J Rheumatol
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To investigate the relationship between control points and symptom and distress severity in fibromyalgia (FM). ⋯ Positive control points are a common feature (63%) in FM, and appear to be a marker for a generally low pain threshold rather than a disproportionate increase in severe symptoms or distress. Control point positivity should not be used to disqualify a diagnosis of FM. Control point measurements do not add much to FM diagnosis or assessment and, perhaps, should be abandoned. At the least, they should be designated "high threshold" points rather than control points. Dolorimetry is considerably less useful in FM assessment than the manual tender point examination.
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Spontaneous chronic widespread pain in combination with hyperalgesia to pressure stimuli is the hallmark of fibromyalgia (FM). We tested whether muscular hyperalgesia can exist in a muscle without spontaneous pain, which could indicate a generalized hyperexcitability of the nociceptive system in patients with FM. ⋯ There is a state of central hyperexcitability in the nociceptive system in FM. This hyperexcitability can be revealed by excitation of intramuscular nociceptors in a muscle with no spontaneous pain.
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Comparative Study
Preliminary evidence for cyclosporin A as an alternative in the treatment of recalcitrant juvenile rheumatoid arthritis and juvenile dermatomyositis.
To evaluate the safety and efficacy of cyclosporin A (CyA) with and without methotrexate (MTX) in refractory juvenile rheumatoid arthritis (JRA) and juvenile dermatomyositis (JDMS). ⋯ CyA may be an effective agent in the treatment of refractory JRA and JDMS and concomitant MTX seems to be well tolerated. These preliminary data also suggest that combined CyA/MTX therapy may be associated with further improvement in clinical outcome.
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Water intoxication is a well described complication of high dose intravenous (i.v.) cyclophosphamide therapy combined with forced hydration. Less well known is that water intoxication can develop even after low dose iv cyclophosphamide. ⋯ Rheumatologists should be aware of this serious adverse effect of iv cyclophosphamide because this drug is being used increasingly for treatment of a variety of rheumatological diseases. The pathogenesis, clinical characteristics, treatment, and methods for prevention of cyclophosphamide induced water intoxication are discussed.
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To characterize sequential ultramorphological changes in synovial sensory peptidergic fibers in different phases of adjuvant induced arthritis. ⋯ The healthy synovial lining is innervated by peptidergic nerve terminals. During the inflammatory phase of arthritis neuropeptides are locally released due to stimulation and degeneration of the axons. The apparently unaffected Schwann cells seem to play a pivotal role in subsequent regeneration of peptidergic axons. However, the ultrastructure and the neuropeptide content (and probably the function) of the regenerating axons are different from those of the normal synovial nerve fibers.