All Fibromyalgia References from 1971 to 2003

1)                Arthritis & other rheumatic disorders. II. Non-articular rheumatism and fibrositis. Q Med Rev 1971; 22(1):1-20.

2)                Klinefelter HF. Primary fibrositis and its treatment with the pyrazolone derivatives, butazolidin and tandearil. Johns Hopkins Med J 1972; 130(5):300-307.

3)                McLeod J. Gout and fibrositis in cold weather. Med J Aust 1972; 1(18):943.

4)                Shinohara S, Arikawa K. Radioisotopic assessment on development of radiation pneumonitis and fibrositis. Australas Radiol 1972; 16(4):363-366.

5)                Fibrositis. JAMA 1973; 224(5 Suppl):746.

6)                Kaldestad E. [Primary fibrositis syndrome]. Tidsskr Nor Laegeforen 1973; %20;93(32):2367-2370.

7)                Petrov S. [Rheumatic fibrositis]. Reumatizam 1973; 20(5):198.

8)                Ivo J. [Hand fibrositis in workers of the stone-processing industry]. Med Arh 1974; 28(0):suppl-40.

9)                Schonberger M, Hellmich K. [Sacroiliac shift and "fibrositis"]. Z Allgemeinmed 1974; 50(25):1097-1098.

10)             Fassbender HG. [Morphological points of departure for the therapy of rheumatic diseases]. Acta Med Austriaca 1975; 2(4):110-113.
Abstract: Pathogenic mechanisms of several rheumatic diseases are reported. Besides signs of nonspecific inflammation there are characteristic features in some rheumatic disorders: in rheumatoid arthritis one can find mesenchymoid proliferation and - in seropositive cases only - necrosis ot tissue. In ankylosing spondylitis osseous metaplasia of the intervertebral discs, in psoriatic arthritis, osteoclastic and in osteoblastic changes without inflammation. In fibrositis syndrome, however, there was no evidence of inflammation, but one may detect local muscular lesions and proliferation of fibroblasts. Pain in osteoarthritis is always caused by secondary inflammation. Due to this data, the possibilities of treatment are discussed, especially those of nonsteroidal drugs

11)             Moldofsky H, Scarisbrick P, England R, Smythe H. Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects. Psychosom Med 1975; 37(4):341-351.
Abstract: In sleep studies of (a) patients with the "fibrositis syndrome" and (b) healthy subjects undergoing stage 4 sleep deprivation, we observed in both groups the anomalous presence of alpha-rhythms in the non-rapid-eye-movement (NREM) sleep EEG. This phenomenon has been termed alpha-delta sleep. In the healthy subjects stage 4 deprivation was accompanied by the temporary appearance of muscoloskeletal and mood symptoms comparable to the symptoms seen chronically in the patients. It is suggested that the external arousing stimulus, which induced alpha-delta sleep in the subjects, is paralleled in the patients by an internal arousing mechanism. Such a mechanism, acting in competition with the NREM sleep system, would impair the presumed restorative function of NREM sleep and lead to the development of symptoms. It is proposed that the "fibrositis" symptom complex be considered a "non-restorative sleep syndrome". Evidence froms presented in support of the hypothesis that a disorder of serotonin metabolism serves as a basis for both the EEG sleep disturbance and the symptoms

12)             Ramsay ML. 'Fibrositis'. Physiotherapy 1975; 61(12):377.

13)             Bianchi PA, Vigo PL, Polli EE. [Evaluation of the effects of some non-steroid anti-inflammatory agents on the gastric mucosa]. Minerva Med 1976; 67(33):2133-2137.
Abstract: 300 mg/day phenylbutazone, 210 mg/day indomethacin, and 600 mg/day pyrasanone were administered for 14 days to three randomised groups of patients respectively, consisting of a total of 76 subjects with various forms of non-infectious inflammation (osteoarthritis, fibrositis, rheumatoid arthritis, gout, phlebitis), in a double-blind trila designed to determine the activity of the three drugs and their tolerance. In 36 cases, gastroscopy was performed before and after the treatment. On the basis of doses that were equivalent as far as their anti-inflammatory effect was concerned, epigastric pain and pyrosis were noted in about 31% of the series, though no significant difference could be made out between the three drugs. Gastroscopic evidence of erythema (8 cases), multiple erosion (2 cases), pomphoid gastritis (1 case), and duodenal ulcer (1 case) was obtained in subjects treated with phenylbutazone or indomethacin, and of erythema only (1 case) after pyrasanone. No relation could be established between the clinical symptoms and the gastroscopic findings

14)             Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med 1976; 38(1):35-44.
Abstract: Two groups of young, healthy, nonathletic volunteers were subjected to selective sleep stage deprivation. Six subjects were deprived of stage 4 sleep and seven subjects of REM sleep. The stage 4 deprived group reported more musculoskeletal symptoms during the deprivation condition than did the REM deprived group. The stage 4 deprived group also showed a significant increase in muscle tenderness between the baseline and deprivation conditions and an altered pattern of overnight change in muscle tenderness in response to deprivation. The REM deprived group did not show either of these changes. These results are discussed in the light of the previously postulated relationship between NREM sleep disturbance and muscoloskeletal pain in patients with so-called "Fibrositis syndrome."

15)             Zuckner J, Baldassare A. Case report. The nonspecific rheumatoid subcutaneous nodule: its presence in fibrositis and scleroderma. Am J Med Sci 1976; 271(1):69-75.
Abstract: "Rheumatoid" subcutaneous nodules that were at one time considered diagnostic of rheumatoid arthritis or rheumatic fever have also been found in individuals withoug known disease, in patients with systemic lupus erythematosus, and in other conditions. In this report, subcutaneous nodules were described in one patient with fibrositis and in another scleroderma. Multiple pathogenic mechanisms are probably responsible for development of these nodules

16)             Crile G, Jr. Injection of steroids in painful breasts. Am J Surg 1977; 133(6):705.
Abstract: Fibrositis of the breast results in unilateral localized pain and tenderness in one breast. In most cases it can be specifically and permanently relieved by injection of steroids

17)             Goldman JA, Julian EH. Pseudo-Sjogren syndrome with hyperlipoproteinemia. JAMA 1977; 237(15):1582-1584.
Abstract: Eight patients with parotid enlargement were seen because of varying musculoskeletal complaints. All were overweight and hypertensive; six had diabetes mellitus, four had palpable hepatomegaly, and six were 49 years or older. One patient had arthritis type IIB hyperlipoproteinemia. Four patients had varying degrees of fibrositis, and two of these also had osteoarthritis. Of the others, one each had gout, Reiter syndrome, and restless legs syndrome. All had hyperlipoproteinemia type IV or IIB, and none abused alcohol. None of these patients have true Sjogren syndrome

18)             Kaplan H. The treatable trio: polymyositis, polymyalgia rheumatica, and fibrositis. Med Times 1977; 105(11):45-51.

19)             Koenig WC, Powers JJ, Johnson EW. Does allergy play a role in fibrositis? Arch Phys Med Rehabil 1977; 58(2):80-83.
Abstract: Twenty patients with active fibrositis and no underlying disease (and with normal electromyographic findings) were evaluated for the possible role of an active allergic process in their conditions. A definite atopic history was obtained in just fewer than 50% of the patients, and an allergic diathesis in slightly more than 50% of the patients' families. Serum immunoglobulin E levels and eosinophil counts for all 20 patients fell within the normal range. Thus the traditional allergic reaction (type I hypersensitivity) would seem unlikely as a mediator of fibrositis

20)             Perez R, V. [Distal fibrositis]. Rev Clin Esp 1977; 145(4):291-298.

21)             Ronn HH. A follow-up study of the use of benoral tablets in non-articular rheumatism. J Int Med Res 1977; 5(1):48-52.
Abstract: A multicentric follow-up study was conducted in general practice to assess disease characteristics which determine analgesic needs in non-articular rheumatism. Of 127 patients studied, those with chronic conditions such as brachial fibrositis and tennis elbow with a history extending over more than a month tended to require a longer course of treatment than those whose symptoms related to muscles of the trunk and spine. For most patients a one or two week course of Benoral tablets proved adequate in length and efficacy

22)             Smythe HA, Moldofsky H. Two contributions to understanding of the "fibrositis" syndrome. Bull Rheum Dis 1977; 28(1):928-931.

23)             Waylonis GW. Long-term follow-up on patients with fibrositis treated with acupuncture. Ohio State Med J 1977; 73(5):299-302.

24)             Barzo P, Toth E, Minik K. [Pulmonary cystic fibrositis with muscular hyperplasia (bronchiolar emphysema; muscular cirrhosis)]. Orv Hetil 1978; 119(10):576-578.

25)             de Bosset P, Gordon DA, Smythe HA, Urowitz MB, Koehler BE, Singal DP. Comparison of osteitis condensans ilii and ankylosing spondylitis in female patients: clinical, radiological and HLA typing characteristics. J Chronic Dis 1978; 31(3):171-181.
Abstract: A study comparing 12 patients with ankylosing spondylitis (AS) to 25 with osteitis condensans ilii (OCI), referred to a rheumatic disease center, was carried out to determine whether OCI represents a varient of AS in women. In the group with OCI, chronic lumbodorsal pain was present in 9, 36%, a 'fibrositis' syndrome in 6, 24%, and 16, 64% had recurrent episodes of polyarthralgia. A definite arthritis with effusion developed in 10 patients, 40%. No patient with OCI had iritis or colitis, whereas 4 patients with AS had iritis and four had colitis. Radiographs of the spine showed no evidence of spondylitis in the OCI group. Of the 25 patients with OCI, only 2, 8% were HLA B27 positive compared with 11 of 12 patients with AS, 92%. These results suggest that OCI is not a variant of AS in women

26)             Jajic I, Delimar N. [Dorsilon in the treatment of fibrositis]. Reumatizam 1978; 25(6):194-201.

27)             Moldofsky H, Warsh JJ. Plasma tryptophan and musculoskeletal pain in non-articular rheumatism ("fibrositis syndrome"). Pain 1978; 5(1):65-71.
Abstract: Plasma-free tryptophan is inversely related to the severity of subjective pain in 8 patients who fulfilled criteria for a variety of non-articular rheumatism, the "fibrositis syndrome". The observation is consistent with animal and human studies suggesting a relationship between reduced brain serotonin metabolism and pain reactivity

28)             Sicuteri F, Fanciullacci M, Michelacci S. Decentralization supersensitivity in headache and central panalgesia. Res Clin Stud Headache 1978; 6:19-33.:19-33.
Abstract: Central panalgesia is a syndrome which includes systemic pains of a central nature, usually classified as hysteria, fibrositis and masked depression. Exploration of the peripheral neuromuscular junctions (in the iris by pupillometry, and in veins by computerized venotest) indicates an increased monoamine receptor sensitivity. 5-HT vein sensitivity is particularly impressive (up to 1,000 times). In the vein there appears to be a decentralization supersensitivity, as it is extended to different monoamines (5-HT, dopamine, noradrenaline, tyramine). This type of supersensitivity is compatible with the theory of a deficiency of neurotransmitters at the level of the anti-nociceptive and integrated systems, with subsequent central and peripheral supersensitivity. A similar condition limited to the rostral section of the anti-nociceptive system is valid for the mechanism of idiopathic headache including migraine: central and peripheral supersensitivity to monoamines and opiates is also episodically observed in headache sufferers

29)             Beetham WP, Jr. Diagnosis and management of fibrositis syndrome and psychogenic rheumatism. Med Clin North Am 1979; 63(2):433-439.
Abstract: Diffuse aching and stiffness may be caused by a fibrositis syndrome or by psychogenic rheumatism. If fibrositis is present, a careful search for underlying disease is made, and appropriate therapy started depending upon the results of all diagnostic studies

30)             Genoud P, Gerster JC, Saudan Y. [Psychological aspect of the patient with fibrositis (poly-insertionitis) (study of 15 cases)]. Rev Med Suisse Romande 1979; 99(2):51-56.

31)             Hamilton PG. Chronic rhomboid strain: an illustration of an approach to fibrositis. Practitioner 1979; 222(1332):841-843.

32)             Sogtrop HH, Weise HT. [Results of treatment with DoloVisano for non-specific pain syndrome related to body movement. Concluding report on a field study of 3326 patients by 314 orthopedists]. Fortschr Med 1979; 97(16):791-796.
Abstract: The effectiveness of ColoVisano with view to the nonspecific pain syndrom of the locomotor system, particularly of the back, was proven on 3,326 ambulant patients. Three weeks after starting of treatment the majority of the patients was found free of pain. Considering the duration of the disease, the result of treatment with DoloVisano is remarkable: 66% = very good--good, 17% = moderate, only 12% = without success. Only in 15% of the cases side effects were found, which never led to an interrupture of the treatment. When listing the side effects, gastric pain with 6% and trousiness with 50% are ranging among the first places. The field study, performed by 314 orthopedic doctors in practice shows the high effectiveness of DoloVisano not only in patients with non-specific pain syndrom resulting from the spine but also with rheumatic syndrom, especially fibrositis and degenerative diseases

33)             Donald JF, Molla AL. A comparative double-blind study of tiaprofenic acid and aspirin in the treatment of muscular rheumatism, fibrositis, sprains and soft tissue injuries in general practice. J Int Med Res 1980; 8(6):382-387.
Abstract: Analgesic and anti-inflammatory properties of tiaprofenic acid 200 mg t.d.s. were compared with those of aspirin 600 mg t.d.s. in 100 patients in general practice suffering from muscular rheumatic pain, fibrositis, sprains and soft tissue injuries. Tiaprofenic acid was shown to be better than aspirin in relieving pain by clinical assessment although both drugs were equally effective according to patients daily assessment. It was not possible to demonstrate any anti-inflammatory action by reduction of swelling, but this was only present in 20% of patients initially. Side-effects, none serious, were similar in both groups

34)             Felder M. [The fibrositis syndrome (author's transl)]. Schweiz Rundsch Med Prax 1980; 69(5):144-147.

35)             Green AP, Mangan FR. The effect of steroidal and non-steroidal antiinflammatory drugs on chronic muscle inflammation. J Pharm Pharmacol 1980; 32(5):319-322.
Abstract: Zymosan (400 microgram) and thioglycollate medium (0.1 ml of 2.4% w/v) have each been shown to induce a chronic inflammation when injected into the hamstring muscle of the mouse. The inflammation is characterized by an increase in muscle weight and N-acetylglycosaminidase concentrations. The response is not inhibited by oral treatment with hydrocortisone, dexamethasone or naproxen, but is inhibited by the local injection of methylprednisolone. The relevance of this model to polymyositis and fibrositis is discussed

36)             Moldofsky H, Lue FA. The relationship of alpha and delta EEG frequencies to pain and mood in 'fibrositis' patients treated with chlorpromazine and L-tryptophan. Electroencephalogr Clin Neurophysiol 1980; 50(1-2):71-80.
Abstract: Aspects of sleep stage evaluation and analysis of alpha and delta EEG frequencies in sleep were shown to be related to musculo-skeletal pain and mood disturbance in patients with 'fibrositis syndrome'. Patients were treated at bedtime for 3 weeks with either chlorpromazine, 100 mg (8 patients), or L-tryptophan, 5 g (7 patients). Chlorpromazine, but not L-tryptophan, was associated with increased slow wave sleep and amelioration of pain and mood symptoms. Mean percent time/min or mean percent power/min of alpha frequency during NREM and REM sleep corrlated with overnight increase in pain measures, hostility, and decrease in energy. On the other hand, mean percent time/min of delta in NREM sleep was related to overnight decrease in pain and mean percent delta power/min was associated with decreased anxiety and hostility, and increased energy

37)             Bennett RM. Fibrositis: misnomer for a common rheumatic disorder. West J Med 1981; 134(5):405-413.

38)             Dreyfus P, Daupleix D, Amouroux J, Badois F. [Sea urchin spines synovitis. A case report with positive pasteurellosis antigen intradermoreaction (author's transl)]. Ann Med Interne (Paris) 1981; 132(6):404-407.
Abstract: A case is reported of a 53 years old woman who injured proximal interphalangeal joint of the right fourth finger on a sea urchin spine. She developed an extensive arthritis after synovial biopsy with sequellar fourth and fifth paw fashioned fingers and a palmar fibrositis. The originality of this observation with typical clinical symptoms and characteristic synovial histology (giant cells granulomatous synovitis) is the combination of a pasteurellosis infection. The diagnosis of the last one can be based on the inoculation in extra-aquatic condition, the extension of arthritis and particularly the positivity of pasteurellosis antigen intradermoreaction

39)             Gohil P, Young JR, Gohil JP, Graham JL. Tension fibrositis of the legs. J Am Podiatry Assoc 1981; 71(3):136-138.

40)             Jacks DA. Fibromyalgia. N Z Med J 1981; 94(692):237.

41)             Treadwell BL. Fibromyalgia or the fibrositis syndrome: a new look. N Z Med J 1981; 94(698):457-459.

42)             Weinberger LM. Fibrositis. West J Med 1981; 135(5):425-426.

43)             Wilke WS, Sheeler LR, Makarowski WS. Hypothyroidism with presenting symptoms of fibrositis. J Rheumatol 1981; 8(4):626-631.
Abstract: Eight patients who initially presented with signs and symptoms of the fibrositis syndrome, without overt hypothyroid disease, were found to have chemical evidence of hypothyroidism. Myalgic symptoms resolved in 6 of 8 patients treated with low dose thyroid replacement. In addition, another hypothesis of pathophysiology of the myalgic symptoms observed in patients with hypothyroidism related to sleep disturbance is offered

44)             Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981; 11(1):151-171.
Abstract: Detailed clinical study of 50 patients with primary fibromyalgia and 50 normal matched controls has shown a characteristic syndrome. Primary fibromyalgia patients are usually females, aged 25-40 yr, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety, poor sleep, headaches, irritable bowel syndrome, subjective swelling in the articular and periarticular areas and numbness. Physical examination is characterized by presence of multiple tender points at specific sites and absence of joint swelling. Symptoms are influenced by weather and activities, as well as by time of day(worse in the morning and the evening). In contrast, symptoms of psychogenic rheumatism patients have little fluctuation, if any, and are modulated by emotional rather than physical factors. In psychogenic rheumatism, there is diffuse tenderness rather than tender points at specific sites. Laboratory tests and roentgenologic findings in primary fibromyalgia are normal or negative. Primary fibromyalgia should be suspected by the presence of its own characteristic features, and not diagnosed just by the absence of other recognizable conditions. This study has also shown that primary fibromyalgia is a poorly recognized condition. Patients were usually seen by many physicians who failed to provide a definite diagnosis despite frequent unnecessary investigations. A guideline for diagnosis of primary fibromyalgia, based upon our observations, is suggested. Management is usually gratifying in these frustrated patients. The most important aspects are a definite diagnosis, explanation of the various possible mechanisms responsible for the symptoms, and reassurance regarding the benign nature of this condition. A combination of reassurance, nonsteroidal antiinflammatory drugs, good sleep, local tender point injections, and various modes of physical therapy is successful in most cases

45)             Anderson G. Fibromyalgia and the biomedical model. N Z Med J 1982; 95(705):243.

46)             Fisk JW. Fibromyalgia. N Z Med J 1982; 95(701):91-92.

47)             Gross D. [Physical therapy and rheumatism of soft tissues]. Schweiz Med Wochenschr 1982; 112(35):1214-1218.
Abstract: Soft tissue rheumatism (extraarticular rheumatism) is a group of common disorders found separately as independent disorders or as a symptom of systemic joint or spine diseases. The most frequent soft tissue rheumatisms are tendinopathies, rheumatism of muscles with myofascial pains, fibrositis of subcutaneous tissue and, finally, bursitis and inflammations of tendon sheaths. The commonest therapeutic procedures are non-steroidal anatirheumatic drugs, local infiltrations of corticosteroids, and physiotherapy. In the acute stages cold packs are the best physical measure against subjective pain. In subacute and chronic cases the pain in subcutaneous tissues can be lessened by connective tissue massage and underwater jet massage, muscle pain by heat and active exercises, and tendinopathies by ultrasonics and electrotherapy but very seldom by heat. In chronic bursitis and tendovaginitis, iontophoresis with potassium iodine may be helpful. Reflex pains in muscles are due to lesions of the spine and should therefore be treated by spine extension and manipulations. Every pain in soft tissue has one source in the anatomic lesion of the tissue and the second in psychogenic disorders. The latter must be sought when soft tissue pains are found all over the body on the lines of a generalized fibrositis syndrome

48)             Hamaty D. Methodology errors in fibrositis study. Arthritis Rheum 1982; 25(11):1389-1390.

49)             Hell D, Balmer R, Battegay R, Labhardt F, Muller W. [Generalized fibrositis syndrome and personality: a controlled study (author's transl)]. Schweiz Rundsch Med Prax 1982; 71(24):1014-1021.

50)             Henriksson KG, Bengtsson A, Larsson J, Lindstrom F, Thornell LE. Muscle biopsy findings of possible diagnostic importance in primary fibromyalgia (fibrositis, myofascial syndrome). Lancet 1982; 2(8312):1395.

51)             Payne TC, Leavitt F, Garron DC, Katz RS, Golden HE, Glickman PB et al. Fibrositis and psychologic disturbance. Arthritis Rheum 1982; 25(2):213-217.
Abstract: Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms

52)             Reynolds MD. The definition of fibrositis. Arthritis Rheum 1982; 25(12):1506-1507.

53)             Trommer PR. Hypothyroidism with presenting symptoms of fibrositis. J Rheumatol 1982; 9(2):335-336.

54)             Wolfe F. Selection bias in fibrositis study. Arthritis Rheum 1982; 25(11):1390.

55)             Yunus M, Masi AT, Calabro JJ, Shah IK. Primary fibromyalgia. Am Fam Physician 1982; 25(5):115-121.
Abstract: Primary fibromyalgia is a common but often unrecognized rheumatic condition. The typical patient is a young woman who complains of diffuse aches, pains and stiffness in joints and muscles. The symptoms are affected by weather and activities. Patients sleep poorly, feel tired and are often anxious. Physical examination reveals multiple tender points without evidence of arthritis or muscle weakness. Laboratory findings are normal. Management requires a program of patient education and reassurance, analgesics, physical therapy, restful sleep and occasional injection of tender areas with lidocaine. Psychoactive drugs are frequently useful

56)             Campbell SM, Clark S, Tindall EA, Forehand ME, Bennett RM. Clinical characteristics of fibrositis. I. A "blinded," controlled study of symptoms and tender points. Arthritis Rheum 1983; 26(7):817-824.
Abstract: Twenty-two patients with fibrositis, selected from a general medical outpatient population by a screening questionnaire and subsequent evaluation, were compared with age-, sex-, and clinic-matched patients without fibrositis. Although there was a high prevalence of musculoskeletal complaints in both groups, the fibrositis patients had a uniform constellation of symptoms, including axial pain, severe aching and stiffness, morning fatigue, and modulation by specific factors. They also had a higher incidence of tension headache and irritable bowel syndrome. The use of a dolorimeter demonstrated that fibrositis patients had many more areas of localized tenderness than control patients, but also that fibrositis patients did not have diffusely diminished pain threshold and tolerance. Using the criteria of this study, fibrositis appears to be a common and readily definable syndrome within the spectrum of soft tissue rheumatism

57)             Danneskiold-Samsoe B, Christiansen E, Lund B, Andersen RB. Regional muscle tension and pain ("fibrositis"). Effect of massage on myoglobin in plasma. Scand J Rehabil Med 1983; 15(1):17-20.
Abstract: In thirteen patients, all women, with regional muscle tension and pain ("fibrositis") plasma myoglobin concentration was measured before and after massage. A significant increase was observed in the plasma myoglobin concentration reaching a maximum three hours after the start of massage treatment (median 133 micrograms/l). A positive correlation was found between the degree of muscle tension and the increase in plasma myoglobin concentration. After repeated massage treatment a gradual decline could be demonstrated in the increase of the plasma myoglobin concentration in coincidence with the efficacy of the treatment. Opposed to this only normal levels of myoglobin were found in plasma when muscles without tenderness and pain were treated with massage. The observed increase of myoglobin in plasma after massage indicates a leak of myoglobin from the muscle fibres, which suggests that regional muscle tension and pain is associated with disorders in the muscle fibres

58)             Ferri S, Di Febo G, Biasco G, Ceroni G, Mariotti S, Muraccini F et al. [Our experience with the effectiveness and tolerance of ibuproxam in rheumatology]. Minerva Med 1983; 74(7):331-336.
Abstract: The tolerance and effectiveness of Ibuproxam were investigated in 54 patients with arthrosis, R.A., ankylosing spondylitis, and fibrositis. Statistically significant reduction of pain at the end of the treatment was accompanied by decreased limitation of joint movement and morning stiffness. Simultaneous investigation of clinical and biological tolerance showed that the drug is infrequently responsible for side-effects that are always of negligible importance. Oesophagogastroduodenoscopy in subjects with a prior history and/or signs of active pathology of the upper digestive tract did not reveal exacerbation or recrudescence of lesions, nor the appearance of acute lesions

59)             Fishel B, Caspi D, Yaron M. [Fibrositis]. Harefuah 1983; 105(3-4):78-80.

