Clinical rheumatology
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Clinical rheumatology · Apr 2007
ReviewCentral sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome.
In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. ⋯ This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc.
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Clinical rheumatology · Nov 2006
ReviewSystematic review of measures and their concepts used in published studies focusing on the treatment of acute inflammatory arthritis.
To identify outcome measures and concepts cited in published studies focusing on the treatment of acute inflammatory arthritis, and to identify and quantify the concepts contained in these measures using the International Classification of Functioning, Disability and Health (ICF) as a reference. This 'research perspective' is part of the development process for an ICF core set in acute arthritis. Electronic searches of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Pedro and the Cochrane Library from January 2000 to July 2004 were carried out. ⋯ Ten (30%) of the 34 categories belong to the component "Body Functions", 3 (9%) to the component "Body Structures" and 21 (61%) to the component "Activities and Participation". The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on the management of patients with acute inflammatory arthritis. Our findings indicate there is good agreement on 'what should be measured' in acute inflammatory arthritis to allow for a comparison of patient populations.
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Clinical rheumatology · Nov 2006
ReviewTNF-receptor-associated periodic syndrome (TRAPS): an autosomal dominant multisystem disorder.
The TNF-receptor-associated periodic syndrome (TRAPS) is an autosomal dominant auto-inflammatory disorder, characterized by recurrent febrile attacks and localized inflammation. TRAPS is caused by mutations in the gene encoding the TNF Receptor Super Family 1A (TNFRSF1A) on chromosome 12p13. ⋯ Although the ethnic diversity and clinical heterogeneity may propose the role of other genes in the pathogenesis of TRAPS, some low-penetrance TNFRSF1A variants contribute to atypical inflammatory responses in other autoimmune diseases. Furthermore, molecular studies on TRAPS and other auto-inflammatory disorders could be suggested to identify additional genes coding the molecules in the TNF signalling process.
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Clinical rheumatology · Jan 2006
ReviewCombination analgesia in 2005 - a rational approach: focus on paracetamol-tramadol.
A multimodal (or balanced) approach to anaesthesia is a familiar concept that offers important benefits in the management of both acute and chronic pain. Rational combinations of analgesic agents with different mechanisms of action can achieve improved efficacy and/or tolerability and safety compared with equianalgesic doses of the individual drugs. Combining different agents also enhances efficacy in complex pain states that involve multiple causes. ⋯ Comparative trials have shown that paracetamol plus tramadol has comparable efficacy to paracetamol plus codeine, but with reduced somnolence and constipation compared with the codeine combination. The paracetamol plus tramadol combination is also free of organ toxicity associated with selective and non-selective non-steroidal anti-inflammatory drugs. Hence, paracetamol plus tramadol offers an effective and well-tolerated alternative to anti-inflammatory drugs or other paracetamol plus weak opioid combinations.
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Clinical rheumatology · Jan 2006
ReviewUpdate on guidelines for the treatment of chronic musculoskeletal pain.
Chronic musculoskeletal pain is a major - and growing - burden on today's ageing populations. Professional organisations including the American College of Rheumatology (ACR), American Pain Society (APS) and European League Against Rheumatism (EULAR) have published treatment guidelines within the past 5 years to assist clinicians achieve effective pain management. Safety is a core concern in all these guidelines, especially for chronic conditions such as osteoarthritis that require long-term treatment. ⋯ There are as yet no updated official guidelines that incorporate these new data and regulatory advice. An international multidisciplinary panel, the Working Group on Pain Management, has generated new recommendations for the treatment of moderate-to-severe musculoskeletal pain. These guidelines, formulated in response to recent developments concerning COX-2 inhibitors and other NSAIDs, focus on paracetamol as the baseline drug for chronic pain management; when greater analgesia is desired, the addition of weak opioids is recommended based on a preferable GI and cardiovascular profile, compared with non-steroidal anti-inflammatory drugs.