Health status of patients with ankylosing spondylitis: a comparison with the general population.

OBJECTIVE: To examine the subjective health in patients with ankylosing spondylitis (AS) compared with the general population, and to explore the associations between health status and age, sex of the patients, and educational level in AS. METHODS: Health status was assessed with a generic instrument (SF-36) in 314 patients with AS and in 2323 people from the general population. Subgroup analyses were performed according to age, sex, and educational level. Standard difference scores (s-scores) were calculated to ensure the clinical meaningfulness of the norm based comparisons. RESULTS: Both men and women with AS reported significantly impaired health on all scales of the SF-36. Women reported significantly worse health on physical health domains. However, when calculating differences from the general population, numerically larger s-scores were found for men (except for physical role and vitality). The relative impact of AS seems to diminish with increasing age. In AS, better health was significantly associated with higher education across all scales. Deviations from the general population on the non-physical health aspects were especially pronounced in patients with low education. CONCLUSIONS: All key dimensions of health are affected by AS. The physical aspects seem to be most severely affected, but in the less educated group of patients, the disease impact on the mental health aspects was also considerable. Evaluation and management planning should take the complexity of AS into consideration. The focus on physical function should be maintained, and additional attention should be paid to the mental and social consequences of AS.

Health status in fibromyalgia--a followup study.

OBJECTIVE: To examine symptoms, physical function, and nutritional status in patients with fibromyalgia (FM) after 6 to 8 years. METHODS: Of 51 women with FM initially included in exercise and patient education programs 6 and 8 years ago, 33 agreed to participate. Median (range) age was 45.5 years (33-64) and symptom duration 18 years (8-46). Symptoms (visual analog scales), cardiovascular capacity (Aastrand's test), and restriction on daily activities (Fibromyalgia Impact Questionnaire) were measured. Employment status and experience of coping with everyday life were addressed in an interview. Nutritional status was evaluated by anthropometric measurements and dietary intake. RESULTS: All the 33 participants had widespread chronic pain, and 79% had enough tender points to satisfy the FM classification criteria. Compared with initital data there were significant reductions in the number of tender points (p = 0.004) in the exercise group, and in fatigue (p = 0.008) and pain (p = 0.5) in the patient education group. Cardiovascular capacity was within normal limits in 33% of the participants. Currently, 26 performed regular physical activity and of these, 10 were engaged in organized exercise. Seventy-two percent reported regular use of dietary supplements and attached importance to a healthy diet. Still, there was a significant increase in weight and body fat, and 24% were obese (BMI > 30). The coping strategies adopted were adjustments to the new situation and distraction from symptoms. CONCLUSION: No worsening of symptoms and no change in employment status, as well as frequent participation in physical activities, suggests a benign longterm outcome in these patients with FM.

Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain.

OBJECTIVE: To examine the effects of pool-based (PE) and land-based (LE) exercise programs on patients with fibromyalgia. METHODS: The outcomes were assessed by the Fibromyalgia Impact Questionnaire, the Arthritis Self-Efficacy Scale, and tests of physical capacity. RESULTS: Eighteen subjects in the PE group and 16 in the LE group performed a structured exercise program. After 20 weeks, greater improvement in grip strength was seen in the LE group compared with the PE group (P < 0.05). Statistically significant improvements were seen in both groups in cardiovascular capacity, walking time, and daytime fatigue. In the PE group improvements were also found in number of days of feeling good, self-reported physical impairment, pain, anxiety, and depression. The results were mainly unchanged at 6 months followup. CONCLUSION: Physical capacity can be increased by exercise, even when the exercise is performed in a warm-water pool. PE programs may have some additional effects on symptoms.

The effect of static traction and orthoses in the treatment of knee contractures in preschool children with juvenile chronic arthritis: a single-subject design.