60)             Hohmeister R. [Soft-tissue rheumatism--diagnosis and therapeutic concept]. Fortschr Med 1983; 101(35):1545-1549.
Abstract: The term fibrositis or soft tissue rheumatism, provides a label to describe a symptom-complex which is common in practice, but the name is suggesting a defined entity that has not been demonstrated. The complaints known as soft tissue rheumatism can be defined as painful states which arise in the muscle and fibrous structures of the body. The patients complain of pain and stiffness in the neck-shoulder girdle and extremities which are worse with work or stress, better with rest or diversion. Physical examination is normal, as are those of x-rays, laboratory tests and biopsies. Numerous forms of therapy, physical and pharmacological, have been employed. Several theories of causative factors are discussed in this paper. Therapy and diagnosis are compared with many theories

61)             Menadue MC, Kothari MK. Primary fibromyalgia: a review and update. J Iowa Med Soc 1983; 73(8):314-315.

62)             Reynolds MD. The development of the concept of fibrositis. J Hist Med Allied Sci 1983; 38(1):5-35.

63)             Ware JC. Tricyclic antidepressants in the treatment of insomnia. J Clin Psychiatry 1983; 44(9 Pt 2):25-28.
Abstract: The use of tricyclic antidepressants as opposed to hypnotics in treating insomnia is reviewed. Available data indicate that TCAs alleviate sleep disturbances related to depression (often before antidepressant effects are seen) and, in selected cases, may prove effective in disturbed sleep related to sleep apnea, fibrositis, and sleep related bruxism, as well as in adults with childhood onset insomnia or a history of hyperkinesis. However, TCAs share many of the problems reported for hypnotics, as well as having some potentially serious side effects not present with benzodiazepines. The need for determination of the etiology of sleep disorders, and specific pharmacotherapy directed toward identified causes rather than the symptom of insomnia, is stressed

64)             Wolfe F, Cathey MA. Prevalence of primary and secondary fibrositis. J Rheumatol 1983; 10(6):965-968.
Abstract: Of 1,473 consecutive new patients seen in an outpatient rheumatology clinic, 3.7% met criteria for "primary fibrositis." Secondary fibrositis was diagnosed in 12.2% of patients with rheumatoid arthritis (RA), 15.7% of patients with primary neck and back pain syndromes and 6.7% of patients with osteoarthritis (OA). When conditions presumed to be associated with secondary fibrositis were excluded, primary fibrositis was identified in 55 of 405 patients or 13.6%. Two hundred fifteen or 14.6% of all patients had either primary or secondary fibrositis. Fibrositis may be the most common disorder seen in rheumatic disease practice after OA and RA

65)             Yunus MB. Fibromyalgia syndrome: a need for uniform classification. J Rheumatol 1983; 10(6):841-844.

66)             Ahles TA, Yunus MB, Riley SD, Bradley JM, Masi AT. Psychological factors associated with primary fibromyalgia syndrome. Arthritis Rheum 1984; 27(10):1101-1106.
Abstract: Forty-five ambulatory patients with primary fibromyalgia syndrome (PFS), 30 with rheumatoid arthritis, and 32 normal controls were administered 3 psychological tests: the Minnesota Multiphasic Personality Inventory (MMPI), the Life Events Inventory, and the Assertiveness-Aggressiveness Inventory. The PFS patients scored significantly higher on 8 MMPI scales when compared with the normal control group and on 4 MMPI scales when compared with the rheumatoid arthritis group. Further subgrouping of PFS patients according to MMPI scores showed that only 31% were "psychologically disturbed," 33% had a typical chronic pain profile, and 36% were within the normal range. The PFS patients scored higher than the rheumatoid arthritis and normal control groups on the Life Events Inventory but not the Assertiveness-Aggressiveness Inventory

67)             Baksi DP. Role of fibrositis of supra and periscapular area in aetiology of brachialgia. J Indian Med Assoc 1984; 82(5):170-173.

68)             Burda CD. Immunoglobulin-G deposits at the dermal-epidermal junction in secondary (traumatic) fibromyalgia syndrome. Clin Exp Rheumatol 1984; 2(2):195.

69)             Caro XJ. Immunofluorescent detection of IgG at the dermal-epidermal junction in patients with apparent primary fibrositis syndrome. Arthritis Rheum 1984; 27(10):1174-1179.

70)             Gerster JC, Hadj-Djilani A. Hearing and vestibular abnormalities in primary fibrositis syndrome. J Rheumatol 1984; 11(5):678-680.
Abstract: A prospective neurootological study of 30 cases of primary fibrositis syndrome (PFS) and 30 sex and age matched healthy volunteers was performed. Results showed that 70% of the PFS patients had decreased painful sound threshold, 40% hyperreactivity of perrotatory nystagmus without neurological or peripheral vestibular lesions, and 27% asymptomatic sensorineural hearing loss at low frequencies. Such abnormal data were not found in the matched controls. These findings suggest that otological problems may be part of the nonrheumatic features encountered in PFS

71)             Hadj-Djilani A, Gerster JC. Meniere's disease and fibrositis syndrome (psychogenic rheumatism). Relationship in audiometric and nystagmographic results. Acta Otolaryngol Suppl 1984; 406:67-71.:67-71.
Abstract: A prospective neuro-otological study concerning 30 cases of fibrositis syndrome (psychogenic rheumatism, PR) and 30 age-matched normal controls was made and a retrospective study concerning 33 cases of Meniere's disease (MD) diagnosed and followed-up, examined between 1965 and 1982. Results showed: sensorineural hearing loss at low frequencies in all early stages of MD and in 10/30 of PR; hyperacusis (pain threshold below 100 dBHL bilaterally for all frequencies) without other sign of recruitment in 73.3% of PR and in 3/4 cases of MD where it was measured (discomfort or vertigo due to noise was noted retrospectively in 16/33 of early stages of MD); hyperreactivity of per-rotatory nystagmus in 53.3% of PR without neurological or peripheral vestibular lesions and, with or without vestibular unilateral lesions, in 39.9% of MD. None of the controls showed hyperacusis, hyperreactivity of per-rotatory nystagmus or deafness at low frequencies

72)             Hudson JI, Pliner LF, Hudson MS, Goldenberg DL, Melby JC. The dexamethasone suppression test in fibrositis. Biol Psychiatry 1984; 19(10):1489-1493.

73)             Kalyan-Raman UP, Kalyan-Raman K, Yunus MB, Masi AT. Muscle pathology in primary fibromyalgia syndrome: a light microscopic, histochemical and ultrastructural study. J Rheumatol 1984; 11(6):808-813.
Abstract: Upper medial trapezius muscle biopsy was obtained from 12 primary fibromyalgia syndrome (PFS) patients (age 17 to 40 years) and studied with histochemistry, light and electron microscopy (EM). No evidence of inflammation was found in any case. Significant histochemical abnormalities were Type II fiber atrophy in 7 and moth-eaten appearance of Type I fibers in 5. EM revealed segmental muscle fiber necrosis with lipid and glycogen deposition as well as subsarcolemmal mitochondrial accumulation in all cases. Papillary projections of sarcolemmal membrane were seen in 11 patients. These observations in 12 PFS cases without obvious muscle trauma indicate definite but nonspecific muscle changes which we suspect are secondary to chronic muscle spasm and ischemia of unknown etiology

74)             Moldofsky H, Tullis C, Lue FA, Quance G, Davidson J. Sleep-related myoclonus in rheumatic pain modulation disorder (fibrositis syndrome) and in excessive daytime somnolence. Psychosom Med 1984; 46(2):145-151.
Abstract: We describe a new syndrome, Rheumatic Pain Modulation Disorder (RPMD) ("fibrositis syndrome") with sleep-related myoclonus (involuntary periodic leg movements). Measures of sleepiness, fatigue and pain, before and after sleep, and aspects of sleep of nine subjects (Ss) with RPMD and sleep-related myoclonus were compared to nine subjects with excessive daytime somnolence and sleep-related myoclonus. In eight of the RPMD with sleep-related myoclonus and three of those with daytime sleepiness, an alpha (7.5-11 Hz) EEG Non-Rapid Eye Movement sleep disorder was demonstrated. The RPMD with sleep-related myoclonus group contained a greater number of women, more pain, morning fatigue, and disturbances in sleep (more stage changes and alpha EEG sleep prior to leg myoclonus); but in comparison to the sleep-related myoclonus, daytime somnolent group, there were no differences in evening and morning sleepiness, number of limb movements, movement arousals, awakenings after sleep onset, sleep duration, and percent sleep stages

75)             Perini C, Muller W, Battegay R, Labhardt F. [Autogenic training in generalized fibrositis]. Schweiz Rundsch Med Prax 1984; 73(5):129-132.

76)             Richards AJ. Carpal tunnel syndrome and subsequent rheumatoid arthritis in the 'fibrositis' syndrome. Ann Rheum Dis 1984; 43(2):232-234.
Abstract: Eight of 11 patients who satisfy Smythe's criteria for the 'fibrositis' syndrome have subsequently developed carpal tunnel syndrome. Six of the 8 patients have gone on to develop an inflammatory polyarthritis, 3 of whom are seropositive and satisfy the criteria for classical rheumatoid arthritis. The relationship between the 'fibrositis' syndrome and rheumatoid arthritis is not clear, but the additional complication of carpal tunnel syndrome in 'fibrositis' points to certain patients with 'fibrositis' developing an inflammatory polyarthritis of rheumatoid type. Acceptance on a definition of 'fibrositis' would enable further prospective studies to take place, but at present the term is used to describe many other nonarticular conditions that do not satisfy Smythe's criteria

77)             Wallace DJ. Fibromyalgia: unusual historical aspects and new pathogenic insights. Mt Sinai J Med 1984; 51(2):124-131.

78)             Wolfe F, Cathey MA, Kleinheksel SM, Amos SP, Hoffman RG, Young DY et al. Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis. J Rheumatol 1984; 11(4):500-506.
Abstract: Psychological status was investigated in 46 primary fibrositis (PF) patients, 32 with fibrositis occurring in association with rheumatoid arthritis (RAFIB) and in 76 control patients with rheumatoid arthritis. Groups were similar in tests of life stresses: Family Inventory of Life Events, Multidimensional Health Locus of Control, and self-motivation. Only 28% of PF and 25% of RAFIB had Minnesota Multiphasic Personality Inventory profiles classified as "normal" compared with 51-60% of controls. Both PF and RAFIB had elevated "neurotic" scales (hypochondriasis, depression, hysteria), but only PF patients had statistically significant elevations in the pychopathic deviancy, psychasthenia and paranoia scales. When the Arthritis Impact Measurement Scales were used, PF but not RAFIB patients demonstrated statistically significant elevations on the anxiety and depression scales

79)             Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol 1984; 11(6):814-818.
Abstract: We studied demographic socioeconomic and clinical characteristics of 38 patients with fibrositis (fibromyalgia) that occurred in association with rheumatoid arthritis (RAFIB) and 242 patients with rheumatoid arthritis (RA) alone. Fewer RAFIB patients were married (57.1%), and most (97.4%) were women. No statistically significant differences in income, medical expenditures or other demographic variables were identified. All measures of function, pain, disease activity and psychological status were more abnormal in RAFIB patients. The clinical characteristics that best differentiated RAFIB and RA patients were pain, depression, anxiety and erythrocyte sedimentation rate, in logistic and stepwise regression models. Evaluation of disease severity markers, including radiographic erosions and frequency of total joint replacement, suggested that disease severity in RAFIB and RA is similar

80)             Yunus MB. Primary fibromyalgia syndrome: current concepts. Compr Ther 1984; 10(8):21-28.
Abstract: PFS is a characteristic and clinically recognizable rheumatologic syndrome. It is a very common condition, but only recently has investigational interest grown in this interesting syndrome. PFS should be diagnosed by its own characteristic features and not merely by excluding other conditions. Pathophysiology of PFS is not well understood at this time and needs further study. Sleep EEG studies in PFS have revealed disturbed non-REM sleep, and normal volunteers deprived of non-REM sleep develop many features of non-REM sleep develop many features of PFS, including musculoskeletal aching, tenderness, and fatigue. Psychologic studies have shown that only a subset of PFS patients have shown that only a subset of PFS patients are significantly disturbed as determined by MMPI scores, and PFS patients as a group are more stressed than RA patients and normal controls as measured by Holmes-Rahe Life Events Inventory. It appears that chronic anxiety-stress causes muscle spasm that can be appreciated clinically in some patients and indirectly, possibly by electron microscopic findings of muscle biopsy. Likely role of other factors, e.g., constitutional, trauma, posture, and weather are also discussed. Biochemical transmitters of pain remain to be studied in PFS. Lack of a specific physical or laboratory finding should not deter acceptance of PFS as an entity, since such specific findings are absent in other similar and well-accepted conditions, e.g., irritable bowel syndrome, with which PFS shares many other common features, including muscle tenderness and spasm. PFS is different from psychogenic pain, and any implication by a physician that it is "all in the head" is certain to perpetuate chronic pain and disability.(ABSTRACT TRUNCATED AT 250 WORDS)

81)             Alonso-Ruiz A, Hoz-Martinez A, Zea-Mendoza AC. Fibromyalgia syndrome as a late complication of toxic-oil syndrome. J Rheumatol 1985; 12(6):1207-1208.

82)             Clark S, Tindall E, Bennett RM. A double blind crossover trial of prednisone versus placebo in the treatment of fibrositis. J Rheumatol 1985; 12(5):980-983.
Abstract: Twenty patients with a diagnosis of fibrositis were entered into a double blinded crossover study to compare the effects of prednisone versus placebo. Each patient was randomly assigned to either prednisone 15 mg/day or placebo for 14 days of therapy and then therapy was switched for a further 14 days. The following measurements were assessed at baseline, end of Week 2 and end of Week 4: analogue scores for pain, sleep disturbance, morning stiffness and fatiguability, and dolorimetry readings of pain tolerance over 14 representative tender points. Overall there was no improvement while taking prednisone, indeed most measured variables showed a trend towards deterioration with this therapy

83)             Clark S, Campbell SM, Forehand ME, Tindall EA, Bennett RM. Clinical characteristics of fibrositis. II. A "blinded," controlled study using standard psychological tests. Arthritis Rheum 1985; 28(2):132-137.
Abstract: Twenty-two patients with fibrositis and 22 control patients selected from a general medical outpatient population were given 3 standardized psychological questionnaires: the Beck Depression Inventory, the Spielberger State and Trait Anxiety Inventory, and the SCL-90-R. There were no statistically significant differences between fibrositis patients and control patients on any of these tests, a finding at variance with a commonly held belief that patients with fibrositis have an underlying psychological disorder. While psychological factors may be important in some patients with fibrositis, these results indicate that the presence of a psychopathologic condition is not mandatory for the persistence of fibrositis

84)             Coulehan JL. Primary fibromyalgia. Am Fam Physician 1985; 32(3):170-177.

85)             Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ 1985; 133(5):379-389.
Abstract: The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, "fibrositis" syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment

86)             Gusso MI, Guzzo GC, Pennisi M. [Proglumetacin: possible first choice in the treatment of orthopedic- traumatologic disorders]. Minerva Med 1985; 76(12):567-573.
Abstract: Ninety-seven patients (44 males and 53 females of mean age 42.6 +/- 12,9 years) with orthopedic-traumatologic disorders (osteoarthritis, 38; painful joints, 26; fibrositis, painful shoulder, 20; peri- and extra-articular disorders, 13) had been treated during 7 to 30 days with two suppositories (400 mg) or three capsules (450 mg) proglumetacin (Proxil Rorer). Most patients responded well to very well to the treatment with significant improvement of pain and inflammatory symptoms as well as restoring of limited function. Such a response resulted proportional to the dose (53% of good responders among those given the lower dose and 82% among those at the higher dose) and to the kind of pathology. The patients with acute disorders (7) responded all very well in 7 days; those with subacute disorders (57) responded well to very well in a proportion of 57% within 15 days; those with chronic disorders responded to a proportion of 48% within 30 days. Tolerance resulted very good anyway: in no case had the treatment to be withdrawn, nor allergic or C.S.N. reactions were observed, so that the overall tolerance was defined excellent to good in 90% of patients. Thirty-three patients complained of accessory symptoms, mainly epigastric pain and nausea, almost always mild and anyway transient. Proglumetacin can therefore be properly defined as a firstchoice treatment for the management, also ambulatory, of orthopedic-traumatologic disorders

87)             Hawley D, Cathey MA. Fighting fibrositis. Am J Nurs 1985; 85(4):404-406.

88)             Hoffberg HJ, Cardenas DD, Lennard ES. Desmoid tumor complicating remobilization treatment for a chronic pain syndrome. Arch Phys Med Rehabil 1985; 66(5):332-334.
Abstract: The criteria for recommending an operant conditioning program for a patient with chronic pain include definable pain behavior. A thorough investigation of all organic factors that may contribute to pain is usually made prior to such treatment. This report describes a patient with chronic pain and mild cognitive deficits related to a truck accident who insidiously developed an extra-abdominal desmoid tumor. Desmoid tumors, which may develop after trauma, are associated with incidental connective tissue anomalies. They can be initially mistaken for fibrocytic nodules because they have a distribution similar to that in fibromyalgia. This patient's painful tumor was diagnosed while he was participating in a remobilization program. Subsequent resection and irradiation adversely affected rehabilitation goals and reinforced the patient's conviction that all his complaints were organically based

89)             Hudson JI, Hudson MS, Pliner LF, Goldenberg DL, Pope HG, Jr. Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiatry 1985; 142(4):441-446.
Abstract: Fibromyalgia is a form of nonarticular rheumatism characterized by diffuse musculoskeletal pain. To investigate the relationship between fibromyalgia and major affective disorder, the authors evaluated 31 patients with fibromyalgia and 14 patients with rheumatoid arthritis for rates of current or past major affective disorder and family history of major affective disorder. Both the rate of major affective disorder and the familial prevalence of major affective disorder were significantly higher in the fibromyalgia patients than the rheumatoid arthritis patients. The results suggest that fibromyalgia may be related to major affective disorder

90)             Layfer L. Fibromyalgia (fibrositis). IMJ Ill Med J 1985; 167(2):131-132.

91)             Manchul LA, Jin A, Pritchard KI, Tenenbaum J, Boyd NF, Lee P et al. The frequency of malignant neoplasms in patients with polymyositis-dermatomyositis. A controlled study. Arch Intern Med 1985; 145(10):1835-1839.
Abstract: Seventy-one patients with polymyositis-dermatomyositis (PM/DM) admitted to the Wellesley Hospital Rheumatic Disease Unit (RDU) in Toronto between 1965 and 1980 were followed up to 1981. The frequencies of malignant neoplasms occurring prior to or concurrent with initial RDU admission were compared, using case-control methods, with age- and sex-matched control groups with a diagnosis of any non-PM/DM rheumatic disease (rheumatic disease controls) or osteoarthritis, fibrositis, or fracture (noninflammatory musculoskeletal controls). In a cohort analysis, the incidence of malignant neoplasm subsequent to initial RDU admission in patients with PM/DM was compared with the expected incidence in the Canadian population. Fifteen of 71 patients with PM/DM had an antecedent or concurrent cancer compared with four of 71 rheumatic disease controls and one of 71 noninflammatory musculoskeletal controls. Cohort analysis showed no increase in the number of subsequent malignant neoplasms in patients with PM/DM compared with the age- and sex-matched Canadian population

92)             Miller MH, Littlejohn GO, Jones BW, Strnad H. Clinical comparison of cultured human epithelial cells and rat liver as substrates for the fluorescent antinuclear antibody test. J Rheumatol 1985; 12(2):265-269.
Abstract: Fluorescent antinuclear antibody (ANA) testing was performed on 141 sera from 114 patients with well defined rheumatic diseases including fibrositis syndrome and 24 sera from 24 healthy subjects using HEp-2 cells and rat liver as substrates. ANA titers were almost always higher on HEp-2, in most cases by 1:5 dilutions. ANA positivity or negativity was usually substrate independent, but there were exceptions. Two patients with SLE were ANA positive on HEp-2 only and rat liver only, respectively; patterns were homogeneous. Thirteen of 15 CREST patients had anticentromere antibodies, detected on HEp-2 only. "False-positive" ANA were invariably low titer, speckled and confined to one substrate

93)             Reynolds MD. Psychogenic rheumatism and fibrositis. Arthritis Rheum 1985; 28(12):1435-1436.

94)             Wallace DJ. Systemic lupus erythematosus, rheumatology and medical literature: current trends. J Rheumatol 1985; 12(5):913-915.
Abstract: An attempt is made to see if any correlation exists between the prevalence of 13 selected rheumatic diseases and the number of literature entries concerning these disorders in 1974 and 1983. Entries on systemic lupus are broken down in detail. It is concluded that interest in autoimmune diseases, especially their immunology, appears healthy. Lower morbidity disorders with a large prevalence (osteoarthritis, fibrositis, gout) may be disproportionately under-investigated. Whether any correlation between funding levels and literature entries can be made is speculative

95)             Wallace DJ. Immunofluorescence and fibromyalgia. Arthritis Rheum 1985; 28(7):836-837.

96)             Wilke WS, Mackenzie AH. Proposed pathogenesis of fibrositis. Cleve Clin Q 1985; 52(2):147-154.

97)             Wolfe F, Hawley DJ, Cathey MA, Caro X, Russell IJ. Fibrositis: symptom frequency and criteria for diagnosis. An evaluation of 291 rheumatic disease patients and 58 normal individuals. J Rheumatol 1985; 12(6):1159-1163.
Abstract: We administered a 17-item symptom questionnaire modified from Campbell to 155 patients with fibrositis diagnosed at 3 centers, each using different criteria sets. A high degree of agreement in symptom proportions was found among centers. "Fibrositic" symptoms were also common in 136 patients with a variety of rheumatic diseases but not in the 58 normal individuals studied. Symptoms distinguished fibrositis patients from normals easily, but had insufficient specificity to distinguish them from other rheumatic disease patients. The tender point count better separated fibrositic and nonfibrositic patients than historical criteria. No combination of questions and tender point count performed better than the tender point count alone

98)             Wysenbeek AJ, Mor F, Lurie Y, Weinberger A. Imipramine for the treatment of fibrositis: a therapeutic trial. Ann Rheum Dis 1985; 44(11):752-753.
Abstract: Twenty fibrositic patients were treated with imipramine 50-75 mg/day. Only two patients responded favourably. Nineteen patients stopped therapy during the initial three-month period: 14 of them due to lack of response, while two of these concomitantly disclosed side effects. The additional five patients stopped therapy mainly due to side effects, while only one of them improved with therapy. One patient, only, improved and adhered to therapy for more than three months

99)             Yonker RA, Panush RS. Idiopathic eosinophilic myositis with preexisting fibromyalgia. J Rheumatol 1985; 12(1):165-167.
Abstract: Idiopathic eosinophilic myositis is a rare entity. Only 6 other cases have been reported in the literature. We report a patient with degenerative joint disease and fibromyalgia who subsequently developed eosinophilic myositis over a tender trigger area

100)         Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum 1985; 28(2):138-145.
Abstract: Primary fibromyalgia syndrome (PFS) is a common and characteristic rheumatologic condition manifested by diffuse musculoskeletal aches, pains, and stiffness frequently modulated by various factors, e.g., weather, physical activity, sleep quality, and anxiety/stress, and accompanied by discrete tender points at typical soft tissue sites. Although well-recognized in adults, this entity has not been reported separately in juveniles. This study documents PFS in 33 juveniles who presented at age 17 or younger and compares their findings with those in age- and sex-matched normal control subjects. As in adult PFS patients, associated non-musculoskeletal symptoms were common, including fatigue, poor sleep, anxiety/stress, headaches, and paresthesias. Physical examination revealed multiple tender points at characteristic soft tissue sites and no objective evidence of arthritis. Routine laboratory test results were normal or negative. Juvenile PFS is often misdiagnosed. Recognition of this common rheumatologic condition in juveniles is important in order to avoid unwarranted investigations and improper management

101)         The fibrositis/fibromyalgia syndrome. Current issues and perspectives. December 13-14, 1985, San Francisco, California. Am J Med 1986; 81(3A):1-115.

