Rheumatic diseases clinics of North America
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Fibromyalgia (FM) can be conceptualized as a failed attempt of our main complex adaptive system (the autonomic nervous system) to adjust to a hostile environment. FM cannot be fully understood through the prevailing linear-reductionist medical model. Conversely, FM can be explained using the new complexity theory paradigms. ⋯ Autonomic dysfunction also explains non-pain-related FM features. Preliminary genetic evidence supports FM's dysautonomic nature. A scientific holistic therapy is proposed to harmonize rigid complex systems and, in doing so, to help to improve FM symptoms.
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Rheum. Dis. Clin. North Am. · May 2009
ReviewClinical manifestations and diagnosis of fibromyalgia.
Since the publication of the American College of Rheumatology Classification Criteria for Fibromyalgia 18 years ago, there have been an ever-increasing number of research articles and reviews. From the National Library of Medicine alone there are more than 10,000 articles related to fibromyalgia. ⋯ This article provides an update on fibromyalgia symptomatology and looks at issues that need to be considered in the development of updated diagnostic guidelines. There is still no gold standard for making a diagnosis of fibromyalgia, but there is an increasing consensus for the development of new guidelines for diagnosis that modifies the currently proscribed tender point evaluation.
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Rheum. Dis. Clin. North Am. · Nov 2008
ReviewPulmonary manifestations of primary Sjögren's syndrome.
Sjögren's syndrome (SS) is a systemic disease with a predilection for the exocrine glands. It also is considered to be an autoimmune epitheliitis, and, as the respiratory system is lined throughout with epithelial cells, it should not be surprising that patients who have SS may develop pulmonary disease. This article describes these manifestations.
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The menisci play a critical protective role for the knee joint through shock absorption and load distribution. Currently, the consensus in surgical treatment of meniscal tears is to preserve as much functional meniscal tissue as possible. ⋯ Surgical resection of nonobstructive degenerate lesions may remove only the evidence of the disorder while the osteoarthritis degradation proceeds. Well-designed randomized, controlled clinical trials are needed.
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Rheum. Dis. Clin. North Am. · Aug 2008
ReviewThe symptoms of osteoarthritis and the genesis of pain.
Symptomatic osteoarthritis (OA) causes substantial physical and psychosocial disability. This article delineates the characteristic symptoms and signs associated with OA and how they can be used to make the clinical diagnosis. ⋯ The remainder of the article focuses on what is known about the causes of pain in OA and factors that contribute to its severity. Much has been learned during recent years, but much of this puzzle remains unexplored or inadequately understood.