J Rheumatol
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Fibromyalgia syndrome (FS) is most common in midlife, but may be seen at any age. Its prevalence and assessment of tenderness in healthy children is not known. We assessed 338 healthy schoolchildren for tenderness thresholds and prevalence of FS. ⋯ Thresholds of tenderness of TP and control points in the children with FS were 2.5 (0.4) (kg) and 4.2 (0.5) (kg) vs 4.5 (1.2) (kg) and 6.6 (1.4) (kg) respectively in the children without FS (p < 0.001). We suggest that FS is common in the pediatric age group. Boys have lower tenderness than girls; children with FS have lower thresholds for tenderness both at control and TP compared to the subjects without FS.
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Case Reports
Embolization of two bleeding aneurysms with platinum coils in a patient with polyarteritis nodosa.
We describe a patient with polyarteritis nodosa who developed a large retroperitoneal hemorrhage from a ruptured suprarenal capsule artery aneurysm. Platinum coils were embolized selectively during arteriography and successfully controlled the aneurysmal bleeding. ⋯ A second embolization was performed with complete success. Selective embolization of small arteries with coils should be considered a good alternative to surgery in patients with polyarteritis nodosa and hemorrhage from a ruptured aneurysm; arteriography may be considered a potent diagnostic and therapeutic tool in the management of the treatment of polyarteritis nodosa.
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Comparative Study
Interrater reliability of the tender point criterion for fibromyalgia.
The diagnosis fibromyalgia (FS) requires the existence of tender points, routinely identified by clinical examination. We evaluated the interrater reliability of digital (thumb) examination for tender points by comparison with dolorimeter examination, a procedure considered to measure accurately muscle tenderness. Subjects were 15 patients with varying rheumatological diagnoses and anatomically widespread pain. ⋯ Results indicate (1) classification as FS vs other diagnosis using pain complaint and digital examination for tender points, was moderately reliable (kappa = 0.74, p < 0.005); (2) interrater agreement about presence/absence of tenderness at individual points was not significantly lowered by digital examination (kappa = 0.51, p < 0.0001) relative to dolorimetry (kappa = 0.62, p < 0.0001); however, (3) analyses on the 12 anatomical points that were common to both methods indicated that digital examination resulted in significantly more anatomical points being considered tender relative to dolorimetry. Our findings indicate that digital and dolorimeter measures are equally reliable, but have poor concurrent validity for defining tender points in FS. Implications of these findings for the classification of fibromyalgia are discussed.
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Only 3 cases of isolated septic arthritis of a lumbar facet joint have been reported, all due to Staphylococcus aureus. We describe a case of Klebsiella pneumoniae septic arthritis of a lumbar facet joint in an HLA-B27 positive patient.
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Randomized Controlled Trial Clinical Trial
Intravenous iloprost treatment of Raynaud's phenomenon and ischemic ulcers secondary to systemic sclerosis.
We conducted this study to assess the clinical usefulness and physiologic effects of intravenous iloprost in patients with Raynaud's phenomenon secondary to systemic sclerosis. ⋯ Iloprost appears useful for the treatment of digital ulcers in systemic sclerosis and is associated with evidence of prolonged physiologic improvement although the mechanism of this effect remains unclear.