102)         Ahles TA, Yunus MB, Gaulier B, Riley SD, Masi AT. The use of contemporary MMPI norms in the study of chronic pain patients. Pain 1986; 24(2):159-163.
Abstract: In a previous study, Ahles et al. [1] compared the MMPI results of primary fibromyalgia, rheumatoid arthritis and non-pain control participants. The purpose of the present study was to reanalyze the original data using the contemporary norms of Colligan et al. [5]. The reanalysis revealed that the pattern of group differences remained the same; however, the number of primary fibromyalgia patients classified as 'psychologically disturbed' was appreciably reduced. These data have clinical relevance in that the incidence of psychopathology in chronic pain patients may be overestimated because of the use of outdated norms. Additionally the data have theoretical relevance in that a large number of patients who present with pain in the absence of a known organic pathology do not present evidence of psychopathology

103)         Bartels EM, Danneskiold-Samsoe B. Histological abnormalities in muscle from patients with certain types of fibrositis. Lancet 1986; 1(8484):755-757.
Abstract: In muscle biopsy specimens from fibrositis patients and healthy subjects no differences in electrical charges on the contractile proteins were detected with a microelectrode technique. However, microscopical examination of fibrositis muscle showed muscle fibres connected by a network of reticular or elastic fibres which are absent in normal muscle and which may be the cause of the disorder

104)         Bengtsson A, Henriksson KG, Jorfeldt L, Kagedal B, Lennmarken C, Lindstrom F. Primary fibromyalgia. A clinical and laboratory study of 55 patients. Scand J Rheumatol 1986; 15(3):340-347.
Abstract: The clinical symptoms of 55 patients with primary fibromyalgia (PF) were studied and compared with 30 patients with rheumatoid arthritis (RA). The PF patients expressed a more intense feeling of illness than did the RA patients. Stiffness occurred just as often in PF as in RA. Trigger points occurred less frequently in RA patients. Muscular fatigue appeared to be one of the most disabling symptoms in PF. Neurophysiological studies indicated that the fatigue was at least partly of central origin. Ischemic forearm exercise test gave no evidence of impaired glycogenolysis. Laboratory investigation revealed normal 25-hydroxyvitamin D, cobalamin, folate, estrogen, testosterone, and myoglobin in the PF patients

105)         Bengtsson A, Henriksson KG, Larsson J. Muscle biopsy in primary fibromyalgia. Light-microscopical and histochemical findings. Scand J Rheumatol 1986; 15(1):1-6.
Abstract: Seventy-seven muscle biopsies from 57 patients with primary fibromyalgia and 17 biopsies from 9 healthy controls were examined by routine histopathological and histochemical methods. All patients fulfilled strict diagnostic criteria. 42 biopsies from patients were deemed normal or borderline, while 35 showed discrete pathological changes (degeneration, regeneration, inflammatory infiltrates, ragged red fibres, and 'moth-eaten' fibres in muscles other than m. trapezius). Biopsies from controls were normal or borderline in 14 and showed mild focal abnormalites in 3 cases. 'Moth-eaten' fibres were found in 35 of 41 trapezius biopsies taken from patients and in 9 of 10 trapezius biopsies from controls. Ragged red fibres were found in 15 of 41 trapezius biopsies taken from patients. In the deltoid muscle, 'moth-eaten' fibres were found in 3 and ragged red fibres in 2 of 9 biopsies from patients. Frequency of type I and type II fibres and the area of muscle fibres were the same in patients as in controls. Capillary density was the same in both groups. These changes, although not sufficient to constitute a diagnostic test for PF, indicate that this condition has an organic basis

106)         Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum 1986; 29(7):817-821.
Abstract: Muscle energy metabolism was studied by chemical analysis of biopsy samples from: 1) trigger points in the trapezius muscle from 15 patients with primary fibromyalgia (PF), 2) nonpainful, anterior tibial muscle from 6 patients with PF, and 3) the trapezius muscle from 8 healthy controls. We found a decrease in the levels of adenosine triphosphate, adenosine diphosphate, and phosphoryl creatine, and an increase in the levels of adenosine monophosphate and creatine, in the trapezius muscles from the patients. These findings support the notion that the pain in patients with PF is of muscular origin

107)         Bennett RM. Current issues concerning management of the fibrositis/fibromyalgia syndrome. Am J Med 1986; 81(3A):15-18.
Abstract: The fibrositis/fibromyalgia syndrome is one of the commonest forms of musculoskeletal pain seen in clinical practice. It is diagnosed on the basis of widespread pain accompanied by the physical finding of multiple tender points in remarkably reproducible locations. Accompanying the pain are two symptoms commonly associated with the "systemic" rheumatic disorders, namely morning stiffness and easy fatigability. Unlike the classical rheumatic diseases, however, fibrositis is not responsive to anti-inflammatory medications, including corticosteroids. Current therapeutic strategies, which are only partly successful, are aimed at modifying those factors that seemingly influence the severity and course of the condition; such afferent features include sleep disturbance, overuse syndromes, mechanical stress, psychic stress, and other causes of chronic pain. Major unresolved issues center around the assessment of functional disability in fibrositis and the apparent relationship to trauma in some patients. Until more is known about the underlying pathogenesis of this common condition, significant progress will be thwarted

108)         Bennett RM. Fibrositis: evolution of an enigma. J Rheumatol 1986; 13(4):676-678.

109)         Burda CD, Cox FR, Osborne P. Histocompatability antigens in the fibrositis (fibromyalgia) syndrome. Clin Exp Rheumatol 1986; 4(4):355-358.
Abstract: HLA antigen Class I (A, B, C) and II (DR) were determined in a small group of fibrositis (fibromyalgia) patients and normal controls. Sixty-seven percent of fibrositis patients had DR4 versus 30% of normal controls. There was also an increased relative risk (4.5). No statitical significance of other Class I and II antigens in fibrositis was found

110)         Calabro JJ. Fibromyalgia (fibrositis) in children. Am J Med 1986; 81(3A):57-59.
Abstract: The features of fibromyalgia (fibrositis) in children are similar to those in adults with the syndrome. Both juveniles and adults report diffuse musculoskeletal aches and/or stiffness with typical modulating factors. Moreover, they have no systemic manifestations, and routine laboratory studies yield normal results. On physical examination in both children and adults, multiple soft-tissue tender points are evident at characteristic, symmetric sites but with no evidence of arthritis

111)         Calabro JJ, Perry RF. Juvenile primary fibromyalgia syndrome. Arthritis Rheum 1986; 29(3):452-453.

112)         Campbell SM, Bennett RM. Fibrositis. Dis Mon 1986; 32(11):653-722.

113)         Campbell SM. Is the tender point concept valid? Am J Med 1986; 81(3A):33-37.
Abstract: The finding of multiple tender points is essential to the diagnosis of the fibrositis/fibromyalgia syndrome. Recent studies have shown that the tender point count seems to correlate with the presence of fibrositis symptoms, and can distinguish fibrositic from normal subjects. Although tender points are present in normal subjects, fibrositis patients have far more tender points that are much more tender. Further work is necessary to establish the reliability of tender point measurement, and to investigate and monitor changes in the tender point count with time or therapy

114)         Carette S, McCain GA, Bell DA, Fam AG. Evaluation of amitriptyline in primary fibrositis. A double-blind, placebo-controlled study. Arthritis Rheum 1986; 29(5):655-659.
Abstract: Seventy patients with primary fibrositis satisfying Smythe's criteria were studied in a 9-week double-blind trial comparing 50 mg amitriptyline with placebo. Fifty-nine patients completed the trial: 27 were treated with amitriptyline, and 32 took a placebo. The patients who received amitriptyline improved significantly in their morning stiffness and pain analog scores at 5 and 9 weeks, compared with baseline scores, whereas no changes were noted in these parameters in the placebo group. Fibrocytic point tenderness did not improve significantly in either of the treatment groups. When compared with the placebo group, the amitriptyline group improved significantly with respect to sleep pattern and patient and physician global assessments. Our data indicate that amitriptyline has some therapeutic benefit in patients with primary fibrositis

115)         Caro XJ. Immunofluorescent studies of skin in primary fibrositis syndrome. Am J Med 1986; 81(3A):43-49.
Abstract: Primary fibrositis syndrome is a painful musculoskeletal disorder of unknown cause. Although numerous hypotheses have been proposed to explain its clinical features, few studies have demonstrated a reproducible tissue abnormality in this condition. Recently, five reports of cutaneous immunoreactant deposition in primary fibrositis syndrome have become available and form the basis of this review. Four of these reports have described immunoglobulin G deposition at the dermal-epidermal junction of sun-exposed skin with a prevalence ranging from 12 to 76 percent. One study reported immunoglobulin M deposition in the dermal vasculature of patients with primary fibrositis syndrome. The reasons for the lack of uniformity in reported prevalence rates and types of skin immunofluorescence in primary fibrositis syndrome are unknown but are assumed to be due to differences in patient populations and immunofluorescence techniques between reporting centers. These factors are discussed in detail and speculations as to the significance of these skin findings are expressed, particularly with respect to the concept of enhanced vascular permeability in these patients

116)         Caro XJ, Wolfe F, Johnston WH, Smith AL. A controlled and blinded study of immunoreactant deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome. J Rheumatol 1986; 13(6):1086-1092.
Abstract: The prevalence of immunoreactant deposition at the dermal-epidermal junction (DEJ) in clinically normal, sun exposed skin was assessed by direct immunofluorescence (IF) in 36 patients with primary fibrositis syndrome (PFS) and 12 clinically healthy control subjects. A granular or homogeneous deposition of IgG was seen at the DEJ in 52.8% (19/36) of patients with PFS and in 16.7% (2/12) of controls. The difference in IgG deposition between patients with PFS and controls was statistically significant (p = 0.030). Patients with PFS and controls did not demonstrate significant IF staining for IgA, IgM, or C3. Albumin deposition at the DEJ appeared to parallel IgG deposition in patients with PFS and control subjects who were positive for this immunoglobulin. No relationship was noted between IgG deposition and demographic or clinical characteristics of these patients' disease. These data suggest that IgG and albumin deposition at the DEJ is frequent in PFS and that further study of this skin phenomenon is warranted

117)         Cathey MA, Wolfe F, Kleinheksel SM, Hawley DJ. Socioeconomic impact of fibrositis. A study of 81 patients with primary fibrositis. Am J Med 1986; 81(3A):78-84.
Abstract: Demographics and health service utilization were studied for 81 patients with fibrositis during 1985. Patients reported high levels of pain, mild disability, and moderate impairment of global health. Work disability was limited and only 6.3 percent described themselves as disabled. Employed patients were able to work full work weeks. Utilization of outpatient medical services was increased compared with that of control subjects and national averages during the study year, but was consistent with other rheumatic disorders such as osteoarthritis and low back pain. Medication usage was limited and seemed appropriate. Very high hospitalization rates were noted prior to diagnosis of fibrositis, both for musculoskeletal and non-musculoskeletal hospitalizations, but these rates dropped during the post-diagnosis study year

118)         Dinerman H, Goldenberg DL, Felson DT. A prospective evaluation of 118 patients with the fibromyalgia syndrome: prevalence of Raynaud's phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction. J Rheumatol 1986; 13(2):368-373.
Abstract: One hundred eighteen consecutive patients with fibromyalgia were evaluated prospectively. Immunoglobulin deposits at the dermal-epidermal junction were found in only 4 of 36 patients. Twelve patients (14%) had at least one positive antinuclear antibody (ANA) test. Eight patients (7%) had at least one low C3. Thirty-five patients (30%) has a history of Raynaud's phenomenon and 22 (18%) had sicca symptoms, defined as symptomatic dry eyes and mouth and a positive Schirmer test. The 35 patients with Raynaud's phenomenon had a significantly higher prevalence of sicca symptoms, positive ANA or low C3 compared to the 83 patients who did not have Raynaud's phenomenon. Thus, a subset of patients with fibromyalgia may have features suggestive of a systemic connective tissue disorder

119)         Felson DT, Goldenberg DL. The natural history of fibromyalgia. Arthritis Rheum 1986; 29(12):1522-1526.
Abstract: The natural history of fibromyalgia was studied in 39 treated patients. All patients were surveyed by interviews conducted in 1983 (at an average of 1.3 years after diagnosis), in 1984, and again in 1985. Throughout the survey period, more than 60% of patients had moderate to severe continuing symptoms, and almost all took medications regularly to control symptoms. Younger patients (P = 0.02), those with less severe symptoms at the initial survey (P = 0.005), and those with isolated Raynaud's phenomenon (P = 0.04) were more likely to be doing well 2 years later, although symptom remission was usually transitory

120)         Fischer AA. Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil 1986; 67(11):836-838.
Abstract: The pressure threshold meter (PTM) and its use for evaluation of tender spots and trigger points are described. Pressure threshold is the minimum pressure inducing pain or discomfort. The PTM consists of a force gauge (11 kg range) to which a rubber disc with lcm2 surface is attached. This surface has been proven adequate for quantification of deep tenderness in soft tissues. Normal threshold values were established in 50 volunteers, 24 men and 26 women, at nine different sites frequently affected by trigger points, including the trapezius, supraspinatus, infraspinatus, teres major, lumbar paraspinals (2 sites), gluteus and pectoralis muscles. The deltoid, where muscle sensitivity is usually normal, was used as a reference. PTM is used clinically for quantification of tenderness for medicolegal purposes, but primarily to prove the presence of trigger points to patients and health professionals. Reaction to various forms of treatment such as physiotherapy and drugs can be assessed quantitatively. When trigger point injections are properly administered to affected areas, pressure threshold measurements usually increase by 4 kg/cm2. Failure to increase the reading indicates that the injection was incomplete and the procedure should be repeated. The PTM can be used for monitoring tenderness, inflammation, arthritis activity, and fibrositis

121)         Gatter RA. Pharmacotherapeutics in fibrositis. Am J Med 1986; 81(3A):63-66.
Abstract: Fibrositis (fibromyalgia) is best treated by attaining patient acceptance of and compliance with a comprehensive treatment program. This includes education, physical therapy, muscle and mental relaxation, examination and adjustment of goals and priorities, and pacing of activities, as well as pharmacotherapeutics. Of the medications in use, anti-inflammatory agents with a high degree of analgesia are more effective than "pure" anti-inflammatory agents. Tricyclic derivatives are beneficial muscle relaxants. The use of long-acting agents improves compliance and is therefore favored. Local agents are of adjunctive value in some cases. Double-blind, placebo-controlled studies show cyclobenzaprine to be an effective medication in the treatment of fibrositis (fibromyalgia)

122)         Goldenberg DL. Psychologic studies in fibrositis. Am J Med 1986; 81(3A):67-70.
Abstract: During the past five years, there have been a number of controlled reports regarding the possible association of fibrositis with psychologic disorders. The results of these studies are quite different, which is not surprising in view of the differences in patient populations and study instruments used. We gave the Diagnostic Interview Schedule to 82 patients with fibrositis and to control subjects, and we found an association of depression with fibrositis. Depression was also more common in first-degree relatives of patients with fibrositis. However, in most instances, the depression antedated fibrositis by more than one year, indicating a possible psychobiologic association, rather than a casual one

123)         Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986; 29(11):1371-1377.
Abstract: Sixty-two patients with fibromyalgia were randomly assigned to receive 25 mg of amitriptyline at night, 500 mg of naproxen twice daily, both amitriptyline and naproxen, or placebo in a 6-week, double-blind trial. Amitriptyline was associated with significant improvement in all outcome parameters, including patient and physician global assessments, patient pain, sleep difficulties, fatigue on awakening, and tender point score. Patients taking the combined naproxen-amitriptyline regimen experienced minor, but not significant, improvement in pain when compared with patients who took amitriptyline alone. Amitriptyline, or amitriptyline and naproxen, is an effective therapeutic regimen for patients with fibromyalgia

124)         Gupta MA, Moldofsky H. Dysthymic disorder and rheumatic pain modulation disorder (fibrositis syndrome): a comparison of symptoms and sleep physiology. Can J Psychiatry 1986; 31(7):608-616.
Abstract: It has been suggested that "fibrositis" or rheumatic pain modulation disorder (RPMD) is a variant of depressive illness. Both disorders are associated with abnormalities in sleep physiology. Since the clinical features of RPMD do not meet all the criteria for a major depressive disorder, the symptoms and sleep physiology in subjects with dysthmic disorder (DSM III criteria) (N = 6), and RMPD (N = 6) were compared, in order to determine the similarity between the two groups. The sleep physiology in dysthymic disorder was first examined over three consecutive nights since a systematic evaluation of the sleep physiology in this group of disorders has not yet been reported. All dysthymic patients showed episodic bursts of high-amplitude (75-150 microvolts) theta (3-5 Hz) bursts in stage 2 sleep, and REM onset latency was abbreviated only on night 2. The theta bursts have not been previously reported, and may be an early marker of disorganization of non-REM sleep in the dysthymic subjects. The comparison of the two groups revealed that RPMD subjects reported more pre- and post-sleep pain (p less than 0.01), lighter sleep (p less than 0.01), and more physical ailments during sleep (p less than 0.01), and had more alpha (7-11.5 Hz) in non-REM sleep (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

125)         Hadler NM. A critical reappraisal of the fibrositis concept. Am J Med 1986; 81(3A):26-30.
Abstract: Physicians could use such terms as "fibrositis" and "the myofascial pain syndrome" simply to describe an easily recognized quality of illness. But the terms are chosen as part of a privileged vocabulary designed to assert a pathophysiologic insight(s). On careful consideration, these insights are tenuous at best. Furthermore, the terms, with their pathophysiologic insights, become labels that may perturb the patient's experience of disease in a fashion that is counterproductive

126)         Hale AA, Stern SL, Wongsam PE. Fibromyalgia in a woman with bipolar disorder, manic phase. Am J Psychiatry 1986; 143(8):1064.

127)         Hench PK, Mitler MM. Fibromyalgia. 2. Management guidelines and research findings. Postgrad Med 1986; 80(7):57-64, 69.
Abstract: Treatment of fibromyalgia includes various forms of therapy--physical, behavioral, psychological, and pharmacologic. No drug therapy has proved uniformly successful, but some drugs provide temporary relief from pain. After an initial therapy program has been established, patients can assume the major responsibility for management. Research studies aimed at defining the cause of fibromyalgia have linked it to sleep disorders, neurogenic mediators, immune mechanisms, muscle disease, and psychological disturbances

128)         Hench PK, Mitler MM. Fibromyalgia. 1. Review of a common rheumatologic syndrome. Postgrad Med 1986; 80(7):47-56.
Abstract: Fibromyalgia is a nonarticular rheumatic syndrome of unknown cause characterized by diffuse musculoskeletal aching, pain and stiffness, easy fatigability, multiple discreet tender points, emotional distress, and often, light and restless sleep with intensification of symptoms upon awakening. Symptoms are modulated by environmental, physiologic, and psychological factors. Generally, findings from laboratory tests and roentgenograms are normal. In primary fibromyalgia, no underlying rheumatic or other systemic organic disease is present. Secondary fibromyalgia is a manifestation of underlying disease

129)         Hench PK. Secondary fibrositis. Am J Med 1986; 81(3A):60-62.
Abstract: Fibrositis is considered primary when there is no associated underlying disorder, and secondary when it occurs in patients with underlying rheumatic or other organic disease. Since fibrositis has become better defined, the list of underlying disorders has grown, and its identification requires careful diagnostic study. The differentiation of primary and secondary fibrositis has therapeutic implications. Secondary fibrositis should respond to treatment of the underlying disorder, whereas the primary syndrome may require additional management directed to the musculoskeletal pain and sleep and emotional disturbances commonly recognized as major manifestations of this syndrome

130)         Landau M, Sigal M, Alfisi S, Weiner P. [Primary fibromyalgia syndrome--a psychosocial analysis]. Harefuah 1986; 110(5):227-230.

