A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg.

OBJECTIVES: The aetiopathogenesis of the fibromyalgia syndrome (FMS) remains unknown. Recent reports, however, suggest that a subgroup of FMS subjects has an immune-mediated disease. Therefore, our primary objective was to study FMS subjects for evidence of an immune-mediated demyelinating polyneuropathy. Our secondary objective was to determine the effects of treating these FMS subjects with the immune modulator, intravenous immunoglobulin (IVIg). METHODS: Fifty-eight FMS subjects, 26 rheumatic non-FMS subjects and 52 non-rheumatic non-FMS subjects were studied. Subjective measures of paraesthesias, weakness, stocking hypaesthesia, pain, fatigue and stiffness were made. Objective measures of tenderness, proximal muscle strength and electrodiagnostic (EDX) evidence of polyneuropathy and demyelination were also made. Eleven other FMS subjects underwent sural nerve biopsy. RESULTS: Paraesthesias, subjective weakness and stocking hypaesthesia were more common in FMS than in rheumatic non-FMS (P < or = 0.0001). Proximal muscle strength was less in FMS than in rheumatic non-FMS (P < or = 0.0001). EDX demonstrated a distal demyelinating polyneuropathy, suggestive of chronic inflammatory demyelinating polyneuropathy (CIDP), in 33% of FMS subjects. No rheumatic non-FMS subject had polyneuropathy (P = 0.005), or demyelination (P = 0.05). Fifteen FMS/CIDP subjects were subsequently treated with IVIg (400 mg/kg each day for 5 days). Pain (P = 0.01), tenderness (P = 0.001) and strength (P = 0.04) improved significantly. Fatigue and stiffness trended towards improvement. CONCLUSIONS: A significant subset of FMS subjects have clinical and EDX findings suggestive of CIDP. IVIg treatment shows promise in treating this subset. These observations have implications for better understanding and treating some FMS patients.

[Measuring bone density--applications, critique, consequences]. / Knochendichtemessung--Anspruch, Kritik, Konsequenzen.

The supporters of bone density measurement or osteodensitometry claim that it is possible to reduce the frequency of fractures if a lack of systemic bone mineral content is detected in time. Important topical points of criticism are brought forward. Meaningful clinical use is only possible if reference data referring to population are accepted, and standardised quality assurance is safeguarded. Densitometrical methods do not guarantee sufficient prognostic data neither for diagnostic purposes nor for estimating the risk of fracture. In addition, they are not reliable enough for assessment of a treatment. The compensation of costs by statutory health insurance for bone density measurements as therapeutic aid should be restricted to regular controls of bone density after having diagnosed a pathological fracture, and to controls of certain secondary forms of osteoporosis.

Evaluating level I fieldwork students: a job model.

This article describes how a job model, a behavioral engineering concept used to improve employee performance, was developed to evaluate the clinical performance of occupational therapy students in Level I fieldwork. The job model emphasizes accomplishments and provides immediate feedback on specific skills needed for the successful completion of Level I fieldwork. In a pilot study of 137 students from the Occupational Therapy Teaching Clinic at Western Michigan University, 68 of the students were evaluated with the job model and 69 were evaluated with Western Michigan University's traditional Level I fieldwork evaluation. The results showed that the job model provided a method by which to identify standard values for measuring accomplishments in Level I fieldwork.