Fibromyalgia onset has a high impact on work ability in Australians.

BACKGROUND: Although the disabling effects of fibromyalgia (FM) are well recognised, there are no published data regarding the impact of FM on work ability in Australians. The impact of the development of FM symptoms on ability to work in Australians was explored in a pilot survey project. METHOD: Members of the Fibromyalgia Support Network of Western Australia were invited to undertake an anonymous online survey. Information was gathered regarding demographics, symptom onset, the timing of diagnosis, employment status and changes in the ability to work. RESULTS: Two hundred and eighty-seven responses were analysed. Of the respondents, 90.6% were female, with a mean age of 51.1 ± 10.6 years and had experienced symptoms between 2 and 20 years; 52.8% were diagnosed less than 5 years previously. Of the participants, 54.2% were working full time and 21.5% working part time at symptom onset; however, only 15.6% were currently working full time, with 44.8% not currently working at all. Because of FM, 24.3% stopped and 32.6% reduced paid work directly within 5 years of symptom development, with 15.3% ceasing and an additional 17.4% reducing work because of symptoms before diagnosis. Due to FM symptoms, 35.1% currently received financial support because they were unable to work. While 24.3% reported FM medication increased their ability to work, 20.8% reported it reduced their ability to work. CONCLUSION: A community pilot survey of Australians with FM indicates a high impact on work ability. This occurs from symptom onset and often before diagnosis. Early diagnosis and intervention may provide a window of opportunity to prevent work disability in FM.

Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami.

OBJECTIVE: To determine whether regional cerebral blood flow (rCBF) is abnormal in any cerebral structure of women with fibromyalgia (FM), following a report that rCBF is reduced in the thalami and heads of caudate nuclei in FM. METHODS: Seventeen women with FM and 22 healthy women had a resting single-photon-emission computed tomography (SPECT) brain scan to assess rCBF and a T1-weighted magnetic resonance imaging (MRI) scan to enable precise anatomic localization. Additionally, all participants underwent 2 manual tender point examinations and completed a set of questionnaires evaluating clinical features. SPECT scans were analyzed for differences in rCBF between groups using statistical parametric mapping (SPM) and regions of interest (ROIs) manually drawn on coregistered MRI. RESULTS: Compared with control subjects, the rCBF in FM patients was significantly reduced in the right thalamus (P = 0.006), but not in the left thalamus or head of either caudate nucleus. SPM analysis indicated a statistically significant reduction in rCBF in the inferior pontine tegmentum (corrected P = 0.006 at the cluster level and corrected P = 0.023 for voxel of maximal significance), with consistent findings from ROI analysis (P = 0.003). SPM also detected a reduction in rCBF on the perimeter of the right lentiform nucleus. No correlations were found with clinical features or indices of pain threshold. CONCLUSION: Our finding of a reduction in thalamic rCBF is consistent with findings of functional brain imaging studies of other chronic clinical pain syndromes, while our finding of reduced pontine tegmental rCBF is new. The pathophysiologic significance of these changes in FM remains to be elucidated.

Validation of fully automatic brain SPET to MR co-registration.

Fully automatic co-registration of functional to anatomical brain images using information intrinsic to the scans has been validated in a clinical setting for positron emission tomography (PET), but not for single-photon emission tomography (SPET). In this paper we evaluate technetium-99m hexamethylpropylene amine oxime to magnetic resonance (MR) co-registration for five fully automatic methods. We attached six small fiducial markers, visible in both SPET and MR, to the skin of 13 subjects. No increase in the radius of SPET acquisition was necessary. Distortion of the fiducial marker distribution observed in the SPET and MR studies was characterised by a measure independent of registration and three subjects were excluded on the basis of excessive distortion. The location of each fiducial marker was determined in each modality to sub-pixel precision and the inter-modality distance was averaged over all markers to give a fiducial registration error (FRE). The component of FRE excluding the variability inherent in the validation method was estimated by computing the error transformation between the arrays of MR marker locations and registered SPET marker locations. When applied to the fiducial marker locations this yielded the surface registration error (SRE), and when applied to a representative set of locations within the brain it yielded the intrinsic registration error (IRE). For the best method, mean IRE was 1.2 mm, SRE 1.5 mm and FRE 2.4 mm (with corresponding maxima of 3.3, 4.3 and 5.0 mm). All methods yielded a mean IRE <3 mm. The accuracy of the most accurate fully automatic SPET to MR co-registration was comparable with that published for PET to MR. With high standards of calibration and instrumentation, intra-subject cerebral SPET to MR registration accuracy of <2 mm is attainable.

