Current rheumatology reports
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Fibromyalgia (FM) and chronic fatigue syndrome (CFS) patients often have memory and cognitive complaints. Objective cognitive testing demonstrates long-term and working memory impairments. ⋯ Neuroimaging studies demonstrate cerebral abnormalities and a pattern of increased neural recruitment during cognitive tasks. Future work should focus on the specific neurocognitive systems involved in cognitive dysfunction in each syndrome.
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Central nervous system (CNS) vasculitis is an increasingly recognized, often devastating inflammatory brain disease of children and adults. In primary or isolated CNS vasculitis/angiitis of childhood (cPACNS), the vascular inflammation is limited to the brain and spinal cord. ⋯ Diagnosis of primary CNS vasculitis in both adults and children is based on the Calabrese criteria. This review summarizes recent data on CNS vasculitis in children; reviews the clinical spectrum at presentation and the role of laboratory tests, neuroimaging, and brain biopsy; and discusses treatment strategies, outcome data, and overlapping conditions of cPACNS.
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The magnitude of placebo analgesia is influenced by environmental and perceptual factors. Environmental factors include past exposure to effective analgesic agents and verbal suggestions and cues that foster a perception of being given an effective treatment. ⋯ Strategies to maximize placebo analgesic effects in clinical practice could focus on using verbal suggestions and external cues to increase expectations of pain relief and/or decrease the perceived need for pain reduction. Placebo analgesic effects could be minimized in clinical trials by avoiding these same suggestions and cues.
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In the last 20 years, the clinician educator has become an integral, indispensable part of the academic team. Competition for clinical revenue and increased rigor of mandating physician competency and evidenced-based treatments have created a niche in academia in which the clinician educator can thrive. Academic clinician educators are needed in adult and pediatric rheumatology. ⋯ Clinician educators must be better prepared for teaching, stimulated to create new curricula and methods of evaluation, and provided opportunities to publish their work. Faculty development programs and advanced degrees in education are essential, and promotion criteria must be modified. Clinician educators have a place in academia, but they must continue to thrive as master clinicians, innovators in competency-based teaching methods and evaluation, and contributors to the literature.
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Widespread chronic pain, fatigue, and distress do not represent risk factors for future systemic lupus erythematosus (SLE) or other autoimmune syndromes. On the other hand, SLE seems to be a significant risk factor for fibromyalgia (FM). Up to 47% of SLE patients fulfill FM criteria. ⋯ Recent research suggests involvement of N-methyl-D-aspartate (NMDA) and neurokinin receptor systems. Thus, autoimmune activity against these receptor systems in SLE patients could result in pain, cognitive defects, and chronic pain states including FM. Conversely, treatment of SLE-FM patients with inhibitors of NMDA or neurokinin receptors may prevent or alleviate cognitive abnormalities and chronic pain, as well as FM.