Zeitschrift für Rheumatologie
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Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) are primary systemic small vessel vasculitides, associated with a positive C/PR3-ANCA in WG and P/MPO-ANCA in MPA. The most prominently involved organs are the upper (only in WG) and lower respiratory tract and the kidneys. The diagnostic work-up is an interdisciplinary approach assessing disease stage and extent. ⋯ Alternatives are leflunomide, mycophenolate or methotrexate (creatinine < 150 micromol/l). Age > or = 50 at diagnosis, renal dysfunction and pulmonary involvement are associated with higher mortality rates. The relapse rate is approximately 50% within 5 years, being higher in WG than MPA.
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Fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) belong to the group of chronic non-inflammatory pain syndromes affecting muscles and tendinous insertions. Important criteria in the diagnosis of both diseases are the presence of "tender points" and "trigger points". ⋯ In addition, analysis of trigger points by microdialysis demonstrated elevated levels of pro-inflammatory substances at these sites. Moreover, local treatment of trigger points either by manipulative therapy or injection appears to be most effective for prompt relief of symptoms.
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Practice Guideline
[Definition, classification and diagnosis of fibromyalgia syndrome].
Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. ⋯ CWP is defined by the criteria of the American College of Rheumatology (ACR-strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).
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The International Classification of Functioning, Disability, and Health (ICF) created by the World Health Organization provides both a framework and a classification comprehensively covering domains of function and disability in rheumatologic patients. The ICF can be used as a universal language understood by medical doctors, health professionals, researchers, patients, and other groups. It is based on an integrative biopsychosocial model of functioning. ⋯ These Sets, which were developed in a standardized scientific process, consist of the ICF categories that are most relevant for a specific group of patients, e.g. chronic patients with rheumatoid arthritis. In rheumatologic rehabilitation, patient problems, medical findings, treatment goals, and treatment concepts can be structured by applying the ICF, ICF Core Sets, and an ICF assessment sheet to patients. In outcomes research, ICF Core Sets can support the selection of relevant outcome domains.
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A symptom-based diagnosis of fibromyalgia syndrome (FMS) without tender point examination is helpful for primary medical care. We tested whether a symptom-based diagnosis of FMS can be based on the symptoms of musculoskeletal pain and fatigue. ⋯ Following the exclusion of inflammatory rheumatoid, endocrinological and neurological diseases, a symptom-based clinical diagnosis of FMS can be based on of the key symptoms of chronic widespread musculoskeletal pain, as well as chronic fatigue.