NSAIDs and faecal blood loss in elderly patients with osteoarthritis: is plasma half-life relevant?

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) vary in their degree of gastrointestinal (GI) toxicity. NSAIDs with longer half-lives are of particular concern as they may be more toxic in the elderly. AIM: To compare the GI toxicity, by measurement of faecal blood loss, of short, intermediate and long half-life NSAID treatments compared with control in elderly patients with osteoarthritis. METHODS: Twenty-three patients, mean age 69 years, with osteoarthritis requiring NSAID treatment, received treatment with diclofenac 100 mg/day, naproxen 750 mg/day and piroxicam 20 mg/day, representing a short, medium and long half-life NSAID respectively, in a double-blind, randomised, three way, cross-over block design. In each case, a three week washout control phase was followed by active treatment phases of two weeks each with three week washout between treatment phases. RESULTS: Faecal blood loss, collected over 72 hours at the end of each treatment phase, was measured by 51Cr-labelled erythrocyte method. Comparison was made of mean 24 hour faecal blood loss with each treatment compared with control using repeated measures analysis of variance. Eighteen patients completed all phases of the study. Three patients were withdrawn due to GI bleeding; two during diclofenac treatment and one during treatment with piroxicam. Mean 24 hour faecal blood loss with diclofenac (0.53 mL +/- 0.21) was not significantly different from control (0.28 mL +/- 0.06), whereas it was significantly increased with naproxen (2.76 mL +/- 2.22) and piroxicam (1.16 mL +/- 0.62), p = 0.0013. CONCLUSION: A short half-life NSAID was associated with lower GI toxicity than a medium and long half-life NSAID, as measured by faecal blood loss.

Screening for genetic haemochromatosis in a rheumatology clinic.

BACKGROUND: Recent data indicate that the prevalence of genetic haemochromatosis (GH) is greater than previously recognised and suggest that this disease is underdiagnosed. AIMS: To determine the prevalence of GH in rheumatology clinic population. METHODS: Over a 12 month period 339 consecutive patients, mean age 67.0 years, attending a rheumatology clinic were screened for iron overload. RESULTS: Twenty three patients had elevated initial screening tests (transferrin saturation [Tf%] > 55%; ferritin > 500 micrograms/L). Repeat fasting Tf% and ferritin concentrations were obtained in 20 of these patients. Twelve patients had persistently elevated results, and of these patients four had liver biopsy tissue hepatic iron indices consistent with GH. One patient in the group had the diagnosis established by liver biopsy just before the screening commenced. Thus, the prevalence of GH in this population was 1.5%--five times that anticipated for the general population. Three of the patients with GH presented with an arthropathy which was not characteristic of the disease. The increased prevalence of GH in this group of patients with peripheral arthropathy provides an excellent justification for the routine screening of patients with peripheral arthritis for the exclusion of iron overload.

Rheumatic manifestations of infective endocarditis.

Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.

Hypersensitivity to tobacco antigens in smokers and nonsmokers.

The examinations were carried out in 336 tobacco smokers, 91 persons who gave up smoking, 175 persons exposed to tobacco smoke indirectly and 112 persons who had nothing to do with tobacco smoke. Together 714 persons were examined. The examinations, which were carried out on the grounds of the clinic observations and the data obtained from interviews, aimed at the discovering of the causal nexus between the attacks of atopic bronchial asthma as well as the occurrence of acute urticaria and the exposure to tobacco smoke. All the patients underwent the dermic allergometric test with the extract from cigarette tobacco. The results of these examinations have not delivered any evidence concerning the allergenic reaction of the immediate type to tobacco smoke.