131)         Leavitt F, Katz RS, Golden HE, Glickman PB, Layfer LF. Comparison of pain properties in fibromyalgia patients and rheumatoid arthritis patients. Arthritis Rheum 1986; 29(6):775-781.
Abstract: Pain properties of 50 fibromyalgia patients were examined and compared with pain properties of 50 rheumatoid arthritis patients. In both fibromyalgia and rheumatoid arthritis, pain was bilateral, involved multiple sites, and was of equal intensity (60.8 versus 58.7, respectively, on a scale of 100). Fibromyalgia pain, however, was less localized to the joints and suggested greater spatial diffusion. It involved more kinds of pain experiences (radiating, steady, spreading, spasms, gnawing, unlocalized, pricking, crushing, shooting, pressing, splitting, cramping, nagging, and pins and needles), and was dispersed over larger areas of the body. The anatomic sites best for discrimination between patients with fibromyalgia and patients with rheumatoid arthritis were the lower back, thigh, abdomen, head, and hips for fibromyalgia, and wrist, foot, and fingers for rheumatoid arthritis. The traditional clinical description of aching and stiffness does not appear to accurately describe the complexity of the fibromyalgia pain syndrome

132)         Leichner-Hennig R, Vetter GW. [Relation between pain experience and psychological markers in patients with fibrositis syndrome and patients with rheumatoid arthritis]. Z Rheumatol 1986; 45(4):139-145.
Abstract: We attempted to ascertain to what degree pain experience in two groups of rheumatic patients is influenced by personality traits and psychosocial characteristics. 20 patients with fibrositis syndrome and 20 patients with rheumatoid arthritis completed the Freiburger Personality Inventory, the Giessen Test and the Revised Multidimensional Pain Scale. There was no difference in mean scores of the three questionnaires between the groups but patients with fibrositis syndrome tend to characterize themselves as being psycho-somatically disturbed. The number of significant correlations between pain scales and the personality scales is distinctly smaller in the fibrositis group than in the arthritis group. This result is interpreted as an indication for alexithymia in the fibrositis group

133)         Lund N, Bengtsson A, Thorborg P. Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 1986; 15(2):165-173.
Abstract: Trigger points in painful muscle are a characteristic sign in patients with primary fibromyalgia. The MDO oxygen electrode was used to evaluate oxygenation in the subcutaneous tissue and in trigger points in the trapezius and brachioradial muscles. Ten patients and 8 normal controls were studied. The results in the patients were abnormal, with scattered or slalom-slope histograms, indicating low tissue oxygenation. The controls were normal, except in one case. The conclusion is that in patients with primary fibromyalgia, the muscle oxygenation is abnormal or low, at least in the trigger point area of the muscles

134)         Masi AT, Yunus MB. Concepts of illness in populations as applied to fibromyalgia syndromes. Am J Med 1986; 81(3A):19-25.
Abstract: Fibromyalgia syndromes are common noninflammatory, painful musculoskeletal disorders that vary in the extent and intensity of involvement. The biologic gradient of musculoskeletal pain varies from no or few symptoms and tender points in the majority of persons to generalized fibromyalgia with multiple tender points. Standardized criteria are needed in order to categorize different strata of the biologic gradient of fibromyalgia syndromes and differentiate them from other conditions. Both the sensitivity and specificity of criteria should be high. The course and prognosis of fibromyalgia syndromes are not yet known. Limited clinical data suggest three basic patterns: remitting-intermittent; fluctuating-continuing; and progressive. However, course patterns need to be derived scientifically. Multiple host and environmental factors seem to contribute to the onset and course of fibromyalgia syndromes, and these require definition. Generalized fibromyalgia syndromes share many constitutional manifestations with other common functional disorders, e.g., irritable bowel syndrome and tension headache syndrome, which suggest common underlying psychoneurophysiologic mechanisms in a subset of patients. Progress made in fibromyalgia research will find application in many dysfunctional syndromes without obvious organ pathology

135)         McCain GA. Role of physical fitness training in the fibrositis/fibromyalgia syndrome. Am J Med 1986; 81(3A):73-77.
Abstract: Cardiovascular fitness training has been suggested as a treatment for the fibrositis/fibromyalgia syndrome. Thirty-four patients with fibrositis/fibromyalgia who met Smythe's original criteria were randomly assigned to enter either a cardiovascular fitness training program or a program consisting only of flexibility exercises. Patients met in supervised groups three times weekly for a 20-week observation period. The cardiovascular fitness group underwent gradual heart rate-elevated training using a bicycle ergometer and achieved a 29.1 +/- 24.4 percent increase in peak work capacity at 170 beats per minute (PWC-170). Patients undergoing flexibility training had a net reduction in their PWC-170 scores of 4.3 +/- 9.4 percent. Patients in the cardiovascular fitness group had statistically significant improvements in the visual analogue pain scale of current pain intensity; total myalgic scores in which pain thresholds at five fibrositic tender points selected for acceptable intra-rater and inter-rater reliability were measured using a dolorimeter; percentage total body area affected as measured by self-administered pain diagrams; and patients' and physicians' global assessment scores. Psychologic profiles as measured by Symptom Checklist-90R also improved in the cardiovascular fitness group compared with the flexibility training group. It is concluded that cardiovascular fitness training is feasible in patients with fibrositis/fibromyalgia and that such training improves subjective measurements of pain-reporting behavior. A theoretic basis for improvements in pain measurement scales and psychologic profiles is discussed in light of recent literature

136)         Moldofsky H, Tullis C, Lue FA. Sleep related myoclonus in rheumatic pain modulation disorder (fibrositis syndrome). J Rheumatol 1986; 13(3):614-617.
Abstract: Thirty-three patients with rheumatic pain modulation disorder (RPMD) were divided into 2 groups: RPMD with sleep related myoclonus (RPMD-SM) (n = 12) and RPMD only (n = 21). Both groups showed chronic nonarticular musculoskeletal pain, fatigue, tender points, and nonrestorative sleep with alpha (7.5-11 Hz) EEG sleep anomaly. RPMD-SM patients were older, had later onset of illness, showed disrupted sleep with periodic involuntary leg movements that were related to fatigue, and alpha EEG sleep related to fatigue and pain

137)         Moldofsky H. Sleep and musculoskeletal pain. Am J Med 1986; 81(3A):85-89.
Abstract: Chronic musculoskeletal pain and fatigue of "fibrositis syndrome" are associated with a physiologic arousal disorder within sleep, the alpha (7.5 to 11 Hz) electroencephalographic, non-rapid-eye-movement sleep anomaly. In this nonrestorative sleep disorder, pain and mood symptoms may be mediated by psychologic distress (e.g., following a nonphysically injurious industrial or automobile accident), noxious environmental stimuli (e.g., noise), physiologic disturbance (e.g., sleep-related myoclonus, painful inflamed joints, i.e., rheumatoid arthritis), and altered central nervous system metabolism (e.g., disordered brain serotoninergic functions). Because such heterogeneous agents influence this hitherto poorly understood nonarticular rheumatic syndrome, the descriptive term "rheumatic pain modulation disorder" is suggested

138)         Molony RR, MacPeek DM, Schiffman PL, Frank M, Neubauer JA, Schwartzberg M et al. Sleep, sleep apnea and the fibromyalgia syndrome. J Rheumatol 1986; 13(4):797-800.
Abstract: A patient who presented with primary fibromyalgia syndrome (PFS) was found to have sleep apnea. Since frequent wakening and nonrestorative sleep are prominent clinical complaints in both disorders, we hypothesized an etiologic relationship. A subsequent clinical survey of 11 additional sleep apneics revealed that 3 (27%) fulfilled proposed criteria for PFS. This was significantly greater than local and literature reported studies of nonrheumatologic patients and was comparable to reported prevalence of fibromyalgia in rheumatologic referral populations. A blinded sleep physiology study of 7 patients with PFS revealed a significantly increased percentage of transitional sleep and increased frequency of miniarousals/h, but no significant evidence of occult sleep apnea compared to matched normal controls. The frequent arousals of sleep apnea may be associated with fibromyalgia in some patients but do not explain the sleep disorder of PFS

139)         Rice JR. "Fibrositis" syndrome. Med Clin North Am 1986; 70(2):455-468.
Abstract: There appears to be as yet undefined but significant and possibly multifactorial elements of personality, stress, or depression in the manifestations and possibly the pathogenesis of FS. If these factors, perhaps amplified by the neurophysiologic effects of disturbed sleep, produce a neurochemical disturbance in CNS function, and if this perturbation includes a reduction or impairment of function involving the pain-modulation pathways, then a simple and perhaps compelling explanation for the experience of pain in FS becomes apparent. Reduced midbrain/brainstem inhibition of ascending nociceptive impulses would clearly explain the finding of tender points in normal-appearing areas of the body, as well as the lack of segmental distribution of discomfort in FS. Local anesthetics, injected peripherally into tender points, would be expected, as is the case, to block pain and tenderness in the local area for the duration of action of the agent used. Analgesics with peripheral activity, such as aspirin and NSAIDs, are relatively ineffective in treating FS, and would be predictably so in a disorder involving reduced central pain inhibition as opposed to increased peripheral nociceptive input. It would not be surprising to find that centrally acting agents, particularly those producing enhancement of serotonergic neurons such as amitriptyline, would provide substantial or total pain relief as well as improvement in mood in a significant number of patients. Most importantly, this concept would highlight the real pain experienced by these patients and the obligation of involved physicians to appropriately diagnose and treat this common pain syndrome. Avoiding excessive conjecture, it is then permissible at the present time to conclude that: FS is a characteristic, clinically common pain syndrome in which aspects of the pain itself appear to be of physiologic origin. Although stress or inherent personality traits may play a role in FS, the relative uniformity in symptomatology virtually excludes conversion hysteria as a major factor in this disorder. The lack of evidence for a disturbance in muscle, fascia, and other soft tissues in FS, the lack of adequate response to NSAIDs, and the frequent response to TCAs suggest that specific dysfunction of the CNS may play a major role in the symptomatology of this entity. Impaired function of the pain-modulation system, located anatomically in the midbrain and brainstem, provides a plausible explanation for the pain and finding of tender points in FS, as well as a potentially rational basis for therapy

140)         Russell IJ, Vipraio GA, Morgan WW, Bowden CL. Is there a metabolic basis for the fibrositis syndrome? Am J Med 1986; 81(3A):50-54.
Abstract: Patients with the fibrositis syndrome experience moderately severe musculoskeletal discomfort, mood changes associated with nonrestorative sleep, and tenderness to palpation at specific body sites. There is no characteristic abnormal laboratory finding in these patients to help identify the population. A report by Moldofsky and Warsh (Pain 1978; 5: 65-71) of low serum levels of free tryptophan in patients with severe fibrositis syndrome is intriguing but remains unexplained. Those data plus the observation by Hudson et al (Am J Psychiatry 1985; 142: 441-446; Biol Psychiatry 1984; 19: 1489-1493) that patients with fibrositis syndrome exhibit an increased prevalence of anxiety and depression suggest a number of possible avenues for further study. They include potential alterations in the homeostasis of catecholamines, corticosteroids, serotonin, aromatic amino acids, platelet membrane receptor levels, and the activity of platelet membrane monoamine oxidase. Among these possibilities, evidence is now available that suggests an increased production of catecholamines in fibrositis syndrome

141)         Saskin P, Moldofsky H, Lue FA. Sleep and posttraumatic rheumatic pain modulation disorder (fibrositis syndrome). Psychosom Med 1986; 48(5):319-323.
Abstract: The clinical features and sleep physiology of 11 female patients with "fibrositis syndrome" or rheumatic pain modulation disorder (RPMD) were compared with 11 female postaccident pain (PAP) patients who complained of widespread musculoskeletal pain, fatigue, and nonrestorative sleep following a nonphysically injurious motor vehicle or work-related accident. Both groups had similar musculoskeletal pain, fatigue, sleepiness and an alpha (7.5-11 Hz) EEG non-rapid eye movement (NREM) sleep anomaly. A psychophysiologic arousal mechanism during NREM sleep induced by the emotional stress of the accident may mediate the subsequent nonrestorative sleep, musculoskeletal pain, and fatigue symptoms in the posttraumatic pain disorder

142)         Sheon RP. Regional myofascial pain and the fibrositis syndrome (fibromyalgia). Compr Ther 1986; 12(9):42-52.

143)         Simons DG. Fibrositis/fibromyalgia: a form of myofascial trigger points? Am J Med 1986; 81(3A):93-98.
Abstract: The diagnostic criteria for fibrositis and primary fibromyalgia are similar to those for myofascial pain syndromes due to trigger points. Tender points in muscles are likely to be myofascial trigger points; nonmuscular tender points clearly are not myofascial trigger points, but may be areas of tenderness referred from such trigger points. Myofascial trigger points refer pain to a distance and restrict range of motion of the muscle. They are associated with a palpable taut band that exhibits a local twitch response of the muscle, and they are responsive to treatment. Persistence of myofascial trigger points is due to perpetuating factors that can usually be corrected. Although their number is unknown, it is likely that some patients who are diagnosed as having fibrositis/fibromyalgia have multiple myofascial trigger points aggravated by a powerful perpetuating factor and also have a systemic disease process independent of the myofascial trigger points. Since myofascial pain syndromes are treatable, these patients would benefit greatly by identification and relief of the myofascial component of their pain

144)         Smythe H. Referred pain and tender points. Am J Med 1986; 81(3A):90-92.
Abstract: A diffuse distribution of characteristic sites of tenderness is recognized to be a distinctive feature of the fibromyalgia/fibrositis syndrome, and is often associated with general symptoms such as exhaustion, stiffness, and irritability to external and internal stimuli. Equally important, and more common, is the development of similar tenderness at precisely the same sites in referred pain syndrome. The distribution of points is clumped, i.e., restricted to the appropriate region, and the general symptoms are lacking. The usual sites of origin are often unknown to the patient, because they lie deep in the cervical or lower lumbar spine. The clumped pattern of points is therefore very helpful in diagnosis and therapy

145)         Smythe H. Tender points: evolution of concepts of the fibrositis/fibromyalgia syndrome. Am J Med 1986; 81(3A):2-6.
Abstract: The association of chronic pain, exhaustion, and multiple somatic complaints with apparent physical good health and long survival has a long history. The syndrome was called by many names including neuresthenia, rheumatism, and invalidism. When skeletal pain and stiffness were prominent, many observers recorded the existence of sites of tenderness and sometimes of areas of induration. The work of Lewis and Kellgren provided an experimentally reproducible method of study of the phenomena of referred pain and referred tenderness, which led to hypotheses about the nature of many of these syndromes, which were unfortunately too numerous and often contradictory. More recently, it has been learned that the sites of tenderness are precisely predictable in location and, under some circumstances, experimentally inducible. They are unknown to the patient and, therefore, due to mechanisms other than distortions of interpretation. The association with a variety of forms of sleep disturbance was discovered. These events have permitted the rapid evolution of controlled, numerical studies of these associations, which are reviewed briefly in this article

146)         Tariot PN, Yocum D, Kalin NH. Psychiatric disorders in fibromyalgia. Am J Psychiatry 1986; 143(6):812-813.

147)         Waxman J, Zatzkis SM. Fibromyalgia and menopause. Examination of the relationship. Postgrad Med 1986; 80(4):165-1.
Abstract: Women predominate at all ages among patients diagnosed as having primary fibromyalgia. Of 100 patients reviewed, the average age at onset of fibromyalgia was 46. Of 65 patients in whom menopause occurred before diagnosis of fibromyalgia, the average age at menopause was 42, and most of these women had menopause related to surgery and insufficient estrogen therapy. Estrogen deficit is, thus, a prominent promoting factor in the majority of fibromyalgia patients and is likely to have an effect on sleep, mood, and anxiety state. These emotional responses may subsequently be somatized as pain. Therefore, estrogen therapy should be added to the treatment armamentarium for fibromyalgia in selected patients

148)         Wolfe F. Development of criteria for the diagnosis of fibrositis. Am J Med 1986; 81(3A):99-104.
Abstract: The essential symptoms of fibrositis--widespread aching and pain, disturbed sleep, morning stiffness, and fatigue--are common in both rheumatic and nonrheumatic patients. But the essential sign of fibrositis--widespread local tenderness over specific anatomic sites ("tender points")--is rare in any patients except those with fibrositis. Clinical criteria for the diagnosis of fibrositis rely heavily on a high tender point count in the presence of characteristic fibrositic symptoms. Multiple tender points are uncommon in normal subjects and in those with rheumatic and nonrheumatic disorders. The tender point count thus also serves to distinguish fibrositis from other musculoskeletal diseases

149)         Wolfe F. The clinical syndrome of fibrositis. Am J Med 1986; 81(3A):7-14.
Abstract: Fibrositis is a disorder of musculoskeletal pain and aching with at least a five to one female-to-male ratio. It is most commonly seen between the ages of 40 and 60, and has a prevalence in the clinic of 6 to 15 percent. Its most common mode of presentation involves generalized musculoskeletal pain and aching, but articular pain, axial skeletal pain, myalgias, and neurovascular complaints sometimes predominate. All patients have multiple areas of local tenderness called "tender points" that are easily identified during physical examination, and are diagnostic. Essential symptoms of fibrositis are disturbed sleep, morning stiffness, and fatigue. Additional rheumatic symptoms include subjective swelling, paresthesias, and numbness. Headaches and irritable bowel syndrome are common nonrheumatic complaints. Modest improvement follows treatment by tricyclic agents such as low-dose cyclobenzaprine and amitriptyline, by physical measures, and by reduction in stress. Remission occurs in 20 percent of patients, but is generally short-lived

150)         Yunus MB, Denko CW, Masi AT. Serum beta-endorphin in primary fibromyalgia syndrome: a controlled study. J Rheumatol 1986; 13(1):183-186.
Abstract: Serum beta-endorphin was assayed without knowledge of study subject category in 44 consecutive patients with primary fibromyalgia syndrome, 3 patients with rheumatoid arthritis (RA), and 30 normal controls, all females. Mean serum beta-endorphin levels were 81 +/- 28 pg/ml in patients with fibromyalgia, whereas those in normal controls and patients with RA were 73 +/- 17 pg/mg and 73 +/- 18 pg/ml, respectively. These differences were not statistically significant. Serum beta-endorphin levels did not correlate with relevant clinical variables in either fibromyalgia or RA groups

151)         Yunus MB, Kalyan-Raman UP, Kalyan-Raman K, Masi AT. Pathologic changes in muscle in primary fibromyalgia syndrome. Am J Med 1986; 81(3A):38-42.
Abstract: Primary fibromyalgia syndrome, also inappropriately called "fibrositis," is a clinically recognizable nonarticular rheumatic condition with diffuse and chronic musculoskeletal aching and stiffness, accompanied by exaggerated tenderness at characteristic sites on physical examination. Results of muscle biopsy from 12 well-defined cases of primary fibromyalgia syndrome without any history of trauma have been published recently. Light microscopic examination revealed no evidence of inflammation. Histochemical analysis demonstrated type II fiber atrophy in seven patients and the "moth-eaten" appearance of type I fibers in five patients. Electron microscopic findings were most impressive, and included myofibrillar lysis with deposition of glycogen and abnormal mitochondria, as well as subsarcolemmal accumulation of glycogen and mitochondria in all 12 patients and papillary projections of sarcolemmal membrane in 11 patients. Mechanisms of these significant muscle changes in primary fibromyalgia syndrome are uncertain but may include subclinical injury of muscle spasm

152)         Painful questions about fibromyalgia. JAMA 1987; 258(11):1476-1477.

153)         Ahles TA, Yunus MB, Masi AT. Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome. Pain 1987; 29(1):105-111.
Abstract: The responses of 45 primary fibromyalgia syndrome (PFS) patients, 29 rheumatoid arthritis (RA) patients and 31 healthy non-pain controls (NC) on the Zung Self-Rating Depression scale were compared. No difference between the PFS and RA groups was found, although the former has no known organic pathology, unlike the latter. Therefore, the hypothesis that the presentation of chronic pain in the absence of a known organic pathology is a variant of 'depressive disease' was not supported in the case of PFS. However, a subgroup of PFS (28.6%) and RA (31.0%) patients appeared to be experiencing significant depressive symptomatology

154)         Bennett RM. Fibromyalgia. JAMA 1987; 257(20):2802-2803.

155)         Buchwald D, Goldenberg DL, Sullivan JL, Komaroff AL. The "chronic, active Epstein-Barr virus infection" syndrome and primary fibromyalgia. Arthritis Rheum 1987; 30(10):1132-1136.
Abstract: Fifty patients with primary fibromyalgia who had been followed in an academic rheumatology practice frequently reported symptoms thought to be typical of "chronic Epstein-Barr virus infection," but not of fibromyalgia: recurrent sore throat (54%), recurrent rash (47%), chronic cough (40%), recurrent adenopathy (33%), and recurrent low-grade fevers (28%). In 55% of the patients, illness had begun suddenly, with what seemed to be a viral syndrome. Antibody titers to Epstein-Barr virus in the patients with fibromyalgia, however, were not significantly different from those in age- and sex-matched "healthy" and "unhealthy" control subjects

156)         Carrabba M, Mele G, Chevallard M, Angelini M. [Diacereine: an original approach in the treatment of degenerative and/or extra-articular rheumatism]. Minerva Med 1987; 78(3):179-185.
Abstract: 71 patients with variously located osteoarthrosis or primary fibromyalgic syndrome were treated with oral diacereine (DAR). The case series was accumulated in successive periods and may be divided into three groups. An "open" test on DAR (100 mg/die for 4 weeks) was conducted on the first group of 31 arthrosis patients. On the second group of 20 other arthrosis patients a "double-blind, cross-over" test was carried out using DAR (100 mg/die) and naproxene (500 mg/die) both for 2 weeks. The third group of 20 patients with fibromyalgia was treated with DAR alone: 100 mg/die 5 days a week for 12 weeks. The efficacy of the treatment was judged on the basis of the following parameters: rest pain, pressure pain, pain on active and passive movement, and functional limitation. In the first group a positive therapeutic effect was noted in 20 cases (68.9%). There were side effects (moderate diarrhea) in 3 patients 2 of whom suspended treatment. In the second group, DAR and naproxene had an almost identical effect. However 7 patients (36.8%) expressed a preference for DAR, 9 (47.4%) expressed no preference and only 3 (15.8%) preferred naproxene. Side effects were encountered in 3 patients treated with naproxene (2 cases of epigastralgia and pyrosis and 1 case of dyspnea so marked as to require suspension of treatment) and in 3 treated with DAR (modest diarrhea). In the third group, a positive therapeutic effect was noted in 68.4% of the patients with fibromyalgia with a 15% incidence of side effects consisting of slight abdominal pain (diarrhea caused suspension of treatment in 1 case only). Blood chemical parameters were studied in all three groups and no alterations attributable to the treatment were found. The obtained result suggests that the new drug is effective and well tolerated in the envisaged indications

157)         Caruso I, Sarzi Puttini PC, Boccassini L, Santandrea S, Locati M, Volpato R et al. Double-blind study of dothiepin versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1987; 15(3):154-159.
Abstract: A double-blind study comparing the efficacy and tolerability of dothiepin with that of placebo in the treatment of primary fibromyalgia syndrome was carried out. Dothiepin was shown to improve significantly the condition of patients with primary fibromyalgia syndrome and there was a significant difference between dothiepin and placebo in all the clinical variables measured. Only mild and transient side-effects were reported. Further controlled studies are required to define the effects of dothiepin on fibromyalgia

158)         Ferraccioli G, Ghirelli L, Scita F, Nolli M, Mozzani M, Fontana S et al. EMG-biofeedback training in fibromyalgia syndrome. J Rheumatol 1987; 14(4):820-825.
Abstract: Fifteen patients with fibromyalgia syndrome were given EMG-BFB (biofeedback) training sessions because of persistent aches after one year of monthly courses of NSAID. A long-lasting clinical benefit was observed in 56%. The improvement was found in those without overt psychopathological disturbances. In fact, a subgroup of clinically depressed patients responded poorly. Our findings were confirmed in a controlled study. Six patients were allocated into "true EMG-BFB" and 6 into "false EMG-BFB" treatment in a blinded fashion. The rheumatological assessment revealed a significant improvement in most of the variables only in the "true EMG-BFB" group

159)         Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain 1987; 30(1):115-126.
Abstract: Pressure threshold is the minimal pressure (force) which induces pain. The pressure threshold meter (PTM) is a force gauge with a rubber disc of 1 cm2 surface. The instrument has been proven to be useful in clinical practice for quantification of deep muscle tenderness. Trigger points, fibrositis, myalgic spots, activity of arthritis as well as assessment of sensitivity to pain can be diagnosed by PTM. This study therefore established standards for pressure threshold as well as the reproducibility and validity of measurement in 24 male and 26 female normal volunteers at 9 sites. Muscles frequently afflicted by trigger points were examined. The deltoid was chosen as a reference since it is rarely a site for trigger points. Comparison of corresponding muscles on opposite sides failed to demonstrate significant differences (except for 1 muscle in females). These identical results obtained over muscles of opposite sides proved the excellent reproducibility and validity of pressure threshold measurement. Results serve as a reference for clinical diagnosis of abnormal tenderness and for documentation of treatment results. The sensitivity of individual muscles varies. Therefore the results presented should be kept in mind when diagnosis of pathological tenderness by palpation is attempted

160)         Goldenberg DL. Fibromyalgia syndrome. An emerging but controversial condition. JAMA 1987; 257(20):2782-2787.
Abstract: The clinical manifestations, laboratory findings, and treatment results of 118 patients with fibromyalgia followed up by one investigator were compared with those of other recent reports. The history of this syndrome and recent efforts to establish diagnostic criteria and to understand underlying pathophysiologic mechanisms were studied. A practical, noninvasive office-based evaluation and conservative treatment approach were developed, determined by an understanding of the natural history of this common but controversial disorder

161)         Hannonen P, Mottonen T, Oka M. Palindromic rheumatism. A clinical survey of sixty patients. Scand J Rheumatol 1987; 16(6):413-420.
Abstract: Sixty patients with palindromic rheumatism (PR) with a total follow-up time of 598 years and 295 years prospectively are presented. The study shows that PR is not a rare condition, but the syndrome is often ignored or misdiagnosed by the physician. Most cases of PR appear to evolve into chronic arthritis. PR may precede other kinds of systemic diseases, such as SLE, Wegener's granulomatosis, and multiple myeloma. The presence of PR in patients with fibromyalgia is reported in this paper. Gold appears to be the best drug for the treatment of PR. Cases of fibromyalgia and PR are treated successfully with antimalarial drugs. Our proposed diagnostic criteria for PR are as follows: 1) recurrent attacks of sudden-onset mono or polyarthritis or of periarticular tissue inflammation, lasting from a few hours to one week; 2) verification of at least one attack by a physician; 3) subsequent attacks in at least three different joints; 4) exclusion of other forms of arthritides

