severity of FMS.

Distribution of rheumatological diseases in rural and urban areas: An adapted COPCORD Stage I Phase III survey of Lucknow district in north India.

OBJECTIVES: To study the distribution of various rheumatological diseases in rural and urban areas of Lucknow, India. METHOD: A study using adapted a Community Oriented Program for the Control of Rheumatic Diseases scheme was carried out in a cluster of rural (n = 5118) and urban (n = 5053) communities through a door-to-door survey. Trained community volunteers completed the questionnaires. Patients with musculoskeletal pain (MSK pain) were clinically evaluated by a physician. X-ray examinations and blood investigations were also done. Diagnosis was made according to International Classification of Diseases-9 classification system. RESULTS: Among persons reporting MSK pain in rural areas, high prevalence of osteoarthritis (OA) knee (35%) was observed followed by fibromyalgia (32.1%), backache (28.4%), non-specific pain (NSP) (20.7%) and rheumatoid arthritis (RA) (1.2%). In urban area, OA knee (36.3%) and backache (36.6%) were found highly prevalent, followed by fibromyalgia (11.1%), NSP (10.9%) and neck pain (7.4%). In urban areas among MSK pain patients, prevalence of RA was only 1.6%. Age-adjusted analysis among urban people showed backache complaints begin early (>20 years) than rural people. Significantly higher numbers of Knee OA complaints emerged among urban people than rural in the age group 21-60 years. Projected population prevalence of knee OA was 44.9 and 106.07/1000 in rural and urban areas, respectively. Further projected population prevalences of fibromyalgia, backache, RA and NSP in rural and urban areas are 41.2 and 32.4, 36.5 and 106.6, 1.56 and 4.74, 26.0 and 32.0 per 1000, respectively. CONCLUSION: OA knee, fibromyalgia, backache and NSP are predominant health problems of both areas. Female preponderance was observed in all rheumatological diseases in both the areas.

Prevalence of rheumatic musculoskeletal symptoms in rural and urban areas : a cross-sectional study in northern India.

OBJECTIVES: To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow. METHOD: The survey was carried out in a cluster of rural (n = 5118) and urban (n = 5053) communities of Lucknow through a door-to-door survey. Demographic data were collected and subjects with musculoskeletal pain (MSK pain) were identified. A Hindi adapted version of the Community Oriented Program for the Control of Rheumatic Diseases questionnaire was used. Trained community volunteers completed the questionnaire. RESULTS: Present and past MSK pain was the most common self-reported problem in urban areas (34.1%), while it was the third most common self-reported problem in rural areas (15.1%), after abdominal pain and cough. Females (214.9 and 419.5 per 1000) were more affected than males (118.8 and 265.2 per 1000) in rural and urban areas, respectively. Point prevalence of MSK pain (pain in last week) was higher in urban areas (28.2%) compared to rural areas (14.1%). In rural as well as urban areas, knee (rural: 49.3%, urban: 50.6%) and spine (rural: 56%, urban: 43.6%) were highly reported pain sites. Fatigue ([n] rural: 328, urban: 368) weakness ([n] rural: 310, urban: 324) and anorexia ([n] rural: 84, urban: 142) were most common systemic symptoms reported by urban as well as rural people. Urethritis/balanitis and ulcers in the mouth were the most common other symptoms reported by people in both the areas. CONCLUSION: MSK pain is a predominant health problem of both rural and urban areas. Sex-adjusted prevalence is higher among females than males. Knee and back were highly prevalent pain sites in both rural and urban areas of Lucknow.

Problem-focused coping and self-efficacy as correlates of quality of life and severity of fibromyalgia in primary fibromyalgia patients.

OBJECTIVES: Patients with fibromyalgia syndrome (FMS) often experience problems such as poor quality of life (QoL), loss of self-efficacy (SE), inappropriate coping behavior, and chronic widespread pain along with other symptoms. Recent studies have indicated that sense of SE and effective coping strategies (CSs) are the crux on which the management of chronic pain and enrichment of QoL of FMS patients depend. Realizing the importance of this subject for the rehabilitation of the people with FMS, this study aimed at analyzing the correlation between severity of FMS, and QoL, SE, and CSs among the patients of FMS. METHODS: One hundred patients with fibromyalgia (FM) and 100 control subjects were studied. Fibromyalgia Impact Questionnaire-Revised, Quality of Life Scale, Arthritis Self-efficacy Scale, and COPE Scales for CSs were administered to both the groups. RESULTS: Significantly lower SE, poor QoL, and less use of CSs were reported by FM patients (P < 0.01) vis-à-vis healthy people. Problem-focused coping (r = 0.27, P < 0.01) and SE (r = 0.20, P < 0.05) were found to be significantly and positively associated with QoL. Components of Fibromyalgia Impact Questionnaire-Revised, namely, pain, function, and symptoms, were found to be significantly and negatively associated with problem-focused coping (P < 0.05), SE (P < 0.01), and QoL (P < 0.01). CONCLUSIONS: This study confirms that problem-focused CSs and SE are important correlates of QoL and severity of FM in Indian as well as other populations.