The american college of rheumatology 1990 criteria for the classification of fibromyalgia
Frederick WolfeH A SmytheMuhammad B. YunusRobert M. BennettClaire BombardierDon L. GoldenbergPeter TugwellStephen CampbellMicha AbelesPatricia ClarkAdel G. FamStephen J. FarberJustus J. FiechtnerCindy FranklinRobert GatterDaniel HamatyJames LessardAlan S. LichtbrounAlfonse T. MasiGlenn A. McCainW. J. ReynoldsThomas J. RomanoI. Jon RussellRobert P. Sheon
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Abstract To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary‐concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left‐ and right‐sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary‐concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary‐concomitant fibromyalgia (as defined in the text) is abandoned.Keywords:
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Abstract To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary‐concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left‐ and right‐sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary‐concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary‐concomitant fibromyalgia (as defined in the text) is abandoned.
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Steaks from 58 beef carcasses were used to determine the effects of antemortem injections of proteolytic enzyme in increasing tenderness and/or in reducing tenderness variability among bullock carcasses. Sensory panel ratings indicated that steaks from the carcasses of treated bullocks did not differ significantly from steaks from treated steer carcasses in tenderness or overall satisfaction, but were significantly more tender and satisfactory overall than steaks from untreated bullocks. Variation in tenderness scores within the group of steaks from treated bullocks was reduced to a level more nearly comparable to that of steaks from treated steers. Since antemortem injections of papain increased tenderness and reduced the variability in tenderness among steaks from bullock carcasses, such treatment could be used to more effectively merchandise beef from young bulls.
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Background
Non-pharmacological approaches are the mainstay of treatment in fibromyalgia. The current recommendations of the European League Against Rheumatism (EULAR) for the management of fibromyalgia highlight that exercise is the only therapy with a 'strong' evidence [1]. Exercise has been typically implemented on either land- or water-based settings. However, it is unclear whether to perform exercise in different settings has different effects on pain; this knowledge might help to maximise the beneficial effects that exercise has in fibromyalgia [2]Objectives
To compare the effects of two exercise interventions (land- and water-based training) on pain in people with fibromyalgia.Methods
From 272 initially randomized, a total of 151 participants (50.6±7.6 years old, 98% women) completed all the assessments and attended to at least 70% of the programme; 48, 42 and 61 participants pertained to the land-based exercise, water-based exercise, and usual care (control) groups, respectively. The intervention groups trained 3 non-consecutive days/week (45-60 minutes per session) for 24 weeks. Each session included aerobic exercises, muscular strengthening and stretching for all the major muscle groups. Pain was measured by the 0-100 mm visual analogue scale (VAS) from the Fibromyalgia Impact Questionnaire (FIQ). Catastrophizing and self-efficacy pain-related cognitions were assessed by the Pain Catastrophizing Scale (PCS total score) and pain management subscale (PSE) of the Chronic Pain Self-efficacy Scale (CPSS), respectively. We calculated an algometer score based on the sum of pain thresholds (kg/cm2) of the 18 tender pints according to the 1990 American College of Rheumatology fibromyalgia diagnostic criteria. Participants were evaluated at baseline (pre-test), at the end of the 24-week intervention (post-test) and after a 12-week detraining period (re-test). The groups were comparable in sociodemographic and clinical characteristics; they only differ on age, which was included as a covariate along with baseline levels of pain.Results
Adjusting for Bonferroni, most of the between-group comparisons of pain changes over time were not significant. As exceptions, in comparison to the control group, participants in the land-based exercise group lowered catastrophizing and improved algometer score at the post-tests; mean difference (95% interval confidence) [MD(95% CI)] = -4.0 (-7.5 to -0.5) and 6.2 (2.0 to 10.5), respectively. These differences became non-significant at the re-test.Conclusion
These preliminary results suggest that a 24-week land-based exercise intervention had beneficial effects by reducing pain catastrophizing and increasing algometer score in people with fibromyalgia. However, these benefits were unsustained after the detraining period. In compassion to the control group, a water-based exercise intervention did not show any effect on pain. Although our finding suggest that a land-based exercise intervention may have short-term beneficial effects on pain, these findings must be considered as preliminary until more robust analyses are performed.References
[1] Macfarlane GJ, et al. Ann Rheum Dis2017;76:318–28. Doi:10.1136/annrheumdis-2016-209724 [2] Carbonell-Baeza A, et al. BMC Musculoskelet Disord2012;13:18. Doi:10.1186/1471-2474-13-18Acknowledgement
This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU14/02518; FPU 15/00002)Disclosure of Interests