162)         Hartz A, Kirchdoerfer E. Undetected fibrositis in primary care practice. J Fam Pract 1987; 25(4):365-369.
Abstract: The prevalence of symptoms related to fibrositis was investigated for patients seen in a primary care setting. Of 692 adult patients evaluated, 33 (4.6 percent) had symptoms of unexplained, chronic, diffuse muscular pain. Only three patients had been diagnosed as having fibrositis by their physician. Eighteen of 31 patients had symptoms sufficiently severe to interfere with their ability to perform their job or household chores. The percentages of these patients who met the fibrositis criteria ranged from 17 to 55 percent. These results suggest that unexplained, diffuse muscular aching is a common problem, that it is rarely diagnosed, and that the use of several criteria to define fibrositis excludes many patients with the typical primary symptoms

163)         Helme RD, Littlejohn GO, Weinstein C. Neurogenic flare responses in chronic rheumatic pain syndromes. Clin Exp Neurol 1987; 23:91-4.:91-94.
Abstract: Chronic rheumatic pain syndromes such as the fibrositis syndrome, 'whiplash' syndrome, low back pain syndrome and regional pain syndrome are common clinical disorders of unknown cause. The presence of tender points in predictable anatomical locations is essential to their diagnosis. Exaggerated dermatographia or flare response to mechanical stimulation is also a commonly observed physical finding. Dermatographia is thought to be a local axon reflex mediated phenomenon, and, as such, is a component of the neurogenic inflammatory response. Because neurogenic inflammation may be mediated by polymodal nociceptors we examined the flare response to topical capsaicin, a chemical method of stimulating local axon reflexes, in 12 patients with chronic rheumatic pain syndromes and in 10 controls. There was a significant correlation (rs = 0.61; p less than 0.01) between the area of flare induced by mechanical stimulation and the area of flare induced by chemical stimulation for all subjects. Patients with chronic rheumatic pain syndromes had a lower threshold for capsaicin-induced flare responses compared with controls. They also had larger flares at capsaicin concentrations of 0.02 and 0.033 mg/mL (p less than 0.05) applied as 20 microL aliquots over 30 minutes. It is concluded that neurogenic flare responses are increased in patients with chronic rheumatic pain syndromes

164)         Jacobsen S, Danneskiold-Samsoe B. Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients. Scand J Rheumatol 1987; 16(1):61-65.
Abstract: A common complaint among patients with fibrositis syndrome is exhaustion and fatique. It was therefore felt desirable to evaluate the muscle strength of these patients compared with normal subjects. Maximum isometric and isokinetic strength of knee extension was measured in 15 patients and 15 healthy matched subjects, using an isokinetic dynamometer (Cybex II). Maximum isometric strength at various knee extension angles (90 degrees, 60 degrees and 30 degrees degrees) was significantly (p less than 0.001) lower in the fibrositis group than in controls, a reduction of approximately 58-66%. Maximum isokinetic strength at various knee extension velocities (30-240 degrees per second) was also significantly (p less than 0.01) lower in the fibrositis group than in controls, the reduction being approximately 41-51%. In conclusion, isometric and isokinetic muscle strength is found to be lower in patients with fibrositis syndrome than in healthy subjects

165)         Keel PJ. [Generalized tendomyopathy: psychological profile of a patient group in the course of integrated treatment]. Z Rheumatol 1987; 46(6):322-327.
Abstract: 27 patients suffering from fibrositis were studied using a series of psychological tests in the course of an integrated group treatment program. In addition, their behaviour in the treatment program was observed and information about their behaviour in interpersonal conflicts was gathered. The results confirmed earlier observations that these patients show similar patterns in a projective test (Rosenzweig Picture Frustration Test) as patients with other rheumatic or other psychosomatic affections. The observations in the group sessions gave further support to these findings. However, in their self-evaluation with a personality inventory (Freiburger Personlichkeits-Inventar), these people described themselves as more disturbed than the other kinds of patients mentioned. But this disturbance seems to be rather the consequence than the cause of this chronic illness of unclear origin. These signs of emotional disturbance were more distinct in those patients who had been suffering for longer from their illness and showed a poorer response to our treatment program

166)         Littlejohn GO, Weinstein C, Helme RD. Increased neurogenic inflammation in fibrositis syndrome. J Rheumatol 1987; 14(5):1022-1025.
Abstract: Mechanically induced vasodilatation or flare on the skin, known as dermatographia, is a common clinical observation in fibrositis syndrome and is thought to be a neurogenically mediated axon reflex response. In our study, mechanically and chemically induced flares were quantitated in 13 patients with fibrositis syndrome and 14 control subjects. There was a reduced threshold for chemically induced flare response and the area of flare was greater in patients compared to controls, although there was a wide range of responses in both groups. There was also a significant positive correlation between mechanically and chemically induced flares, and the number of tender points in all subjects correlated with the size of the chemically induced flare. We suggest that exaggerated neurogenic inflammatory responses in patients with fibrositis syndrome reflect increased activity of polymodal nociceptors of unmyelinated primary afferent nerves. This increased receptor activity may also contribute to the pain and tenderness experienced by these patients

167)         Malterud K. [Patients with fibrositis--or chronic overstrain in women?]. Tidsskr Nor Laegeforen 1987; 107(30):2648-2649.

168)         Miller DR, Seifert RD. Management of fibromyalgia, a distinct rheumatologic syndrome. Clin Pharm 1987; 6(10):778-786.
Abstract: The pathophysiology and management of fibromyalgia, a unique nonarticular rheumatologic syndrome characterized by diffuse musculoskeletal aches and pains, stiffness, discrete tender points at typical soft-tissue sites, and a characteristic sleep disturbance, are reviewed. The prevalence and incidence of fibromyalgia are not known, but it is one of the most common conditions seen by rheumatologists (after degenerative joint disease and rheumatoid arthritis). It was previously thought to involve inflammation of fibrous intermuscular septa and is sometimes referred to in the literature as fibrositis. It is not primarily psychogenic, but psychological factors may contribute. The tender points are the key to diagnosis. Fibromyalgia may be classed as primary (when no underlying disease is present) or secondary (when an associated condition exists). The pathophysiology of fibromyalgia is unknown but appears to involve complex interactions of central neurotransmitters with a relationship to pain perception, mood, and sleep. Treatment is empiric; nondrug treatment involving education, relaxation, and increased physical activity is essential. Few controlled trials of drug therapy have been conducted. Analgesics, anti-inflammatory drugs, phenothiazines, tricyclic antidepressants, and the tricyclic muscle relaxant cyclobenzaprine have been used; low doses of amitriptyline or cyclobenzaprine provide increased control of pain and mood.(ABSTRACT TRUNCATED AT 250 WORDS)

169)         Muller W. The fibrositis syndrome: diagnosis, differential diagnosis and pathogenesis. Scand J Rheumatol Suppl 1987; 65:40-53.:40-53.
Abstract: The fibrositis syndrome represents a clinically definable entity, which is characterised by spontaneous pain, especially in the lumbar and cervical region, and more rarely in other movable parts, multiple tendomyosis, tendinitis and insertion tendinitis, as well as a wide variety of functional syndromes, vegetative symptoms and psychological disturbances. The course of the illness is rather variable; its commencement can be slow to develop or acute, initially presenting a localised clinical picture similar to a lumbar or cervical condition, and gradually, or in jumps, showing a deterioration accompanied by a generalisation of complaints. Various factors are probably instrumental in triggering off the fibrositis syndrome. The most important ones are emotional stress whereby symptoms of fear, depression, etc. lead to muscle tension and insertion tendinitis. Somatic factors such as malposition of the spinal column, may also contribute towards the manifestation of the clinical picture. The so-called secondary fibrositis syndromes should be defined from the point of view of differential diagnosis; they can develop within the framework of inflammatory rheumatic conditions, through infections and endocrinopathy. Differential diagnosis is very difficult considering depression alongside pain in the movable parts and "psychogenic rheumatism". Smooth transitions are in existence. Polymyalgia rheumatica and polymyositis, which produce similar clinical pictures, must be differentiated from the fibrositis syndrome

170)         Rosenhall U, Johansson G, Orndahl G. Eye motility dysfunction in chronic primary fibromyalgia with dysesthesia. Scand J Rehabil Med 1987; 19(4):139-145.
Abstract: Thirty-six patients with "chronic primary fibromyalgia" combined with dysesthesia were studied using oculomotor tests. The test results were compared with those of a control group consisting of 71 healthy persons. The saccades were found to be abnormal in 42% of the patients studied. The maximum velocity of the saccades was often reduced, while the accuracy was normal. The smooth pursuit eye movements were deranged in 89% of the patients. The velocity gain was reduced and the number of corrective saccades was increased. The results indicate that brain dysfunction, often at the brainstem level, is commonly seen in patients with chronic primary fibromyalgia syndrome combined with dysesthesia

171)         Rosenhall U, Johansson G, Orndahl G. Neuroaudiological findings in chronic primary fibromyalgia with dysesthesia. Scand J Rehabil Med 1987; 19(4):147-152.
Abstract: Thirty-six patients (31 females and 5 males) with "chronic primary fibromyalgia" combined with dysesthesia were studied using neuroaudiological tests. Auditory brainstem response (ABR) was pathological in 11 patients (31%). In six instances the I-V interpeak latency (IPL) was prolonged, in two instances the interaural difference of wave V (IT5) was pathological, and in three instances there was a reduction of the amplitude of wave V. A comparison of the I-V IPLs between the female patient group and a matching control group showed that there was a significant prolongation of this parameter in the patient group. The ABR-findings indicate that a brainstem dysfunction might be present in some patients with fibromyalgia. The results of the impedance audiometric tests were generally normal in the patient group

172)         Scudds RA, Rollman GB, Harth M, McCain GA. Pain perception and personality measures as discriminators in the classification of fibrositis. J Rheumatol 1987; 14(3):563-569.
Abstract: Twenty patients with fibrositis were compared to age and sex matched groups of patients with rheumatoid arthritis (RA) and normal controls regarding personality variables measured by the Basic Personality Inventory (BPI) and responsiveness to experimentally induced pain. The group with fibrositis scored significantly higher than the normal group on 4 of the BPI scales and had lower pain threshold and tolerance than the normal group. The group with RA was found to be significantly different from the normal group on hypochondriasis and pain tolerance. Using only pain and personality measures, a statistical discriminant function that was developed resulted in a 72% classification accuracy for the 3 groups studied and 85% accuracy when only the 2 clinical groups were considered

173)         Smeltzer KJ. Fibromyalgia: the frustration of diagnosis and management. Orthop Nurs 1987; 6(3):28-31.

174)         Spongsveen KL. [Fibromyalgia--a new disease?]. Tidsskr Nor Laegeforen 1987; 107(30):2646-2648.

175)         Tavoni A, Vitali C, Bombardieri S, Pasero G. Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Am J Med 1987; %20;83(5A):107-110.
Abstract: The effect of S-adenosylmethionine (SAMe) and placebo was evaluated in a short-term crossover study of 17 patients with primary fibromyalgia. Eleven of 17 patients had a significant depressive state as assessed by either the Hamilton Depression Rating Scale or the Scala di Autovalutazione per la Depressione (SAD) rating scale. The number of trigger points plus painful anatomic sites decreased after administration of SAMe (p less than 0.02) but not after placebo treatment. In addition, scores on both the Hamilton and SAD rating scales improved after SAMe administration (p less than 0.05 and p less than 0.005, respectively), whereas they did not significantly change after placebo treatment. In all the patients, there was a good correlation between scores on the Hamilton rating scale and the number of trigger points. Thus, this preliminary study confirms the close relationship between primary fibromyalgia and psychologic disturbances, particularly with regards to a depressive state. SAMe treatment, by improving the depressive state and reducing the number of trigger points, seems to be an effective and safe therapy in the management of primary fibromyalgia

176)         Trinkl W. [Primary fibromyalgia syndrome]. Med Klin (Munich) 1987; 82(22):786-90, 803.

177)         Winnem MF, Landro NI. [Examination of patients with fibrositis syndrome]. Tidsskr Nor Laegeforen 1987; 107(30):2650-2, 2662.

178)         Allen AD. Is RA27/3 rubella immunization a cause of chronic fatigue? Med Hypotheses 1988; 27(3):217-220.
Abstract: Patients with chronic fatigue syndromes (primary fibrositis syndrome, major affective disorder, etc.) have elevated IgG serum antibodies to multiple common viruses. Only IgG rubella antibodies are positively correlated with the intensity of symptoms and have a height that is clearly significant compared to healthy controls. The lymphotropic properties of the rubella virus could account for the multiple elevated antibodies. Adult women are over-represented in the population of patients with chronic fatigue, and are especially susceptible to developing such symptoms following exposure to attenuated rubella virus. A new more potent strain of live rubella vaccine (strain RA27/3) was introduced in 1979. Within three years reports of patients with chronic fatigue began surfacing in the literature. Considering all this, the possible role of rubella immunization in the etiology of chronic fatigue syndromes deserves further study

179)         Backman E, Bengtsson A, Bengtsson M, Lennmarken C, Henriksson KG. Skeletal muscle function in primary fibromyalgia. Effect of regional sympathetic blockade with guanethidine. Acta Neurol Scand 1988; 77(3):187-191.
Abstract: Muscle fatigue is the most disabling symptom in primary fibromyalgia (PF), which in addition is characterized by generalised pain and muscle stiffness. In order to assess whether the fatigue is of central and/or peripheral origin, skeletal muscle function was studied by measuring maximum voluntary hand grip strength, and by measuring various contraction characteristics in the adductor pollicis muscle after electrical stimulation of the ulnar nerve. The PF-patients were also studied after a regional sympathetic blockade of the forearm with guanethidine. A lower hand grip strength was found in the PF-patients compared to the controls, before as well as during the sympathetic blockade. The developed force, measured during electrical stimulation, did not differ between patients and controls. A lower muscle relaxation rate was found in the PF-patients. The relaxation rate increased in the PF-patients during the sympathetic blockade. The results indicate both a central and a peripheral cause of muscle dysfunction. Activity in the muscle sympathetic system may be one link in the chain of events that leads to muscular symptoms in PF

180)         Bengtsson A, Bengtsson M. Regional sympathetic blockade in primary fibromyalgia. Pain 1988; 33(2):161-167.
Abstract: Twenty-eight patients with primary fibromyalgia participated in the study. Eight patients received a stellate ganglion blockade with bupivacaine, and 14 days later an intravenous regional sympathetic blockade with guanethidine. The remaining patients served as controls and were randomly allocated to receive either a sham (placebo) injection with physiologic saline superficial to the stellate ganglion (n = 10) or bupivacaine intramuscularly (n = 10). The efficiency of the stellate ganglion blockade was evaluated by measuring skin blood flow (using a laser Doppler flowmeter), skin temperature, and skin conductance responses ('sympathogalvanic reflex'). Trigger and tender points (TePs) were counted, and rest pain in the arm, shoulder and neck evaluated at intervals up to 4 h after the injection. The guanethidine blockade was evaluated 24 h after the injection by counting TePs and by assessment of rest pain in the hand and forearm. The results indicate that a complete sympathetic blockade, produced by a stellate ganglion blockade, markedly reduced the number of TePs and produced a marked decrease in rest pain. The guanethidine blockade reduced the number of TePs, but had no effect on rest pain. The reduction in pain and TePs produced by a sympathetic blockade may be due to an improvement in microcirculation. Sympathetic activity may, in some patients, contribute to the pathogenesis of primary fibromyalgia

181)         Bennett RM, Gatter RA, Campbell SM, Andrews RP, Clark SR, Scarola JA. A comparison of cyclobenzaprine and placebo in the management of fibrositis. A double-blind controlled study. Arthritis Rheum 1988; 31(12):1535-1542.
Abstract: The efficacy of cyclobenzaprine (Flexeril), as compared with placebo, was tested in a 12-week, double-blind, controlled trial of 120 patients with fibrositis. Of the patients who received placebo, 52% dropped out due to lack of efficacy of the drug, compared with 16% of patients taking cyclobenzaprine. The dropout rate due to adverse reactions was similar in the 2 groups. Patients taking cyclobenzaprine experienced a significant decrease in the severity of pain and a significant increase in the quality of sleep. There was a trend toward improvement in the symptoms of fatigue, but morning stiffness was not alleviated. These improvements in symptoms were associated with a significant reduction in the total number of tender points and in muscle tightness. Our findings indicate that cyclobenzaprine is a useful adjunct in treating patients with the fibrositis syndrome

182)         Carette S, Lefrancois L. Fibrositis and primary hypothyroidism. J Rheumatol 1988; 15(9):1418-1421.
Abstract: The prevalence of fibrositis was determined in 100 patients with subclinical or biochemical primary hypothyroidism. Nineteen patients reported symptoms of joint and/or muscle pain with stiffness. Five of these patients presented 7 or more tender points on examination, thus allowing a diagnosis of fibrositis to be made in only 5% of the total group. Symptomatic improvement after thyroid hormone replacement occurred in 10 of the 19 patients, including 3 of those with fibrositis. There were no significant changes in tender points. Our data indicate that fibrositis is uncommon in patients with primary hypothyroidism despite the frequent occurrence of symptoms suggestive of this syndrome

183)         Darby PL, Schmidt PJ. Psychiatric consultations in rheumatology: a review of 100 cases. Can J Psychiatry 1988; 33(4):290-293.
Abstract: Consultation-liaison psychiatry has contributed much to our understanding of the psychological complications of physical illness, both in general responses to illness and in particular problems related to specific diseases. We reviewed 100 psychiatric consultations from a specialized rheumatology unit. Eighty percent of the consultations consisted of patients with systemic lupus erythematosus (36%), rheumatoid arthritis (29%), and fibrositis (15%). The majority of S.L.E. patients had organic brain syndromes related to central nervous system involvement or corticosteroids, while the majority of rheumatoid arthritis patients had a depressive diagnosis. Fibrositis patients showed no specific psychiatric diagnosis. Some future areas of research for consultation-liaison psychiatry in this area are suggested

184)         Desnuelle C, Serratrice G. [From diffuse functional myalgias to primary fibromyalgias]. Rev Rhum Mal Osteoartic 1988; 55(4):293-298.
Abstract: Diffuse and chronic muscular pains, without any noticeable underlying anomaly, are a frequent cause for consultation. The origin of the pain was, at the beginning of the century, attributed to an inflammation of fascia, tendons, ligaments, subcutaneous tissues and even the muscle itself. Although this inflammatory etiology is not based on proven anatomical facts, some authors advocate an organic pathology of unknown origin and the terms of fibrositis or primary fibromuscular pain are used in the literature, especially the anglo-saxon literature, to describe such symptomatology. Clinical diagnostic criteria have been recently proposed in order to differentiate primary fibromuscular pain from functional diffuse muscular pains. The authors discuss the legitimacy of such distinction

185)         Dubey AD, Gerster JC. [Apropos of 30 cases of primary fibrositis treated by eutonia]. Rev Med Suisse Romande 1988; 108(3):195-205.

186)         Edwards RH. Hypotheses of peripheral and central mechanisms underlying occupational muscle pain and injury. Eur J Appl Physiol Occup Physiol 1988; 57(3):275-281.
Abstract: In an overview of the problem of occupational muscle pain the evidence indicates that injury is more common the greater the load and the worse the posture in which the work is performed. The commonest are backstrains or ligament or joint damage due to overuse. Fatigue is associated with alterations in energy metabolites in muscle while pain is often due to microscopical damage to the cellular architecture. The progress of pathological changes in muscle following occupational injury may be similar to those seen in primary fibromyalgia (fibrositis) because of a final common pathway involving calcium-induced secondary damage. Occupational muscle pain frequently occurs in the muscles supporting the upper limb girdle and head in workers engaged in repetitively performing skilled manipulations or activities requiring high or sustained mental concentration. It is suggested that both occupational myalgia of this kind may be due to an imbalance in the use of muscles for postural activity (holding or supporting fine movements) compared to phasic use in dynamic work. While there are undoubtedly muscular indications of damage these may be secondary to alterations in (unconscious) central motor control mechanisms

187)         Eriksson PO, Lindman R, Stal P, Bengtsson A. Symptoms and signs of mandibular dysfunction in primary fibromyalgia syndrome (PSF) patients. Swed Dent J 1988; 12(4):141-149.
Abstract: Primary fibromyalgia syndrome (PFS) is a form of nonarticular rheumatism characterized by muscular pain and stiffness, commonly located in the neck-, shoulder-, back-, and pelvic regions. The most common finding in patients with mandibular dysfunction (MD) is pain or tenderness of the masticatory muscles, but tender and painful neck and shoulder muscles are also often found in relation to jaw muscle affection. Complaints presented by patients suffering from musculoskeletal conditions may overlap one another. Indeed, there may be some common causative factors for these complaints. To test the hypothesis that some complaints by PFS patients could be explained by mandibular dysfunction, we have investigated the subjective symptoms and the clinical state of the stomatognathic system in eight patients suffering from PFS. According to the Helkimo anamnestic dysfunction index, six patients were classified as having severe signs of MD. The Helkimo clinical dysfunction index revealed severe or moderate dysfunction in all patients. Recurrent headaches was reported by half of the patients. In conclusion, the present study shows that PFS patients also may suffer from mandibular dysfunction. Thus, an examination of the function of the stomatognathic system would be an important part in the investigation to elucidate possible etiological factors behind the reported complaints by PFS patients. PFS may also be of etiological importance for mandibular dysfunction

188)         Fam AG. Approach to musculoskeletal chest wall pain. Prim Care 1988; 15(4):767-782.
Abstract: Pain in the chest may be the presenting feature of a diverse number of musculoskeletal chest wall conditions. The more common causes are costochondritis, trauma to the chest wall, benign overuse myalgia, fibrositis, referred pain, and psychogenic regional pain syndrome. These disorders are often mistaken for angina pectoris and other serious disorders. Information about onset, location, character, duration and modulating factors of the pain and other symptoms, a meticulous examination of the ribs, spine, sternum and their articulations, and a few judiciously selected diagnostic studies will establish the diagnosis in most patients. Knowledge and understanding of the underlying pathogenic mechanisms of these musculoskeletal disorders is important for optimal management

189)         Frodin T, Bengtsson A, Skogh M. Nail fold capillaroscopy findings in patients with primary fibromyalgia. Clin Rheumatol 1988; 7(3):384-388.
Abstract: The nail fold capillary morphology and blood flow were examined by capillaroscopy in 10 patients with primary fibromyalgia. Only slight morphological anomalies such as moderate enlargement of capillary loops and variations in calibre were found. No obvious correlation emerged between capillary morphology and the duration of the disease, smoking, or history of Raynaud's phenomenon. Three patients with a history of Raynaud's phenomenon showed sluggish capillary flow correlated with subnormal skin temperature during registration. The findings suggest that marked generalized capillary abnormality such as that often involving the nail fold capillaries in many connective tissue disorders is not a prominent feature of primary fibromyalgia

190)         Fye KH, Whiting-O'Keefe QE, Lennette ET, Jessop C. Absence of abnormal Epstein-Barr virus serologic findings in patients with fibrositis. Arthritis Rheum 1988; 31(11):1455-1456.

191)         Goldenberg DL. Research in fibromyalgia: past, present and future. J Rheumatol 1988; 15(6):992-996.
Abstract: Research in regard to fibromyalgia has greatly increased during the last 5 years. Initially, investigators concentrated on clinical descriptions and diagnostic criteria. Early pathophysiologic aspects studied included sleep disturbances and psychiatric aspects of the syndrome. More recently, studies have focused on peripheral tissue abnormalities, including sophisticated studies of abnormal muscle metabolism, immunologic and neurotransmitter abnormalities. Future suggested research directions are reviewed

192)         Goldenberg DL. Fibromyalgia and other chronic fatigue syndromes: is there evidence for chronic viral disease? Semin Arthritis Rheum 1988; 18(2):111-120.