OBJECTIVE: External applied devices are sometimes used in the treatment of persistent knee contractures in juvenile chronic arthritis (JCA). This study examined the effect of static night traction and orthoses on passive and active extension range of motion (ROM) in preschool children with JCA. METHOD: A single-subject design was used, comparing the outcome of periods without intervention (A) with that of periods with intervention in the form of traction and orthoses (B). Five patients, 3 girls and 2 boys, participated. Active and passive extension ROM was measured weekly. The data were examined by visual inspection of trend, slope, and mean level in each period. RESULTS: Greater improvement in both active and passive extension ROM was seen in the B periods than in the A periods. The intervention was not observed to have any negative effects on the children. CONCLUSION: Static night traction may be a useful supplement to physiotherapy and medication to reduce knee flexion contractures in small children with JCA. The effect of the orthoses was difficult to evaluate because they were used for an insufficient time.

[Physiotherapy as manual therapy]. / Fysioterapi som manuell terapi.

Manual therapy includes methods where the therapist's hands are used to stretch, mobilize or manipulate the spinal column, paravertebral structures or extremity joints. The aims of these methods are to relieve pain and improve function. In Norway only specially qualified physiotherapists and chiropractors are authorized to perform manipulation of joints (high velocity thrust techniques). To become a qualified manual therapist in Norway one must have a minimum of two years of clinical practice as physiotherapist followed by two year full time postgraduate training in manual therapy (a total of six years). Historically the Norwegian manual therapy system was developed in the 1950s by physiotherapists and medical doctors in England (James Cyriax and James Mennell) and Norway. As a result doctors allowed physiotherapists to use manipulation as a treatment method of both spinal and peripheral joints. In 1957 the Norwegian health authorities introduced reimbursement for manual therapy performed by physiotherapists.

[Effect of physical exercise in fibromyalgia]. / Effekt av fysisk trening ved fibromyalgi.

The aim of the present study was to review and discuss the literature on exercise-induced pain and physical fitness training in patients with fibromyalgia. Normal muscle metabolism during exercise and no muscle damage after physical activity are reported from recent studies. However, no rise in blood noradrenaline concentration during exercise was found in fibromyalgia patients as compared with a many-folded rise in healthy subjects. Exercise has been used in the treatment of fibromyalgia. Training has shown little benefit as regards pain, but has improved the physical fitness of the patients. Since pain may be exacerbated by physical activity, many patients become physically inactive, with possible development of reduced physical fitness. In the long run, fibromyalgia patients who exercise report less symptoms than sedentary patients do. Thus, exercise should be aimed at preventing physical inactivity and improving the patients' physical fitness.

Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects.

OBJECTIVE: To examine whether general feelings of fatigue, exercise-induced pain in the extremities, and exertion were different in female patients with fibromyalgia syndrome (FS) compared with sedentary healthy women. METHODS: Thirty-seven FS patients and 20 healthy subjects were studied. Cardiovascular fitness was assessed by Aastrand's indirect, submaximal method. The period of repetitive dynamic muscle contractions and sustained static muscle contraction were measured. General feelings of fatigue before exercise and exercise-induced extremity pain were assessed by visual analogue scales. Exercise-induced exertion was recorded by Borg's Rating Scale of Perceived Exertion. RESULTS: No significant group difference in cardiovascular fitness was found (p = 0.8). In the FS patients general fatigue was (median 95% confidence interval) 69 (59 - 75) versus 32 (22 - 47) for the healthy controls (p < 0.0001). At the moment of interrupting the bicycle test, the perceived exertion score was 17 (16 - 18) among patients versus 13 (13 - 15) among controls (p < 0.0001). Compared with the controls, high exercise-induced extremity pain was found after sustained static and repetitive dynamic muscle contractions in the FS patients (p < 0.004), and 24 hours later the patients' pain intensities had not returned to pre-exercise values (p < 0.01). CONCLUSION: High general fatigue, exercise-induced extremity pain, exertion and 24 hours post-exercise extremity pain in FS patients compared with healthy controls could not be explained by any group difference in cardiovascular fitness.

Multidisciplinary approach to fibromyalgia. A pilot study.

