Nature reviews. Rheumatology
-
Fibromyalgia is a disorder characterized by chronic widespread pain in the presence of widespread tenderness, and multiple somatic symptoms. Since the publication of the American College of Rheumatology (ACR) 1990 classification criteria for fibromyalgia, research has proliferated and, in a relatively short period, investigators have begun to unravel the etiology and long-term impact of this complex condition. Although the ACR 1990 criteria have been central to fibromyalgia research during the past two decades, a number of practical and philosophical objections have been raised in relation to them. ⋯ In developing the ACR 2010 criteria, experts have sought to address these issues and to simplify clinical diagnosis. An implicit aim was to facilitate more rigorous study of etiology. The purpose of this Review is to summarize research to date that has described the epidemiology, pathology and clinical course of fibromyalgia, and to assess the probable impact of the ACR 2010 criteria on future research efforts.
-
Biologic therapies have revolutionized the treatment of rheumatic diseases in the past decade. As with any drugs, however, a variety of important safety concerns affect the choice and use of these agents. Several issues, such as the risk of infection, malignancy, or administration reactions, apply to all of these compounds, although some conditions that affect patient selection and management within these categories seem to be specific to particular biologic treatments. ⋯ Despite all these concerns, the therapeutic indices for biologic agents remain fairly high in relation to non-biologic DMARDs. Available safety data for all biologic agents approved for the treatment of rheumatoid arthritis are reviewed in this manuscript. With careful patient selection and appropriate vigilance on the part of treating physicians and other care providers, these compounds can be safely integrated into the therapeutic plan.
-
Individuals with fibromyalgia generally experience chronic widespread pain, which can be accompanied by further symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. As the recognition and diagnosis of fibromyalgia has improved, the availability of therapeutic options for patients has increased. ⋯ The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed. In addition, pharmacological treatments, including monoamine modulators, calcium channel modulators and γ-aminobutyric acid modulators, as well as nonpharmacological treatment options are considered.