193)         Hart FD. Fibrositis (fibromyalgia). A common non-entity? Drugs 1988; 35(3):320-327.
Abstract: The literature on fibrositis (fibromyalgia), which originated in the early years of the last century in the UK and proliferated there in the first half of this century, has since diminished there in the last 30 years or so, but has increased in Canada and the US. Criteria suggested for diagnosis have created a syndrome with no diagnostic tests, serological or radiological signs, and no truly objective physical signs, but with predictable tender spots on pressure. The syndrome is largely, but not completely, confined to females, mostly of middle age; the symptoms include widespread aching of more than 3 months' duration, disturbed sleep, morning fatigue and stiffness, a failure to respond satisfactorily to any one form of therapy and a tendency to persist over long periods, but without permanent tissue changes. Features of psychological disturbance are present in many patients but not in all or even the majority. Definition of the condition as a disorder of pain modulation - a pain amplification syndrome - would seem to fit the facts best. Most would agree that an abnormal response to stress is an important factor in the appearance of the syndrome, as other stress related disorders, such as the irritable bowel syndrome and tension headaches, may coexist. Response to therapy, whether physical or pharmacological, is on the whole unsatisfactory. This type of patient has been well recognised in hospital clinic and general practice for many years.(ABSTRACT TRUNCATED AT 250 WORDS)

194)         Hawley DJ, Wolfe F, Cathey MA. Pain, functional disability, and psychological status: a 12-month study of severity in fibromyalgia. J Rheumatol 1988; 15(10):1551-1556.
Abstract: We mailed monthly questionnaires regarding fibromyalgia symptoms to 75 patients during a one-year period. Fibromyalgia symptoms in individual patients were generally stable over time as assessed by repeated measures and slope analyses, but patients clearly differed from one another in symptom severity. Pain, psychological status, and functional disability, but not sleep disturbance or morning stiffness, were the independent explanatory factors for disease severity in regression models. Functional disability has not been recognized previously as an important factor in fibromyalgia severity, but our data suggest that it should be assessed as a process and outcome measure in future fibromyalgia studies

195)         Henriksson KG. Muscle pain in neuromuscular disorders and primary fibromyalgia. Eur J Appl Physiol Occup Physiol 1988; 57(3):348-352.
Abstract: Muscle fibre degeneration and regeneration, inflammation in intramuscular connective tissue and hypoxia in resting muscle are not necessarily associated with pain. However, when sustained or dynamic muscle contractions are performed in an ischaemic muscle, severe pain develops. In the chronic muscle pain syndrome called fibromyalgia (or fibrositis) the most likely cause of the pain is a combination of muscle tension and muscle hypoxia. This conclusion is supported by the finding of a pathological distribution of tissue oxygen tension in painful muscles and a subjective feeling of muscle tension and muscle stiffness in the majority of patients. A decrease in high energy phosphates is found in biopsies from painful muscle. The most characteristic morphological finding is the so called ragged red fibre, which is a finding that can been seen in mitochondrial disorders. The morphological and chemical findings are possibly a consequence of a long standing hypoxia. The possibility that activity in muscle sympathetic nerves is important for the development of chronic muscle pain is discussed

196)         Isomaki H. The sauna and rheumatic diseases. Ann Clin Res 1988; 20(4):271-275.
Abstract: Although sauna bathing is a traditional means of treating rheumatism, its effects on rheumatic diseases have not been studied. Animal studies suggest that hyperthermia could have a favourable effect in cases of chronic rheumatic inflammation. More than fifty percent of patients find that sauna bathing alleviates rheumatic pain and improves joint mobility. The effect is similar in both inflammatory and non-inflammatory disorders. Nearly all men experience sauna bathing as helpful, whereas one-fourth of women find it detrimental. Rheumatic pain is exacerbated and joint mobility decreases on the day after a sauna. Exacerbation of pain is more obvious in non-inflammatory diseases, especially in fibromyalgia, than in inflammatory diseases, and more obvious in women than men. It can be prevented by proper cooling

197)         Jensen LT, Jacobsen S, Horsley-Petersen K. Serum procollagen type III aminoterminal peptide in primary fibromyalgia (fibrositis syndrome). Br J Rheumatol 1988; 27(6):496.

198)         Jensen OH. [Fibromyalgia syndrome in spondylarthritis ankylopoietica]. Ugeskr Laeger 1988; 150(36):2128-2129.

199)         Kantor KP. Fibromyalgia syndrome. Postgrad Med 1988; 84(1):45-46.

200)         Kirmayer LJ, Robbins JM, Kapusta MA. Somatization and depression in fibromyalgia syndrome. Am J Psychiatry 1988; 145(8):950-954.
Abstract: Psychiatric diagnoses, self-reports of symptoms, and illness behavior of 20 fibromyalgia patients and 23 rheumatoid arthritis patients were compared. The fibromyalgia patients were not significantly more likely than the arthritis patients to report depressive symptoms or to receive a lifetime psychiatric diagnosis of major depression. These results do not support the contention that fibromyalgia is a form of somatized depression. Fibromyalgia patients, however, reported significantly more somatic symptoms of obscure origin and exhibited a pattern of reporting more somatic symptoms, multiple surgical procedures, and help seeking that may reflect a process of somatization rather than a discrete psychiatric disorder

201)         Kogstad O. Primary fibromyalgia syndrome--subgroups of inflammatory rheumatic nature? Scand J Rheumatol 1988; 17(3):154.

202)         Kogstad O. [Fibromyalgia (fibrositis). A heterogenous pain syndrome]. Tidsskr Nor Laegeforen 1988; %20;108(32):2997-3000.

203)         Lautenschlager J, Bruckle W, Schnorrenberger CC, Muller W. [Measuring pressure pain of tendons and muscles in healthy probands and patients with generalized tendomyopathy (fibromyalgia syndrome)]. Z Rheumatol 1988; 47(6):397-404.
Abstract: A newly developed dolorimeter was tested by repeated measurements in 25 healthy volunteers to demonstrate its reliability. Repeated measurements at 12 different points demonstrated good correlation. Measurements at these points gave a highly significant difference between 100 patients with generalized tendomyopathy (fibrositis-syndrome/fibromyalgia) and a group of 50 age- and sex-matched healthy volunteers

204)         McCain GA, Bell DA, Mai FM, Halliday PD. A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. Arthritis Rheum 1988; 31(9):1135-1141.
Abstract: Forty-two patients with primary fibromyalgia were randomized into a 20-week program consisting of either cardiovascular fitness (CVR) training or simple flexibility exercises (FLEX) that did not lead to enhanced cardiovascular fitness. Patients were supervised by the same medical fitness instructors. Patients in neither group had contact with members of the other group, and were blinded as to the exercise taught to the alternative group. Groups met for 60 minutes 3 times each week. The compliance rate was 90%. Thirty-eight patients completed the study (18 with CVR training and 20 with FLEX). Blind assessments (standardized in preliminary trials to achieve acceptable inter-rater agreement) were performed by the same 2 examiners. After 20 weeks, patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training (t[35] = -4.22, P less than 0.003). Logistic regression analysis showed clinically and statistically significant improvements in pain threshold scores, which were measured directly over fibrositic tender points, in patients undergoing CVR (t[35] = 2.21, P less than 0.04). There was also a trend toward improvement in pain scores (visual analog scale) in the CVR group, but this did not reach statistical significance. There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep (self-report inventories). However, compared with the FLEX group, the CVR-trained patients improved significantly in both patient and physician global assessment scores.(ABSTRACT TRUNCATED AT 250 WORDS)

205)         McCain GA, Scudds RA. The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes. Pain 1988; 33(3):273-287.
Abstract: PFS, MPS and TMPDS can be identified using positive diagnostic criteria among patients presenting with chronic pain. A directed rather than exhaustive search for organic diseases known to coexist with these syndromes is usually all that is necessary. Criteria are presently empirical but do identify homogeneous populations of patients for study and treatment. Some patients, however, provide examples of overlap and it may be useful to think of CMPS in terms of the Venn diagram depicted in Fig. 2. In this report we have attempted an initial classification for a group of common and perplexing chronic pain disorders of the musculoskeletal system which at present have no identifiable cause. Previous investigations have been hampered by erroneous pathological concepts, heterogeneous patient populations and poor study design particularly with respect to treatment modalities. We hope that this classification, while empirical, will lead to needed epidemiological studies outlining the similarities and differences between these clinically observable and different musculoskeletal syndromes. We hope, further, that it will foster cooperation between different medical disciplines so that clinical biases might be tested in light of current concepts of the scientific method

206)         Miller MH, Topliss DJ. Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients. J Rheumatol 1988; 15(11):1705-1712.
Abstract: The epidemic of chronic upper limb pain is the most important and controversial issue in industrial rheumatology in Australia today. Two hundred and twenty-nine consecutive patients referred with chronic upper limb pain which had been labelled "repetitive strain injury" or "overuse syndrome" were assessed according to a protocol designed to give insight into the questions: Is the pain genuine or falsely reported, i.e., malingering? If genuine is it due to a physical injury, a pain syndrome, or a mixture of both? Twenty-nine patients fulfilled criteria for specific rheumatological diagnoses (fibrositis 15, rotator cuff syndrome 3, rheumatoid arthritis 3, cervical referred pain 3, lateral epicondylitis 2, de Quervain's tenosynovitis 1, carpal tunnel syndrome 1, and psoriatic monoarthritis 1). In the remaining 200 (mean age 37 years, range 19-58, 91.5% female) many different pain patterns and nonspecific associated symptoms were recorded. Eighty-nine percent had greater than or equal to 2 Smythe tender points, 1.5% had 1 tender point, and 9.5% had no tender point. Diffuse pain and greater than 7 tender points is sufficient to diagnose fibrositis, and localized pain and a smaller number of tender points strongly suggests a genuine chronic rheumatic pain syndrome. Stress, personal susceptibility and poor motivation appeared important in some cases. The liberal workers' compensation system, early labeling as repetitive strain injury, and social acceptability appeared important in the development of the epidemic

207)         Moldofsky H, Saskin P, Lue FA. Sleep and symptoms in fibrositis syndrome after a febrile illness. J Rheumatol 1988; 15(11):1701-1704.
Abstract: Sleep physiology and symptoms of 9 patients with fibrositis syndrome secondary to a febrile illness were compared to 9 patients with fibrositis syndrome who did not attribute their symptoms to a febrile illness and to 10 healthy controls. Both patient groups showed an alpha EEG (7.5 to 11 Hz) nonrapid eye movement sleep anomaly, had similar observed tender points, and self-ratings of musculoskeletal pain. These findings suggest that patients with postfebrile fibrositis have a nonrestorative sleep disorder characteristic of patients with fibrositis syndrome and share similar symptoms with patients who have a "chronic fatigue syndrome."

208)         Nolli M, Ghirelli L, Ferraccioli GF. Pain language in fibromyalgia, rheumatoid arthritis and osteoarthritis. Clin Exp Rheumatol 1988; 6(1):27-33.
Abstract: Using the Italian version of the McGill Pain Questionnaire (MGPQ), the language of pain was assessed in three chronic rheumatic diseases, namely Fibromyalgia syndrome (FS), Rheumatoid Arthritis (RA) and Osteoarthritis (OA). The Pain Rating Index (PRI) of the MGPQ clearly allowed OA to be distinguished from RA and FS. Words of the affective and sensory subclasses were chosen more frequently in FS, RA and OA respectively. By analyzing words chosen by at least 33% of the patients, a thermal sensory descriptor arose in FS. Data from this study suggest that the MGPQ-PRI might be useful for the assessment of fibromyalgic pain in a clinical setting and during follow-up of the disease

209)         Perry F, Heller PH, Levine JD. Differing correlations between pain measures in syndromes with or without explicable organic pathology. Pain 1988; 34(2):185-189.
Abstract: We investigated the use of pain measures in chronic pain syndromes with and without explicable organic cause by correlating scores obtained from the Visual Analog Scale and from subscales of the McGill Pain Questionnaire in patients with either inflammatory arthritis or primary fibrositis. We confirmed the finding that patients with fibrositis, despite having significantly less demonstrable pathology, report more pain on a significant number of measures. In patients with arthritis, we observed large positive correlations between scores on different pain measures, supporting the hypothesis that these scores validly measure pain secondary to tissue injury. In the fibrositis group, however, significantly lower correlations, and one even strongly negative, were found between scores on different measures. We suggest that commonly used pain measures which have been shown to be valid to study patients with demonstrable pathology may be less valid for measurement of pain in patients with syndrome such as fibrositis, whose pain may be different or more complex than that of patients with explicable organic basis

210)         Pritchard C. Fibrositis and the chronic fatigue syndrome. Ann Intern Med 1988; 108(6):906.

211)         Quimby LG, Block SR, Gratwick GM. Fibromyalgia: generalized pain intolerance and manifold symptom reporting. J Rheumatol 1988; 15(8):1264-1270.
Abstract: We tested the current criteria for fibromyalgia. Pain tolerance was measured at tender point and control point sites using a pressure algometer, and responses to 6 standard psychological self-reports were obtained from 125 patients with generalized nonarticular rheumatism, rheumatoid arthritis, or osteoarthritis. Among patients with generalized nonarticular rheumatism, published symptom criteria for fibromyalgia did not correlate significantly with the number of tender points. Only lower generalized pressure point pain tolerance distinguished fibromyalgia from other generalized nonarticular rheumatism. Generalized nonarticular rheumatism mean scores were much higher than controls on tests measuring the tendency to report physical symptoms, including headaches and functional bowel syndrome. It is probable that patients with fibromyalgia do not differ in any important physical or psychological respect from other patients with generalized nonarticular rheumatism except for the presence of tender points. However, the presence of tender points is merely a reflection of the patient's general pressure pain sensitivity and is not indicative of any special localized pathological phenomenon. The concept of fibromyalgia as an entity separate from the rest of generalized nonarticular rheumatism may be an artifact of a physician's approach to the patient. Most patients with generalized nonarticular rheumatism demonstrate an abnormally high frequency of reporting manifold disagreeable symptoms and probably come to the attention of many medical disciplines

212)         Reynolds WJ, Chiu B, Inman RD. Plasma substance P levels in fibrositis. J Rheumatol 1988; 15(12):1802-1803.
Abstract: The mechanism of pain in the fibrositis syndrome is unknown. We measured plasma levels of substance P in 32 patients with fibrositis and 26 sex and age matched controls using a radioimmunoassay. The mean plasma level of substance P in the patients with fibrositis was 371 +/- 91 pg/ml and in controls 397 +/- 84 pg/ml (p = NS). We conclude that determination of plasma levels of substance P in fibrositis is of no diagnostic value. This does not exclude the possible role of substance P as a neurotransmitter in the fibrositis syndrome

213)         Romano TJ. Fibrositis in men. W V Med J 1988; 84(6):235-237.

214)         Romano TJ. The fibromyalgia syndrome. It's the real thing. Postgrad Med 1988; 83(5):231-243.

215)         Romano TJ. Coexistence of irritable bowel syndrome and fibromyalgia. W V Med J 1988; 84(2):16-18.

216)         Semble EL, Wise CM. Fibrositis. Am Fam Physician 1988; 38(1):129-139.
Abstract: Fibrositis is a common clinical syndrome characterized by diffuse musculoskeletal pain and multiple tender points on physical examination. The symptoms wax and wane but do not produce severe disability. Although no single treatment is curative, a comprehensive program of patient education, drug therapy and appropriate physical activity is beneficial in many patients

217)         Semble EL, Wise CM. Chest pain: a rheumatologist's perspective. South Med J 1988; 81(1):64-68.
Abstract: Chest pain is a frequent patient complaint that requires a careful history and physical examination to determine its cause. Cardiac and esophageal causes of chest pain are common, but musculoskeletal disorders such as Tietze's syndrome, chest wall pain syndromes, fibrositis, inflammatory arthritic conditions, cervical osteoarthritis, and disease of the thoracic spine may also result in chest pain. Musculoskeletal diseases must be differentiated from other causes of chest pain, since specific treatment of these rheumatic conditions often produces good results

218)         Simms RW, Goldenberg DL, Felson DT, Mason JH. Tenderness in 75 anatomic sites. Distinguishing fibromyalgia patients from controls. Arthritis Rheum 1988; 31(2):182-187.
Abstract: We studied tenderness at 75 unilateral anatomic locations in 10 fibromyalgia patients and 10 normal control subjects to determine which sites best identified patients with fibromyalgia. Using a dolorimeter, the mean amount of pressure required to elicit tenderness was significantly lower in patients than in controls at 19 sites (P less than 0.001). Of the previously proposed tender points, only 2 were included in those 19 best discriminating points. Fifteen of the 19 best discriminating points were clustered in regions around the anterior shoulder, anterior chest, posterior scapula, and medial knee. The 19 sites that we have identified best separate patients with fibromyalgia from controls, although the discriminating power of these sites in other chronic pain syndromes will require further study. Examination of specific regions may be more useful clinically than the exact anatomic sites within these regions

219)         Simms RW, Goldenberg DL. Symptoms mimicking neurologic disorders in fibromyalgia syndrome. J Rheumatol 1988; 15(8):1271-1273.
Abstract: Recent reports have not emphasized the presence of paresthesias in fibromyalgia syndrome. In our retrospective review of 161 patients with fibromyalgia we found that 84% complained of numbness or tingling at initial evaluation. Most had either bilateral upper and lower extremity or bilateral upper extremity paresthesias. None had concurrent diseases commonly associated with peripheral neuropathy. Thirty-six patients with paresthesias had electromyograms performed before the diagnosis of fibromyalgia and 32 were normal. At a second assessment performed at a mean of 25 months from time of diagnosis, 56 of these 57 patients reported current paresthesias. Paresthesias are common in fibromyalgia and may mimic a neurologic disorder, although objective abnormalities are rare. Judicious use of neurodiagnostic tests are therefore indicated in the clinical setting of fibromyalgia

220)         Simons DG. Myofascial pain syndromes: where are we? Where are we going? Arch Phys Med Rehabil 1988; 69(3 Pt 1):207-212.
Abstract: In recent years, research activity related to myofascial pain syndromes due to trigger points (TrPs) has blossomed. This paper introduces and relates the presentations made in a symposium entitled "Myofascial Pain Syndromes: Where are we? Where are we going?" at the 47th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation in Kansas City October 2, 1985. It summarizes a number of recent research advances and key research issues related to myofascial pain syndromes: 1. Thermography appears valuable for imaging the reflex thermal tracks of previously identified TrPs. 2. Three new devices are reported to measure reliably the pressure threshold for pain of TrPs and tender points (TePs). 3. Fibrositis/fibromyalgia and myofascial pain syndromes may or may not be separate entities. The question needs to be resolved. 4. New evidence strongly supports previous indications that a TrP is a region of increased energy consumption with an inadequate oxygen supply. 5. A foundation has been established for investigating the sensitizing agent(s) responsible for the increased sensitivity of TrPs and muscular TePs. 6. At least four mechanisms can account for the pain referred by TrPs in muscles. The convergence-projection mechanism appears to be consistently present in visceral pain pathways and to be likely in mammalian muscle nociceptive pathways

221)         Smythe HA. Does modification of sleep patterns cure fibrositis? Br J Rheumatol 1988; 27(6):449.

222)         Solvkjaer M. [Primary fibromyalgia]. Ugeskr Laeger 1988; 150(45):2714-2719.

223)         Tunks E, Crook J, Norman G, Kalaher S. Tender points in fibromyalgia. Pain 1988; 34(1):11-19.
Abstract: To establish inter-rater and test-retest reliability of use of a pressure algometer, 5 males and 5 females suffering from chronic fibromyalgia ('fibrositis'), and a normal group of 5 males and 5 females, were examined 2 times by each of 2 independent examiners, using 1 kg/sec rate of application, over 10 paired and typical 'tender points,' localized by skin marker. Tenderness thresholds of tender points were coded and analyzed using repeated measures ANOVA, for factors sex, normal/fibromyalgia, and side, rater, and time 1/time 2. There was significantly lower tenderness thresholds of tender points in fibromyalgia compared to normal subjects. Generalizability coefficients were calculated and showed high inter-rater (0.85), and test-retest (0.85) reliability. Highly significant differences were found between specific tender points. A further 10 normals and 10 fibromyalgia subjects were then examined for 5 paired tender points and 5 paired non-tender points. A 2-way ANOVA was conducted for summed and averaged scores for all tender and non-tender points, with factors normal/fibromyalgia and tender/non-tender; again, there was a large difference between normal and fibromyalgia subjects, and between tender and non-tender points. The interaction was small but significant, but there was a larger difference between fibromyalgia and normal subjects observed on non-tender points. The low tenderness threshold observed at the tender points of fibromyalgia patients may reflect a more generalized lowering of tenderness thresholds, seen at non-tender points as well

224)         Vaeroy H, Helle R, Forre O, Kass E, Terenius L. Cerebrospinal fluid levels of beta-endorphin in patients with fibromyalgia (fibrositis syndrome). J Rheumatol 1988; 15(12):1804-1806.
Abstract: Cerebrospinal fluid (CSF) samples from 18 female patients with fibromyalgia (fibrositis syndrome) were analyzed for beta-endorphin. The mean CSF level of beta-endorphin was 20.7 +/- 0.7 fmol/ml in the patients compared to 20.5 +/- 2.0 fmol/ml (mean +/- SEM) in healthy controls (p greater than 0.05). Thus, patients with fibromyalgia (fibrositis syndrome) seem to have normal CSF levels of the pain modulatory neuropeptide beta-endorphin

225)         Vaeroy H, Helle R, Forre O, Kass E, Terenius L. Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis. Pain 1988; 32(1):21-26.
Abstract: In 30 patients with diagnosed fibromyalgia, the CSF level of immunoreactive substance P (SP) was investigated. Compared to normal values (9.6 +/- 3.2 fmol/ml), all the patients had elevated CSF levels of SP (36.1 +/- 2.7 fmol/ml, range 16.5-79.1 fmol/ml). Anamnestic information from the patients revealed that 53.3% had Raynaud/Raynaud-like phenomenon localized in the fingers, the toes or both. Although SP levels did not differ significantly in patients with or without the Raynaud phenomenon, elevated activity may be present in the peripheral branches of SP neurons which could be responsible for the last (rubor) phase of the triphasic Raynaud's phenomenon. SP levels were significantly higher in patients who were smokers (40.1 +/- 2.7 fmol/ml, range 25.3-64.1 fmol/ml), compared to patients who were non-smokers (29.2 +/- 5.0 fmol/ml, range 16.5-79.1 fmol/ml). We propose elevated CSF levels of SP and the Raynaud phenomenon as characteristic features for fibromyalgia with potential as diagnostic markers of the disease and further that smoking might be an aggravating factor for its pathogenesis or development

226)         Verdon F, Studer JP. [Left-sided pectobrachialgia]. Schweiz Med Wochenschr 1988; 118(21):806-811.
Abstract: Left pectorobrachialgia, described here in 41 patients, is a frequent rheumatoid affection seen in general practice. It causes anterior chest pain with irradiation into the left arm, and patients often interpret it as being of coronary origin. The latter, however, is characterized by its different clinical presentation. Two forms can be distinguished: the typical form, which is an isolated entity, and the second, associated with and modified by fibromyalgia. It may coexist with angina pectoris and occur after myocardial infarction

227)         Wallace DJ, Margolin K, Waller P. Fibromyalgia and interleukin-2 therapy for malignancy. Ann Intern Med 1988; 108(6):909.