The aim of the study was to instruct a group of fibromyalgia patients how to solve problems related to activities of daily life. Sixteen female fibromyalgia patients completed a ten week multidisciplinary program, consisting of a cognitive and an exercise part. After ten weeks a reduction in general pain intensity (p < 0.05) was found. At six months follow-up sensory (somatic) pain intensity was reduced compared to baseline recordings (p = 0.05). All patients had made adjustments to their everyday life after ten weeks. Eight patients reported that they regularly practised relaxation techniques, and seven patients had undertaken dietary changes. Thus, the study shows that adjustment of activities in daily living may reduce pain in patients with fibromyalgia. Controlled studies are needed in the future.

Muscle fatigue in early fibromyalgia.

OBJECTIVE: To compare the processes connected with muscle fatigue during prolonged exercise in patients with fibromyalgia (FM) with studies of healthy individuals. METHODS: Nine female patients with FM, all employed in full or part time, performed repetitive isometric contractions of the quadriceps muscles at 30% of maximal voluntary contraction (MVC) force in 6 s with 4 s rest between until exhaustion. RESULTS: The MVC and electrically stimulated tetanic forces fell continually and almost in parallel, indicating no central fatigue. The relaxation rate of the muscle became gradually faster as previously seen in healthy subjects. Plasma catecholamine concentrations remained unchanged during the exercise period, whereas a modest rise in blood lactate and plasma K+ was seen. The electromyographic (EMG) amplitude recorded during contractions increased gradually, while no changes were seen in EMG recorded in resting periods between contractions. Heart rate and VO2 rose gradually and a small exercise induced pain was recorded. CONCLUSION: Our study showed normal physiological muscle fatigue responses, except for the lack of increase in plasma catecholamine concentrations during exercise.

Pain and fatigue in patients with rheumatic disorders.

The purpose of the study was to investigate whether fibromyalgia patients (n = 50) differed from patients with rheumatoid arthritis (n = 22) and ankylosing sponylitis (n = 31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p < 0.01) and the visual analogue scale (p < 0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p < 0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p < 0.01) and high intensity of fatigue (p < 0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.

[Fibromyalgia--a relationship between psyche and soma?]. / Fibromyalgi--et forhold mellom psyke og soma?

Fibromyalgia is regarded a state of pain that can both be triggered and maintained by a broad spectre of events, ranging from massive psychogenic stress to long-lasting excessive somatic strain. Based on a review of selected studies supported by the Norwegian Medical Research Council, this paper focuses on muscular exercise and related pain, the functional significance of certain neuropeptides, the contribution of the sympathetic nervous system and the psychological aspects of the condition.

The effects of 20 weeks of physical fitness training in female patients with fibromyalgia.

During a period of 20 weeks 18 female patients with fibromyalgia participated in a 60-minute exercise program twice a week. A control group, comprising 17 patients, was told not to change their physical activity level. Eleven patients in the training group and fourteen in the control group completed the study. The results at entry were compared to those after 20 weeks, as well as being compared to the results of the control group. No statistically significant changes or differences in general pain, pain coping and fatigue were seen after 20 weeks. Improved dynamic endurance work performance for the upper extremity was found, however, in the training group, measured as the strength of the first (p = 0.01) and the last repetition (p = 0.003). These results differed from the results of the control group (p = 0.02 and p = 0.003). It is concluded that fibromyalgia patients may undergo low-intensity dynamic endurance training without experiencing exacerbation of their general pain and fatigue symptoms.

Muscle strength and aerobic capacity in primary fibromyalgia.

Twenty-six women with primary fibromyalgia were tested for muscle strength and for aerobic capacity and fatigue. Grip strength was measured with a manometer. In the patient group the grip strength was 58 +/- 22 kPa (mean +/- SD) versus 97 +/- 17 kPa in healthy matched controls (p less than 0.01). The patients performed a mean of 10 +/- 6 repetitions with maximal grip pressure (dynamic endurance work), while the controls performed 13 +/- 6 repetitions (p less than 0.01). The upper extremity was kept in a fixed position for 152 +/- 147 seconds in the patient group versus 413 +/- 244 seconds in the control group (static endurance work), p less than 0.004. Normal aerobic capacity (O2 ml/kg min) was found in the patient group. Expected fatigue values were determined by Borg's rating scale for perceived exertion according to the heart rate in a cycle ergometer test. There was a significantly higher mean fatigue score in the patient group as compared to the expected values (p less than 0.0001).