La mejoría de la calidad de vida de las personas con fibromialgia requiere promover creencias de control propio del dolor y un afrontamiento activo / Improving the quality of life of people with fibromyalgia requires promoting beliefs of self-control of pain and active coping

Introducción: Las personas con fibromialgia refieren una notable interferencia de la enfermedad en su calidad de vida. A pesar de que los síntomas de la fibromialgia suelen seguir un curso crónico, la calidad de vida de las pacientes puede mejorar. Por consiguiente, la mejoría de la calidad de vida debería ser un objetivo terapéutico prioritario. El objetivo de este estudio longitudinal fue evaluar los determinantes de la calidad de vida en las pacientes con fibromialgia seis meses después de haber recibido un tratamiento multidisciplinario. Método: En 40 pacientes seleccionadas consecutivamente se analizaron las variables previamente descritas como sólidos determinantes de la calidad de vida antes y seis meses después de realizar un tratamiento multidisciplinario. Se realizó un análisis de componentes principales del cambio observado en cada uno de estos determinantes y se analizó su relación con la mejoría de la calidad de vida mediante análisis de regresión multivariante. Resultados: El análisis de los componentes principales observó 7 factores independientes que explicaron el 76.4% de la varianza entre sujetos del cambio en las variables clínicas evaluadas. Los análisis de regresión multivariantes mostraron que la mejoría en las distintas facetas de la calidad de vida dependió principalmente de las creencias favorables a la posibilidad de disminuir el dolor mediante recursos propios y de un afrontamiento activo que conllevara un incremento de la capacidad funcional subjetiva.Conclusiones: Dada la cronicidad de los síntomas de la fibromialgia, la mejoría de la calidad de vida de las pacientes debería basarse en la promoción de las creencias de control del dolor y el incremento de la autoeficacia teniendo, no obstante, en cuenta el efecto a la vez negativo y positivo de la ayuda externa.(AU)

Introduction: People with fibromyalgia report a significant interference of the disease in their quality of life. Although the symptoms of fibromyalgia usually follow a chronic course, the quality of life of patients can improve. Therefore, improving quality of life should be a priority therapeutic goal. The objective of this longitudinal study was to assess the determinants of quality of life in patients with fibromyalgia six months after receiving multidisciplinary treatment. Method: In 40 consecutively selected patients, the variables previously described as solid determinants of quality of life were analyzed before and six months after receiving a multidisciplinary treatment. A principal component analysis of the change observed in each of these determinants was performed and their relationship with improvement in quality of life was analyzed using multivariate regression analysis. Results: Principal component analysis of change found 7 independent factors that explained 76.4% of the between-subject variance of change in clinical variables assessed. The multivariate regression analysis showed that the improvement in the different facets of quality of life depended mainly on the promotion of perceived ability to control pain through one’s own resources and on active coping that would lead to an increase in subjective functional capacity. Conclusions: Given the chronicity of fibromyalgia symptoms, improvement of patients’ quality of life should be based on the promotion of pain control beliefs and the increase of self-efficacy considering, however, the effect both negative and positive of significant others’ assistance.(AU)

Tapentadol effects on brain response to pain in sensitized patients with knee osteoarthritis.

OBJECTIVE: Pain sensitization, in the form of knee tenderness and anatomically spread hyperalgesia, is notably common in patients with knee OA and is often refractory to conventional interventions. Tapentadol, as an opioid receptor agonist and noradrenaline reuptake inhibitor, has been proposed as a potentially effective symptomatic treatment for pain-sensitized OA patients. We empirically tested whether tapentadol could attenuate brain response to painful stimulation on the tender knee using functional MRI. METHODS: Painful pressure stimulation was applied to the articular interline and the tibial surface, a commonly sensitized site surrounding the joint. Thirty patients completed the crossover trial designed to compare prolonged release tapentadol and placebo effects administered over 14 days. RESULTS: We found no effects in the direction of the prediction. Instead, patients administered with tapentadol showed stronger activation in response to pressure on the tender site in the right prefrontal cortex and somatosensory cortices. The somatosensory effect was compatible with the spread of neural activation around the knee cortical representation. Consistent with the functional MRI findings, the patients showed higher clinical ratings of pain sensitization under tapentadol and a significant positive association was identified between the number of tapentadol tablets and the evoked subjective pain. CONCLUSION: The tapentadol effect paradoxically involved both the spread of the somatosensory cortex response and a stronger activation in prefrontal areas with a recognized role in the appraisal of pain sensations. Further studies are warranted to explore how OA patients may benefit from powerful analgesic drugs without the associated risks of prolonged use. TRIAL REGISTRATION: EudraCT, https://eudract.ema.europa.eu, 2016-005082-31.

Influence of anti-osteoporosis treatments on the incidence of COVID-19 in patients with non-inflammatory rheumatic conditions.

Coronavirus disease 19 (COVID-19) is currently a global pandemic that affects patients with other pathologies. Here, we investigated the influence of treatments for osteoporosis and other non-inflammatory rheumatic conditions, such as osteoarthritis and fibromyalgia, on COVID-19 incidence. To this end, we conducted a cross-sectional study of 2,102 patients being treated at the Rheumatology Service of Hospital del Mar (Barcelona, Spain). In our cohort, COVID-19 cumulative incidence from March 1 to May 3, 2020 was compared to population estimates for the same city. We used Poisson regression models to determine the adjusted relative risk ratios for COVID-19 associated with different treatments and comorbidities. Denosumab, zoledronate and calcium were negatively associated with COVID-19 incidence. Some analgesics, particularly pregabalin and most of the studied antidepressants, were positively associated with COVID-19 incidence, whereas duloxetine presented a negative association. Oral bisphosphonates, vitamin D, thiazide diuretics, anti-hypertensive drugs and chronic non-steroidal anti-inflammatory drugs had no effect on COVID-19 incidence in the studied population. Our results provide novel evidence to support the maintenance of the main anti-osteoporosis treatments in COVID-19 patients, which may be of particular relevance to elderly patients affected by the SARS-CoV-2 pandemic.

Inflammatory linear verrucous epidermal nevus associated with erosive monoarthritis.

Inflammatory linear verrucous epidermal nevus and linear psoriasis are different entities with clinical and histopathologic similarities. Isolated reports of inflammatory linear verrucous epidermal nevus with concomitant psoriasis or a positive family history of psoriasis have been described, and the possibility that inflammatory linear verrucous epidermal nevus may be a mosaic form of cutaneous psoriasis has been postulated. We report a 17-year-old boy with a congenital, linear, erythematous, keratotic plaque on the dorsum of the fifth finger of the left hand with ipsilateral nail dystrophy. Histopathologic examination showed epidermal hyperplasia with alternating orthokeratosis and parakeratosis. During follow-up, he developed erosive monoarthritis of the distal interphalangeal joint. This case seems to confirm the association between inflammatory linear verrucous epidermal nevus and arthritis and supports a possible relationship between inflammatory linear verrucous epidermal nevus and psoriasis.