228)         Waylonis GW, Wilke S, O'Toole D, Waylonis DA, Waylonis DB. Chronic myofascial pain: management by low-output helium-neon laser therapy. Arch Phys Med Rehabil 1988; 69(12):1017-1020.
Abstract: Therapeutic benefits of low-output helium-neon laser therapy have not been established, but laser therapy has been suggested as an effective means of treating many acute and chronic musculoskeletal pain syndromes. Although not released for general clinical use by the FA, the helium-neon laser has been promoted to physical therapists and athletic trainers as potentially useful for the treatment of pain syndromes. In particular, it has been proposed that it may be more effective than conventional measures such as medication and conventional physical therapy in the treatment of myofascial pain syndromes (fibrositis, fibromyalgia). The citations in the literature include only case reports. Sixty-two patients were treated by using acupuncture points. Two sessions of five treatments were given six weeks apart. A crossover double-blind technique was used in the treatments. The clinical responses were assessed using portions of the McGill Pain Questionnaire. No statistical difference between the treatment and the placebo groups could be determined

229)         Weisman MH, Vecchione TR, Albert D, Moore LT, Mueller MR. Connective-tissue disease following breast augmentation: a preliminary test of the human adjuvant disease hypothesis. Plast Reconstr Surg 1988; 82(4):626-630.
Abstract: It has been proposed that scleroderma in particular or connective-tissue diseases in general may be caused by exposure to silicone-containing materials used for breast augmentation. We performed a historical cohort study to estimate the point prevalence of this potential complication sometimes referred to as "human adjuvant disease." Three-hundred and seventy-eight patients who underwent augmentation mammaplasty with silicone-containing envelope-type prostheses from 1970 through 1981 were surveyed. Regional musculoskeletal syndromes, fibrositis, or osteoarthritis occurred in a third (38 of 125) of our responders. No patient developed an inflammatory systemic rheumatic disease during the period of observation (mean 6.8 years for the 125 subjects). Using calculations based on risk for development of rheumatic disease, it does not appear likely that augmentation mammaplasty is a significant or major inducer of inflammatory connective-tissue diseases in general. However, the number of patients surveyed was small, and our results must be considered preliminary. We could not exclude a specific risk for the development of scleroderma

230)         Wolfe F. Fibrositis, fibromyalgia, and musculoskeletal disease: the current status of the fibrositis syndrome. Arch Phys Med Rehabil 1988; 69(7):527-531.
Abstract: Fibrositis (fibromyalgia) is a common disorder, but is often not considered or diagnosed by clinicians. It is characterized by widespread musculoskeletal pain and aching, disturbed sleep, fatigue, morning stiffness, and local tenderness. The presence of multiple (seven or more) tender points and widespread pain or aching are necessary and sufficient conditions for diagnosis. Fibrositis occurs in a "primary" form, but most commonly in association with other rheumatic diseases where it is a concomitant condition. The designation "myofascial pain syndrome" has replaced older concepts of localized fibrositis, and is considered a separate entity

231)         Wolfe F. Fibromyalgia: whither treatment? J Rheumatol 1988; 15(7):1047-1049.

232)         Wolfe F. Fibromyalgia in the elderly: differential diagnosis and treatment. Geriatrics 1988; 43(6):57-60, 65, 68.
Abstract: Fibromyalgia in the elderly often occurs in the presence of other musculoskeletal disorders where it is often unsuspected. The clue to the diagnosis of concomitant fibromyalgia lies in the widespread distribution of the pain and in its severity. All patients with this disorder have multiple, symmetrically distributed "tender points," a physical sign which is specific for fibromyalgia. Treatment includes, first, explanation. Aerobic exercise may be helpful in many patients, and administration of tricyclic compounds in very low doses is often effective in treating the associated sleep disorder and in reducing overall disease severity

233)         Worth WD, Keller B, Graber G, Muller W. [The temporomandibular joint from the rheumatologic viewpoint]. Z Rheumatol 1988; 47(2):69-79.
Abstract: Temporomandibular joint affections in rheumatic disease are described. They were seen in inflamed joint diseases, mostly in rheumatoid arthritis, and less so in juvenile rheumatoid arthritis, psoriatic arthritis, Reiter's syndrome, ankylosing spondylitis, and collagen vascular disease. In osteoarthrosis, the temporomandibular joint affection occurs frequently but pain seems to occur most infrequently. We must bear in mind that a painful temporomandibular joint could be a symptom of myalgia, especially fibrositis syndrome with its painful tendon

234)         Yunus MB, Holt GS, Masi AT, Aldag JC. Fibromyalgia syndrome among the elderly. Comparison with younger patients. J Am Geriatr Soc 1988; 36(11):987-995.
Abstract: Thirty-one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self-assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P less than .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation

235)         Yunus MB. Diagnosis, etiology, and management of fibromyalgia syndrome: an update. Compr Ther 1988; 14(4):8-20.
Abstract: Recent controlled studies suggest a physiologic basis for FMS, which should be diagnosed by its own characteristic features and not by exclusion of other conditions alone. Diffuse musculoskeletal aching, accompanied by multiple TPs in the absence of an underlying arthritic or systemic condition, are the key features for diagnosis. Based on our controlled study, guidelines for diagnosis are provided in Table 5. Successful management of an FMS patient is often challenging, but frequently gratifying if approached with a positive and caring attitude. The most important aspects of management are a firm diagnosis, reassurance regarding the benign nature of the condition, help in changing patient behavior in order to accept pain and increase functional activities and exercise tolerance, and the use of tricyclic agents. Overall, management of fibromyalgia is an art that requires the combined ingredients of patience, understanding, and firmness in helping patients to assume responsibility for their pain management through behavior modifications

236)         Yunus MB, Kalyan-Raman UP, Kalyan-Raman K. Primary fibromyalgia syndrome and myofascial pain syndrome: clinical features and muscle pathology. Arch Phys Med Rehabil 1988; 69(6):451-454.
Abstract: Primary fibromyalgia syndrome (PFS) is a common form of nonarticular rheumatism with diffuse musculoskeletal aching and stiffness at multiple sites and tender points at characteristic locations. Nonmusculoskeletal "systemic" symptoms, eg, fatigue, poor sleep, irritable bowel symptoms, and chronic headaches, are also common. Although PFS is similar to myofascial pain syndrome (MPS) in that both conditions cause muscle pain and tenderness, important differences exist. Unlike PFS, muscle pain in MPS is usually local or regional, accompanied by trigger points. Unlike tender points, trigger points produce a referral pain pattern specific to each muscle. Moreover, "systemic" features of PFS are usually absent in MPS. Common and important pathologic changes in muscle in PFS are moth-eaten appearance of Type I fiber by histochemistry, and myofibrillar lysis with glycogen and mitochondria deposition by electron microscopy; inflammatory changes are absent by light microscopy. Recent investigations have shown that PFS is a characteristic clinical entity. Further controlled studies are, however, essential to establish the pathologic changes in tender muscles in PFS

237)         The fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(1):1-191.

238)         Fibromyalgia syndrome. Proceedings of the Palm Springs Fibromyalgia Syndrome Symposium. Palm Springs, CA, March 18-20, 1988. J Rheumatol Suppl 1989; 19:1-57.:1-57.

239)         Fibromyalgia syndrome. Proceedings of the First International Conference on Fibromyalgia. London, ON, September 16-17, 1988. The 3rd Edward Dunlop Symposium. J Rheumatol Suppl 1989; 19:58-192.:58-192.

240)         Alfici S, Sigal M, Landau M. Primary fibromyalgia syndrome--a variant of depressive disorder? Psychother Psychosom 1989; 51(3):156-161.
Abstract: Primary fibromyalgia syndrome (PFS) is a form of connective tissue rheumatism, characterized by diffuse chronic pain in periarticular tissue, for which no organic cause can be identified. The present study examined the personal and family history, clinical and psychodynamic features of 40 PFS patients, and compared them to a matched control group of patients suffering from rheumatoid arthritis. Depression, either in the past or at present, was seen significantly more often among PFS patients that among controls. Dependence and passivity, idealization of family relationships, obsessive-compulsive personality, maladaptive response to loss, and prepain ergomania were the psychodynamic features characteristic of PFS patients. It is suggested that PFS is a well-defined disorder, in which specific premorbid, familial, and psychodynamic characteristics result in a depressive disorder which takes the form of a physical symptom: pain

241)         Bengtsson A, Henriksson KG. The muscle in fibromyalgia--a review of Swedish studies. J Rheumatol Suppl 1989; 19:144-9.:144-149.
Abstract: In Sweden, several studies have been performed in patients with fibromyalgia to study muscle morphology, chemistry and physiology in order to understand the origin of the most prominent symptoms in fibromyalgia: muscle pain, muscle fatigue and muscle stiffness. These studies have shown changes indicating disturbed microcirculation, mitochondrial damage and a reduced content of high energy phosphates. Thus, there may be an energy deficiency state in the resting painful muscle in fibromyalgia. Pain analysis has supported the idea that there is a nociceptive origin of the pain. Our hypothesis is that any condition that could lead to constant muscle hypoxia, e.g., through establishment of abnormal motor patterns, might be a possible cause of fibromyalgic pain

242)         Bengtsson M, Bengtsson A, Jorfeldt L. Diagnostic epidural opioid blockade in primary fibromyalgia at rest and during exercise. Pain 1989; 39(2):171-180.
Abstract: Nine patients with primary fibromyalgia participated. The patients were studied prior to, during and immediately after 4 identical periods of exercise (bicycle ergometer) each performed 30 min after injection with saline, repeated saline, an opioid and naloxone. All substances were given epidurally, except for naloxone which was given intravenously. Finally, with the patients resting in bed, lignocaine was injected epidurally. Physiological variables, general exertion, dyspnoea, lower extremity exhaustion, pain and tender points in the lower half of the body were examined. Resting pain and tender points diminished significantly after the opioid injection. Lignocaine completely abolished resting pain and tender points. Lower extremity exhaustion was reduced by the opioid. General exertion and dyspnoea were unaffected by the opioid. In conclusion the results support the hypothesis that the pain in fibromyalgia is of peripheral nociceptive or spinal origin. We raise the hypothesis that the fatigability is, at least partly, due to inhibition because of pain

243)         Bennett RM. Beyond fibromyalgia: ideas on etiology and treatment. J Rheumatol Suppl 1989; 19:185-91.:185-191.
Abstract: A common syndrome of musculoskeletal pain, currently called fibrositis or fibromyalgia, accounts for 10-30% of all rheumatology consultations in North America. Lacking a distinctive pathophysiological basis the nature of the pain experienced by these patients remains elusive and treatment is not based on sound scientific principles. An hypothesis is advanced which suggests that skeletal muscle is the "end organ" responsible for the pain of fibromyalgia and that previous studies on muscle deconditioning and microtrauma may be relevant to the etiopathogenesis of fibromyalgia syndrome

244)         Bennett RM. Confounding features of the fibromyalgia syndrome: a current perspective of differential diagnosis. J Rheumatol Suppl 1989; 19:58-61.:58-61.
Abstract: Patients eventually diagnosed as having the fibromyalgia syndrome often have symptoms which suggest alternate diagnoses such as peripheral neuropathy, spondylitis, metabolic myopathy, polymyalgia, early rheumatoid arthritis, early systemic lupus erythematosus or a chronic fatigue syndrome. Delay in diagnosis of fibromyalgia often proves costly and frustrating to the patient and may lead to inappropriate therapy

245)         Bennett RM. Muscle physiology and cold reactivity in the fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(1):135-147.
Abstract: The contention that muscles are the "end organs" responsible for fibromyalgia symptomatology is unproven. This review presents a contemporary synopsis of muscle physiology and then describes studies in the fibromyalgia syndrome which have yielded objective data of distorted muscle physiology and cold reactivity

246)         Bennett RM, Clark SR, Goldberg L, Nelson D, Bonafede RP, Porter J et al. Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle. Arthritis Rheum 1989; 32(4):454-460.
Abstract: Aerobic fitness was evaluated in 25 women with fibrositis, by having them exercise to volitional exhaustion on an electronically braked cycle ergometer. Compared with published standards, greater than 80% of the fibrositis patients were not physically fit, as assessed by maximal oxygen uptake. Compared with matched sedentary controls, fibrositis patients accurately perceived their level of exertion in relation to oxygen consumption and attained a similar level of lactic acidosis, as assessed by their respiratory quotient and ventilatory threshold. Exercising muscle blood flow was estimated by 133xenon clearance in a subgroup of 16 fibrositis patients and compared with that in 16 matched sedentary controls; the fibrositis patients exhibited reduced 133xenon clearance. These results indicate a need to include aerobic fitness as a matched variable in future controlled studies of fibrositis and suggest that the "detraining phenomenon" may be of relevance to the etiopathogenesis of the disease

247)         Berry H. Homeopathic treatment and fibrositis. BMJ 1989; 299(6703):858.

248)         Bill-Harvey D, Rippey RM, Abeles M, Pfeiffer CA. Methods used by urban, low-income minorities to care for their arthritis. Arthritis Care Res 1989; 2(2):60-64.
Abstract: The purpose of this study is to describe the current treatment methods minorities use and believe are effective in relieving the pain and discomfort of arthritis. One hundred sixty subjects from two urban, low-income minority communities reported to case finders that they had some form of arthritis. Subsequently they were interviewed and examined by a rheumatologist. Sixty-six percent were black, and 34% were Hispanic. The study found that 83% had some type of rheumatic disease. Differences existed between the black and Hispanic samples in age, rheumatic disease distribution, and methods of care. The majority of black respondents were older, with a frequent diagnoses of osteoarthritis, compared to the Hispanics, who reported fibrositis as their dominant rheumatic problem. An array of conventional and nonconventional therapies were used by both groups to care for their arthritis. Prayer (92%), equipment (70%), and heat (33%) were reported as "most helpful" for the blacks. Hispanics reported prayer (50%), heat (40%), and topical ointments as "most helpful." In order to communicate and provide optimal care to patients from divergent cultural backgrounds, it is important to understand both likenesses and differences, and to be sensitive to the patient's belief system and health care practices

249)         Bjelle A, Bengtsson A, Henriksson KG, Idstrom JP, Torebjork E, Thornell LE. [Fibromyalgia--a new name for a syndrome with diffuse muscular disorders]. Lakartidningen 1989; 86(7):528-530.
Abstract: This new name for an old and common disease has introduced fresh criteria and initiated clinical and basic research. The present clinical knowledge of the diagnosis and treatment is reviewed. Morphological and biochemical findings in the muscle of fibromyalgia patients have shown an unevenly distributed reduction of the oxygen tension. Hypoxia in the muscle sensitizes nociceptors, resulting in hyperalgesia with a diffuse distribution of pain symptoms. These are difficult for the individual to localize and are often combined with muscle stiffness and increased fatigability. These symptoms correspond to complaints received from fibromyalgia patients

250)         Blasberg B, Chalmers A. Temporomandibular pain and dysfunction syndrome associated with generalized musculoskeletal pain: a retrospective study. J Rheumatol Suppl 1989; 19:87-90.:87-90.
Abstract: Sequential patients seen in a Temporomandibular Joint Clinic were reviewed for evidence of generalized musculoskeletal pain. A greater proportion of patients with myofascial pain dysfunction syndrome than those with other causes of temporomandibular joint pain and complaints of pain outside the jaw in the head and neck region, pain on neck muscle palpation and bilateral symptoms. Demographic and other abnormalities in these patients suggest similarities to fibromyalgia syndrome

251)         Bradley LA. Cognitive-behavioral therapy for primary fibromyalgia. J Rheumatol Suppl 1989; 19:131-6.:131-136.
Abstract: The purpose of cognitive-behavioral therapy is to teach individuals the skills necessary to control pain and disability as well as to believe that they can successfully employ these skills. Cognitive-behavioral therapy has been used successfully in patients with back pain and rheumatoid arthritis and represents a potentially effective intervention for patients with primary fibromyalgia. This article describes cognitive-behavioral treatment procedures, presents 2 experimental designs that may be used in randomized, controlled clinical trials of cognitive-behavioral therapy in patients with primary fibromyalgia and identifies the methodological features that should be included in the trials

252)         Buckelew SP. Fibromyalgia: a rehabilitation approach. A review. Am J Phys Med Rehabil 1989; 68(1):37-42.
Abstract: Primary fibromyalgia syndrome, a myofascial disorder, is characterized by diffuse pain and tender points. Effective long term rehabilitation interventions for this disorder have not been demonstrated. The current rehabilitation interventions of fibromyalgia are evaluated and the psychologic consequences are summarized

253)         Burckhardt CS, Clark SR, Padrick KP. Use of the modified Balke treadmill protocol for determining the aerobic capacity of women with fibromyalgia. Arthritis Care Res 1989; 2(4):165-167.

254)         Caidahl K, Lurie M, Bake B, Johansson G, Wetterqvist H. Dyspnoea in chronic primary fibromyalgia. J Intern Med 1989; 226(4):265-270.
Abstract: We investigated the prevalence of dyspnoea, according to a 5-grade score proposed by the World Health Organization (WHO), among 87 consecutive women (age 44.0 +/- 8.4, range 26-65 years), with severe chronic primary fibromyalgia (CPF). In total 73 women (84%) were dyspnoeic, 47, 17, six and four patients reported dyspnoea corresponding to WHO grades 1, 2, 3 and 4, respectively. In multivariate analysis WHO dyspnoea grade was the most important determinator of exercise capacity. The higher WHO dyspnoea grade reported, the lower exercise capacity and heart rate were reached at graded bicycle exercise tests (r = -0.48, P less than 0.001 and r = -0.40, P less than 0.001). WHO dyspnoea grade correlated directly to breathing frequency at rest (r = 0.45, P less than 0.001) and inversely to maximum inspiratory pressure (r = -0.29, P less than 0.01). It did not correlate with maximum expiratory pressure, nor with spirometric measurements of pulmonary function. It is concluded that dyspnoea is common among CPF patients and is not explained by cardiac or pulmonary causes, but may partly be due to diaphragmatic muscular insufficiency and physical inactivity

255)         Callahan LF, Smith WJ, Pincus T. Self-report questionnaires in five rheumatic diseases: comparisons of health status constructs and associations with formal education level. Arthritis Care Res 1989; 2(4):122-131.
Abstract: Self-report questionnaire scales to assess various constructs of health status were compared in 602 patients with five rheumatic diseases, including 134 rheumatoid arthritis (RA), 216 osteoarthritis (OA), 84 fibromyalgia, 124 systemic lupus erythematosus (SLE), and 43 scleroderma patients. RA patients showed significantly higher degrees of difficulty, dissatisfaction, and pain in performing eight activities of daily living (ADL) compared to patients with the other four diseases (P less than 0.01), while SLE patients reported the least difficulty, dissatisfaction and pain. Fibromyalgia patients showed significantly higher scores on a visual analog pain scale than patients with the other four diseases (P less than 0.05), followed by OA patients. Fibromyalgia patients reported significantly higher levels of learned helplessness, assessed according to a rheumatology attitudes index (RAI), than patients with all other diseases, and scleroderma patients showed significantly lower RAI scores (P less than 0.05). Patients with all five diseases who had not completed high school showed poorer clinical status than patients who had completed high school on all six scales. Significant differences in questionnaire scores were seen for 24 of 30 comparisons (five diseases and six scales) according to formal education level, versus only two according to age, and none according to duration of disease

256)         Campbell SM. Regional myofascial pain syndromes. Rheum Dis Clin North Am 1989; 15(1):31-44.
Abstract: MPS are regional pain syndromes characterized by a tender trigger point in muscle (sometimes with an accompanying palpable abnormality in consistency) producing pain in a characteristic reference zone. There is abundant evidence supporting MPS as an important cause of regional musculoskeletal pain, and a small but growing body of quantitative clinical and experimental data. The pathogenesis is unknown, but probably involves both a peripheral (muscle) and central (spinal cord) mechanism. Several modes of therapy have been proposed as effective. MPS may be related to fibrositis, but conclusive evidence is lacking

257)         Carette S. [Fibromyalgia: a mysterious and old fashionable disease]. Union Med Can 1989; 118(6):255-257.

258)         Caro XJ. Is there an immunologic component to the fibrositis syndrome? Rheum Dis Clin North Am 1989; 15(1):169-186.
Abstract: PFS is an enigmatic disorder whose etiology remains largely unknown. Its clinical spectrum probably encompasses a heterogeneous group of patients displaying multifactorial symptomatology. Recent evaluation of PFS patients, on both a clinical and laboratory basis, suggests that there is a subpopulation of these patients who exhibit a low grade connective tissue disorder. This group of patients exhibit many of the clinical features expected with rheumatic diseases such as SLE and Sjogren's syndrome. They can be distinguished on a clinical basis from other PFS patients and from patients with the CEBV syndrome. Their disease may be disablingly painful and resistant to many therapeutic modalities. Results of newer information reviewed here suggests that these patients may have EVP on the basis of a peripheral, low grade, quasi-inflammatory process that may have a neurologic and an immune dysregulatory component. The implications of such a mechanism of injury are profound and potentially impact on the treatment of this group of patients

259)         Caro XJ. New concepts in primary fibrositis syndrome. Compr Ther 1989; 15(5):14-22.
Abstract: PFS is a painful rheumatologic disorder that may be detected by the wary clinician attuned to the presence of seven or more tender points. This common disorder may be seen at any age, including childhood, and may be associated with secondary symptoms of depression and other affective disorders. It may also be associated with findings of disturbed sleep, hearing and vestibular abnormalities, and profound complaints of fatigue. The vagueness of this latter complaint means that PFS must be distinguished from the newly described CEBV syndrome. Although the etiology of PFS remains unknown, recent investigations suggest that these patients may suffer a disorder with a central nervous system component as well as a subtle peripheral tissue lesion. Newer PFS studies demonstrate tissue changes that may be consistent with altered microvascular permeability and blood flow, tissue hypoxia, and chronic muscle spasm. An immunologic abnormality, or even a previously undescribed connective tissue disease, may be important as a pathogenic factor in some PFS patients

260)         Cicuttini F, Littlejohn GO. Female adolescent rheumatological presentations: the importance of chronic pain syndromes. Aust Paediatr J 1989; 25(1):21-24.
Abstract: The clinical features of 60 female adolescents (mean age 15 +/- 0.3 years) presenting consecutively to a rheumatologist are reviewed. Thirty-five per cent met criteria for well-defined chronic pain syndromes, 19 having fibrositis syndrome and two having a reflex sympathetic dystrophy syndrome. Other diagnoses were inflammatory arthritis (30%), anterior knee pain syndromes (13.3%), tendinitis (8.3%) and miscellaneous conditions (13.3%). The high prevalence of chronic pain syndromes in this patient group is highlighted and an approach to management is suggested

261)         Davies AE, Davey RW. Effect of homoeopathic treatment on fibrositis. BMJ 1989; 299(6704):918.

262)         Egle UT, Rudolf ML, Hoffmann SO, Konig K, Schofer M, Schwab R et al. [Personality markers, defense behavior and illness concept in patients with primary fibromyalgia]. Z Rheumatol 1989; 48(2):73-78.
Abstract: Recent studies indicate the relevance of psychological factors in the pathogenesis of primary fibromyalgia, although the results sometimes differ. Most of the studies investigated personality features and depression. Beyond these our study investigates defense mechanisms and illness behavior in primary fibromyalgia comparing them with those of psychogenic pain patients and with controls. All patients (fibromyalgia n = 47, psychogenic pain n = 63, controls n = 84) completed German adaptations of the Defense Mechanisms Inventory (DMI) and the Illness Behavior Questionnaire (IBQ) and the "Questionnaire of Psychosomatic Disease-Patterns" (FAPK). The two chronic pain groups show a high conformity: Reduced relation to reality, emotional vacancy in relationships, aggression restraint are the predominant personality features. Immature defense mechanisms and abnormal illness behavior are predominant. Somatic pain and its hypochondrical pursuit substitute the tackling of seemingly unsolvable life problems. Conclusions for the management of fibromyalgia patients are outlined

263)         Elert JE, Rantapaa Dahlqvist SB, Henriksson-Larsen K, Gerdle B. Increased EMG activity during short pauses in patients with primary fibromyalgia. Scand J Rheumatol 1989; 18(5):321-323.

264)         Fagerlund I. [Fibromyalgia--a musculoskeletal disease?]. Lakartidningen 1989; 86(26-27):2439.