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To evaluate the impact of concomitant fibromyalgia on the rating of pain, fatigue, and dysfunction, in patients with various rheumatic disorders.A cross-sectional study was carried out in a hospital-based rheumatology unit. Standard clinical and laboratory data were obtained and all patients completed questionnaires on pain, fatigue, and daily function. The rate of concomitant fibromyalgia was estimated using the 1990 American College of Rheumatology (ACR) classification criteria for fibromyalgia and the analysis concentrated on visual analogue scales (VAS).Six hundred and eighteen visits of 383 patients with inflammatory as well as non-inflammatory rheumatic disorders were analyzed. Concomitant fibromyalgia was noted in 74 patients (23% of the cohort). Patients with rheumatic diseases and concomitant fibromyalgia had significantly higher mean VAS scores for pain, fatigue, and function (79±17, 81±18, 80±18, respectively) as compared to patients who had no features of fibromyalgia (47±28, 50±29, 44±30 respectively; all p values <0.001). The scores reported by patients with rheumatic diseases and concomitant fibromyalgia were similar to the scores obtained from patients with primary FM.Concomitant FM is common both among patients with inflammatory and patients with non inflammatory rheumatic disorders. Concomitant FM has a remarkable impact on the severity of symptoms and, moreover, patients with concomitant FM exhibit extreme and significantly distinct levels of pain and fatigue which is as severe as that reported by patients with primary FM. It seems that fibromyalgic features dominate and become the main cause of morbidity in rheumatological patients with concomitant FM.
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As with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question - do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain?To compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom).A cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS.A total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen's d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms).Fibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.
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The improvement in meat tenderness during post storage of carcasses were mainly caused by calpain. The main content of this paper were: the mechanism of tenderness of calpain,tenderness modeling of post mortem,effect of calcium chloride on the tenderness and influencing factor of calpain activity.
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Abstract Background Exercise has been shown to significantly improve pain and function in individuals with fibromyalgia. Research into the effectiveness of exercise is often based on standardised exercise programmes that are chosen by the investigating clinical research team. However, such programmes may not necessarily be appealing to the participating patients. Furthermore, in addition to being taught exercises, patients with chronic conditions like fibromyalgia also need to learn to manage their condition themselves and so be actively involved in their treatment. The primary aim of this study is to compare the effects of two, 6-month physical activity programs on quality of life in patients with fibromyalgia. One group followed a patient-led, fibromyalgia-orientated programme (experimental) whilst the control group followed a standard, general exercise programme. Methods This protocol is an open-label, two-centre, randomised, controlled superiority trial. Two treatment arms will be compared: an experimental group (patient-led, fibromyalgia-orientated exercise) and a control group (general exercise program). The control group will participate in the exercise programme currently provided in our centre, which involves general, group exercise for patients with various pathologies. The experimental group will be taught the principles of exercise specifically for fibromyalgia during a one-to-one coaching session. They will then be guided in the choice of one or several types of exercise that they enjoy. They will be instructed to perform the exercise according to the recommendations for exercise in fibromyalgia with regard to intensity, duration and frequency. The protocol will last for 6 months; participants will then be followed-up for a further 6 months. They will also be encouraged to continue exercising after the end of the protocol. Outcomes will be evaluated at baseline, 6 and 12 months. The primary outcome will be quality of life (Fibromyalgia Impact Questionnaire) and the secondary outcomes will include measures of pain (including a visual analogue scale and the neuropathic characteristics of the pain), depression (Hospital Anxiety and Depression Scale), kinesiophobia (Tampa scale of kinesiophobia) and adherence (Polar OH1 heart rate monitor). Discussion The results of this study will show if patient-led, fibromyalgia-orientated exercise is more effective than a general exercise programme on fibromyalgia-related outcomes, including quality of life, and on adherence to continued exercise. Trial registration ClinicalTrials.gov NCT03895086 . Registration no. 2018-A02881-54. Registered on 29 March 2019
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SUMMARY As an introduction to a long‐term investigation of meat tenderness, seven series of comparisons were made between sensory and objective evaluations of the tenderness of roasted lamb rib‐loins. Using a tenderometer based on that of Volodkevich, high coefficients of correlation (0.68‐0.94) were found despite the occasional occurrence of large variations in tenderness within single muscles and the detection of slight panel fluctuation in three of the more prolonged series. Sensory assessment of tenderness was shown to be more nearly linearly related to either the reciprocal or the square root of shear force than to shear force itself.
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