265)         Felson DT. Epidemiologic research in fibromyalgia. J Rheumatol Suppl 1989; 19:7-11.:7-11.
Abstract: This paper reviews epidemiological methods, discusses the epidemiology of fibromyalgia and attempts to provide a blueprint for epidemiologic research in fibromyalgia by suggesting a number of studies that might be undertaken in the future

266)         Ferraccioli GF, Fontana S, Scita F, Chirelli L, Nolli M. EMG-biofeedback in fibromyalgia syndrome. J Rheumatol 1989; 16(7):1013-1014.

267)         Fishbain DA, Goldberg M, Steele R, Rosomoff H. DSM-III diagnoses of patients with myofascial pain syndrome (fibrositis). Arch Phys Med Rehabil 1989; 70(6):433-438.
Abstract: Rheumatology centers report that chronic pain patients with myofascial pain (fibrositis) are prone to psychiatric pathology. However, the distribution of DSM-III diagnoses in this population is unknown. This distribution is reported for 238 chronic pain patients with fibrositis. Statistical comparisons of men and women were also made with regard to the prevalence of each diagnosis, and the results were compared to published DSM-III diagnoses prevalence data for mixed chronic pain patients and rheumatology fibrositis patients. In our sample, women with fibrositis were equally as likely as men with fibrositis to have current depression. Within the general chronic pain population, women are more likely to have current depression. The incidence of current major depression and current and past major depression was much lower in our fibrositis sample than that reported by rheumatology programs. These results indicate that there may be psychiatric differences between chronic pain patients with and without fibrositis. Fibrositis patients in rheumatology programs may also be psychiatrically different from chronic pain program patients with fibrositis

268)         Fisher P, Greenwood A, Huskisson EC, Turner P, Belon P. Effect of homeopathic treatment on fibrositis (primary fibromyalgia). BMJ 1989; 299(6695):365-366.

269)         Gabriel SE, Bombardier C. Clinical trials in fibrositis: a critical review and future directions. J Rheumatol Suppl 1989; 19:177-9.:177-179.
Abstract: A critical appraisal of the design of clinical trials which examined the effectiveness of various interventions in fibrositis was conducted. Therapeutic interventions included physical fitness, biofeedback, acupuncture, dothiepin, imipramine, cyclobenzaprine, S-adenosylmethionine and amitriptyline. The design and analysis of the randomized, controlled studies render their results reliable. Major areas for methodologic improvement in future trials were identified. Standardized, validated and reliable diagnostic and outcome criteria need to be established. Factors which could predict response need to be identified to enable the selection of the most appropriate patient population for inclusion in future studies. Finally, the incorporation of measures of patient function will result in more clinically meaningful outcome evaluation

270)         Geller SA. Treatment of fibrositis with fluoxetine hydrochloride (Prozac). Am J Med 1989; 87(5):594-595.

271)         Gerecz-Simon EM, Tunks ER, Heale JA, Kean WF, Buchanan WW. Measurement of pain threshold in patients with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and healthy controls. Clin Rheumatol 1989; 8(4):467-474.
Abstract: Pain threshold was measured using a pressure algometer in 126 subjects, of whom 54 were females and 72 males. These subjects included 18 males and 18 females with rheumatoid arthritis, 18 males and 18 females with osteoarthritis, 18 males with ankylosing spondylitis, and 18 male and 18 female healthy control volunteers. Six points were studied on each side of the body: 2 cm above the eyebrow on the forehead, lateral aspect of the arm at the insertion of the deltoid muscle, midpoint of the ulna, hypothenar eminence in the palm, midpoint of the quadriceps muscle, and midpoint of the antero-medial aspect of the tibia. None of these points corresponded to the "trigger" points in fibromyalgia. The pain threshold was statistically significantly higher in patients with ankylosing spondylitis than in patients with osteoarthritis, and these in turn were statistically higher than in the normal subjects. Patients with rheumatoid arthritis had significantly lower pain thresholds than the normal subjects. No laterality in pain threshold was identified, but females had in general a lower pain threshold

272)         Gerster JC. [Fibrositis]. Rev Med Suisse Romande 1989; 109(8):601-605.

273)         Goldenberg DL. Fibromyalgia and its relation to chronic fatigue syndrome, viral illness and immune abnormalities. J Rheumatol Suppl 1989; 19:91-3.:91-93.
Abstract: Fibromyalgia and chronic fatigue syndrome have similar clinical and demographic features. We found that most patients with chronic fatigue syndrome have a tender point examination similar to patients with fibromyalgia. Similar pathophysiologic mechanisms are also being explored in each syndrome, including a potential role for viral induced immune dysfunction

274)         Goldenberg DL. Management of fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(3):499-512.
Abstract: The treatment of fibromyalgia syndrome is complex because there is no real evidence that inflammation or immune abnormalities are present. This article reviews the possible pathophysiologic changes in fibromyalgia, and presents several possible treatment modalities

275)         Goldenberg DL. An overview of psychologic studies in fibromyalgia. J Rheumatol Suppl 1989; 19:12-4.:12-14.
Abstract: Prior psychologic and psychiatric studies in fibromyalgia are reviewed. Most of these reports had methodologic problems, but there is an association of depression with fibromyalgia described in the better studies. Hudson and Pope's hypothesis that there are 3 possible mechanisms to explain this association is examined and discussed in relation to current and future research in fibromyalgia

276)         Goldenberg DL. Psychological symptoms and psychiatric diagnosis in patients with fibromyalgia. J Rheumatol Suppl 1989; 19:127-30.:127-130.
Abstract: Previous studies of psychological symptoms and psychiatric diagnoses in fibromyalgia have methodologic shortcomings. Although depressive and somatic symptoms are common, they are not more prominent than in other chronic medical conditions. There may be an association of depression with fibromyalgia, but this is not a causal one. The vast majority of patients with fibromyalgia do not meet criteria for a current psychiatric diagnosis

277)         Goldenberg DL. Psychiatric and psychologic aspects of fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(1):105-114.
Abstract: Most previous psychologic and psychiatric studies of patients with fibromyalgia have utilized instruments that do not control for pain and therefore may be falsely interpreted as indicative of increased depression, hysteria, or hypochondriasis. Future studies must utilize psychiatric techniques that take into account a coexistent medical condition and such evaluation should include patients with varying levels of severity of fibromyalgia symptoms and utilization of health care

278)         Goldenberg DL. A review of the role of tricyclic medications in the treatment of fibromyalgia syndrome. J Rheumatol Suppl 1989; 19:137-9.:137-139.
Abstract: The rationale behind the use of tricyclic medications in the treatment of fibromyalgia is reviewed. Controlled therapeutic trials have demonstrated significant improvement with these agents. However, important and sustained clinical improvement occurs in the minority of patients

279)         Goldenberg DL. Treatment of fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(1):61-71.
Abstract: The therapeutic role of medications in fibromyalgia is reviewed. The tricyclics, amitriptyline and cyclobenzaprine, have been the most extensively evaluated, and in controlled studies have proven to be more effective than placebo or NSAIDs. Their mode of action is not known, but their effect may relate to a number of potential mechanisms. However, neither the tricyclics nor any other medication has provided long-term, clinically meaningful improvement in the majority of patients

280)         Goldenberg DL. Diagnostic and therapeutic challenges of fibromyalgia. Hosp Pract (Off Ed) 1989; 24(9A):39-52.

281)         Hamaty D, Valentine JL, Howard R, Howard CW, Wakefield V, Patten MS. The plasma endorphin, prostaglandin and catecholamine profile of patients with fibrositis treated with cyclobenzaprine and placebo: a 5-month study. J Rheumatol Suppl 1989; 19:164-8.:164-168.
Abstract: During a 5 month, double blind crossover study of the clinical effect of cyclobenzaprine on 7 patients with fibrositis, weekly measurements were done of plasma beta-endorphin (endorphin, prostaglandin E (PGE) and catecholamines). Endorphin levels were normal but varied with tender point tenderness. Mean plasma dopamine and PGE were elevated. Norepinephrine was normal to very high while epinephrine levels were continuously low to normal. We conclude that patients with fibrositis have a neurotransmitter plasma profile like other chronic pain states having stress and increased vasomotor activity with the possible exception of having low circulating epinephrine. This disparity may mark a failure of central nervous system pain modulation in fibrositis

282)         Hench PK. Evaluation and differential diagnosis of fibromyalgia. Approach to diagnosis and management. Rheum Dis Clin North Am 1989; 15(1):19-29.
Abstract: The combination of widespread musculoskeletal pain, high tender point count, and nonrestorative sleep are sufficient criteria for the diagnosis of fibromyalgia. The condition is primary in the absence of underlying disease and is considered concomitant or secondary when closely associated with another organic disease. Despite more simplified diagnostic criteria, the work-up for fibromyalgia must always be directed toward excluding the underlying causes. In addition to general and rheumatic history and physical examination and selected laboratory studies, careful attention to defining any existing sleep and mood disturbances is important in designing a management program. Although 46 medical conditions have been associated with fibromyalgia, a practical differential diagnostic list included polymyalgia rheumatica, myofascial pain, connective tissue disease, endocrine myopathies, psychoneuroses, and other chronic fatigue syndromes

283)         Henriksson KG. Muscle pain in neuromuscular disorders and primary fibromyalgia. Neurologija 1989; 38(3):213-221.
Abstract: Muscle fiber degeneration and regeneration, inflammation in the intramuscular connective tissue and hypoxia in resting muscle are not necessarily associated with pain. However, when sustained or dynamic muscle contractions are performed in an ischaemic muscle, severe pain develops. In the chronic muscle pain syndrome called fibromyalgia (or fibrositis) the most likely cause of the pain is a combination of muscle tension and muscle hypoxia. This conclusion is supported by the finding of a pathological distribution of tissue oxygen pressure in painful muscles and a subjective feeling of muscle tension and muscle stiffness in the majority of patients. A decrease of high energy phosphates is found in biopsies from painful muscle. The most characteristic morphological finding is the so-called ragged red fiber, a finding that can be seen in mitochondrial disorders. The morphological and chemical findings are possibly a consequence of a long standing hypoxia. The possibility that sympathetic nerve activity is important for the development of chronic muscle pain is discussed

284)         Henriksson KG, Bengtsson A. [Fibromyalgia--an entity?]. Lakartidningen 1989; 86(8):617, 619.

285)         Hudson JI, Pope HG, Jr. Fibromyalgia and psychopathology: is fibromyalgia a form of "affective spectrum disorder"? J Rheumatol Suppl 1989; 19:15-22.:15-22.
Abstract: Several lines of evidence support a relationship between fibromyalgia and various forms of psychopathology, particularly major affective (mood) disorder. We evaluate 3 hypotheses that might explain this relationship: (1) that psychopathology is an effect of fibromyalgia; (2) that fibromyalgia is an effect of psychopathology; or (3) that both fibromyalgia and its associated psychopathology are caused by a common (but as yet unknown) abnormality. The third hypothesis may be expanded to the more general proposition that fibromyalgia, major affective disorder, and several other medical and psychiatric disorders may represent a family of related conditions--provisionally named "affective spectrum disorder" (ASD)--that share common pathophysiologic features

286)         Jacobsen S, Danneskiold-Samsoe B. Inter-relations between clinical parameters and muscle function in patients with primary fibromyalgia. Clin Exp Rheumatol 1989; 7(5):493-498.
Abstract: In forty-four female patients with primary fibromyalgia, muscle function was related to clinical parameters such as age, height, number of tenderpoints, subjective scores of physical capacity and number of subjective symptoms. Muscle function was determined as the dynamic muscle strength measured with an isokinetic dynamometer. Muscle function was found to be low in primary fibromyalgia patients with pronounced muscle tenderness compared to matched controls. Furthermore the reduction in muscle function increased with increasing number of tenderpoints and subjective symptoms. In primary fibromyalgia patients correlations between muscle strength and age/height were either not present or were weaker than in the control subjects. It is concluded that voluntary dynamic muscle strength is a useful parameter for measuring disease impact in primary fibromyalgia patients

287)         Jacobsson L, Lindgarde F, Manthorpe R. The commonest rheumatic complaints of over six weeks' duration in a twelve-month period in a defined Swedish population. Prevalences and relationships. Scand J Rheumatol 1989; 18(6):353-360.
Abstract: In 900 randomly selected individuals, 50-70 years old, we examined the prevalence over the preceding 12-month period of rheumatic complaints of more than 6 weeks' duration. We found them to represent a major health problem, with an overall prevalence of 37.8%, the predominant diagnoses being subacromial shoulder pain (6.7%), neck pain (6.5%), low back pain (6.3%), osteo-arthrosis (8.5%), and arthralgia (4.9%). With a prevalence of 1.0%, primary fibromyalgia was as common as rheumatoid arthritis (0.7%) and other chronic arthritides (1.1%). The prevalences of the different diagnoses were higher among participants whose data were obtained from personal investigation by a physician than among non-participants where data were obtained by interview, letter, and scrutiny of case records. The odds ratio from incurring more than one rheumatic disease was higher for subacromial shoulder pain and lowest for arthralgia and osteo-arthrosis

288)         Kaada B. [Treatment of fibromyalgia by low-frequency transcutaneous nerve stimulation]. Tidsskr Nor Laegeforen 1989; %20;109(29):2992-2995.
Abstract: Fibromyalgia is a syndrome of a non-inflammatory nature characterized first and foremost by great pain in a number of tendons and muscles. The syndrome has only recently been delineated as a separate entity, the criteria for which are still being discussed. Recent studies have revealed reduced oxygenation in the trigger points, apparently a result of reduced microcirculation due to sympatho-inhibition (5). Since low-frequency TNS is known to increase microcirculation in skin and muscles in widespread areas, and since such stimulation also produces widespread pain-relief through the activation of endogenous opioids, this appears to be a rational therapy for this syndrome. In the present study, 40 patients with fibromyalgia received low-frequency TNS. The effects were beneficial in about 70% of the cases

289)         Kirkengen AL. [Gudrun's story. What stuff is illness made of?]. Tidsskr Nor Laegeforen 1989; 109(19-21):2038-2040.
Abstract: What stuff is illness made of? Anne Luise Kirkengen, MD A story of life and a story of illness are two versions of the same issue. We are such stuff as dreams are made of, and our little life is rounded with a sleep. Prospero, The Tempest, by William Shakespeare Gudrun, 60 years old, married to Gunnar, mother of Nils 35 and Nicole 30 years old, grandmother of Mads, six months old. Previous office-manager, disabled since 1986. Diagnosis: fibrositis syndrome, hypothyreosis, depression, chronic obstructive lung-disease. Sexually abused by her stepfather at age 11 until 14. Gudrun reflects about how this may have influenced her life, her health and her personal relationships

290)         Klug GA, McAuley E, Clark S. Factors influencing the development and maintenance of aerobic fitness: lessons applicable to the fibrositis syndrome. J Rheumatol Suppl 1989; 19:30-9.:30-39.
Abstract: Exercise may have therapeutic benefits in the treatment of fibrositis/fibromyalgia. However, little is known concerning what type of exercise best serves patients with this condition, their capacity for exercise or the identity of the physiological or psychological alterations elicited by increased activity that might be responsible for the positive effects. We discuss these issues from the perspective of the classical responses reported in healthy subjects. In addition, since the benefits of exercise programs are dependent upon continual participation. strategies for initiating activity and maximizing compliance are discussed

291)         Kolar E, Hartz A, Roumm A, Ryan L, Jones R, Kirchdoerfer E. Factors associated with severity of symptoms in patients with chronic unexplained muscular aching. Ann Rheum Dis 1989; 48(4):317-321.
Abstract: Subjects with chronic, diffuse, unexplained muscular aching were recruited--21 from a primary care practice, nine from a rheumatology practice, and two from a pain clinic. No additional criteria were used to select subjects. Subjects with mild or moderate symptoms differed from those with severe symptoms with respect to the following characteristics: the presence of fatigue on awakening, the number of tender points, difficulty in sleeping, and the degree of tenderness in typical fibromyalgia areas as measured by a dolorimeter. These findings suggest that muscular aching is likely to be of greater severity if other symptoms or signs of fibromyalgia are also present

292)         Komaroff AL, Goldenberg D. The chronic fatigue syndrome: definition, current studies and lessons for fibromyalgia research. J Rheumatol Suppl 1989; 19:23-7.:23-27.
Abstract: Chronic fatigue syndrome (CFS) is characterized by chronic, debilitating fatigue lasting greater than 6 months. Frequent chronic and recurrent findings include fever, pharyngitis, myalgias, adenopathy, arthralgias, difficulties in cognition and disorders of mood. In the majority of patients, the illness starts suddenly with an acute, "flu-like" illness. The following laboratory abnormalities are seen with some frequency, although none are seen in all patients: lymphocytosis, atypical lymphocytosis, monocytosis, elevation of hepatocellular enzymes, low levels of antinuclear antibodies, varying levels of antithyroid antibodies, partial hypergammaglobulinemia, elevated CD4:CD8 ratio, decreased cytolytic activity of natural killer cells, and low levels of immune complexes. Clinical and serologic studies suggest an association of CFS with all of the human herpesviruses, particularly Epstein-Barr virus (EBV) and the recently discovered human B lymphotropic virus (HBLV) or human herpesvirus 6; neither EBV nor HBLV has yet been shown to play a causal role in the illness. Preliminary evidence suggests that many of these features of CFS also are seen in patients with fibromyalgia

293)         Kushmerick MJ. Muscle energy metabolism, nuclear magnetic resonance spectroscopy and their potential in the study of fibromyalgia. J Rheumatol Suppl 1989; 19:40-6.:40-46.
Abstract: The fields of muscle physiology and biochemistry have already identified some of the key components of ATPase hydrolysis products that are involved in muscle fatigue. The concentration of the relevant chemical species can be readily measured by nuclear magnetic resonance techniques in muscle. Now the question is: is alteration of cellular energy balance and the normal balance between supply and demand disturbed in fibromyalgia? Since these chemical events account for a very large amount of muscle reduced performance as well as reduction in both velocity and force, at the very least one ought to identify how large these changes are in any patient in whom we are trying to assess the degree to which these chemical changes might be associated with muscle fatigue. An objective chemical criteria for muscle performance is possible with modern noninvasive phosphorus magnetic resonance spectroscopy

294)         Lautenschlager J, Bruckle W, Seglias J, Muller W. [Localized pressure pain in the diagnosis of generalized tendomyopathy (fibromyalgia)]. Z Rheumatol 1989; 48(3):132-138.
Abstract: 56 tender points were examined in 100 patients and 50 age- and sex-matched healthy volunteers using a dolorimeter. 24 of the 56 points were especially selected according to ability of discrimination, best possible distribution on the body, and easy localization. All 56 points as well as the 24 specially selected points were examined as to their sensitivity and specificity in the diagnosis of generalized tendomyopathy. The sensitivity and the specificity for both point-combinations were acceptable. The sensitivity and specificity of the 24 points were superior to the 56 points in the case of discrimination ability. A 100% sensitivity and specificity could not, however, be achieved. It remains to be considered if functional and vegetative symptoms must still be used to support the diagnosis of generalized tendomyopathy (fibromyalgia)

295)         Leavitt F, Katz RS. Is the MMPI invalid for assessing psychological disturbance in pain related organic conditions? J Rheumatol 1989; 16(4):521-526.
Abstract: The Minnesota Multiphasic Personality Inventory (MMPI) was analyzed in 30 patients with fibromyalgia and 30 patients with rheumatoid arthritis (RA). Eighteen statements on the hypochondriasis, depression and hysteria scales and 14 statements on the schizophrenia scale differentiated patients with fibromyalgia and RA. Patients with fibromyalgia had higher scores on 29 of the 32 statements. Patients with RA seemed appropriately concerned about health and the possibility of additional illness. By contrast, patients with fibromyalgia were more symptomatic and presented a more unusual and complex syndrome, raising the possibility of a somatoform disorder and also greater personal distress in these patients. On the basis of analyzing the scores of patients with RA, one can also conclude that physical illness alone is not sufficient to drive MMPI profiles into the abnormal range. Patients with fibromyalgia who have a similar degree of pain intensity compared with patients with RA (61.3 vs 60 on a scale of 100) have significantly more abnormal MMPI, and analysis of their MMPI suggest a more complex somatic syndrome and greater psychological disturbance

296)         Littlejohn G. Medicolegal aspects of fibrositis syndrome. J Rheumatol Suppl 1989; 19:169-73.:169-173.
Abstract: The recent Australian epidemic of localized fibrositis syndrome is used to highlight the role of compensation and medicolegal systems on the clinical features and outcome of fibrositis syndrome. It is suggested that psychological factors are of great importance when this syndrome occurs after minor injury or de novo in the workplace. Current compensation and medicolegal systems usually negate appropriate management plans and thus lead to perseveration of fibrositis syndrome. It is suggested that public health policies in regard to fibrositis syndrome in this context need reappraisal

297)         Littlejohn GO. Fibrositis/fibromyalgia syndrome in the workplace. Rheum Dis Clin North Am 1989; 15(1):45-60.
Abstract: A recent major epidemic of localized fibrositis/fibromyalgia syndrome occurring in the workplaces of Australia is reviewed. The clinical features are described and the important provoking factors are detailed. A neurogenic model is proposed to explain this localized phenomena and also encompass primary generalized fibrositis/fibromyalgia syndrome

298)         Livneh A. [Fibromyalgia--recent advances--a critical review of the literature]. Harefuah 1989; 116(6):316-320.

299)         Magaro M, Altomonte L, Zoli A, Mirone L, Corvino G, Berchicci M. [Nimesulide in the treatment of osteoarthrosis and extra-articular rheumatism]. Minerva Med 1989; 80(9):1015-1018.
Abstract: Nimesulide is a new non-steroidal anti-inflammatory drug which seems to be characterized by a low inhibitory action on prostaglandin synthesis and a high inhibitory action on oxygen free radicals production. The aim of this trial was to determine the effect of Nimesulide on degenerative joint disease and on non-articular rheumatism. One hundred and forty, 64 females and 76 males aged 51.9 +/- 1.2 years, affected with osteoarthritis or non-articular rheumatism (fibromyalgia, periarthritis, tendinitis, tenosynovitis, bursitis and enthesitis) were studied. Nimesulide was administered at a daily dosage of 200 mg. A significative improvement in the clinical parameters studied was observed in all the patients, but a more remarkable progress was noted in the group with non-articular rheumatism. The incidence of adverse reactions was irrelevant: 2 patients complained of epigastralgia that subsided reducing the daily dosage to 100 mg

300)         Margoles MS. The concept of primary fibromyalgia. Pain 1989; 36(3):391-392.

301)         McCain GA, Cameron R, Kennedy JC. The problem of longterm disability payments and litigation in primary fibromyalgia: the Canadian perspective. J Rheumatol Suppl 1989; 19:174-6.:174-176.
Abstract: The determination of disability in fibromyalgia syndrome is problematic because of its perceived subjective nature and the absence of well defined criteria for diagnosis. This, together with an unclear idea of the natural history, creates problems in litigation and determination of rehabilitation costs. Lawyers and third party payers must cooperate with physicians to determine the "hidden costs" of fibromyalgia so that a fairer estimate of longterm disability is achieved

302)         McCain GA. Nonmedicinal treatments in primary fibromyalgia. Rheum Dis Clin North Am 1989; 15(1):73-90.
Abstract: To date, few nonmedicinal treatments for primary fibromyalgia have been studied using acceptable scientific standards. This has led to rather arbitrary use of disparate treatment modalities, often in a haphazard sequence. Because primary fibromyalgia syndrome is a chronic painful condition, rationale for treatment should be based on present concepts of pain perception supported by studies in the basic sciences. Recent clinical studies in the treatment of primary fibromyalgia syndrome conforming to the scientific method have been discussed in light of what is presently known about pain transmission and perception

303)         McCain GA, Tilbe KS. Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis. J Rheumatol Suppl 1989; 19:154-7.:154-157.
Abstract: Twenty patients with fibromyalgia syndrome and 20 patients with rheumatoid arthritis (RA) were assessed as outpatients over a 3 day period with respect to peak and trough levels of plasma cortisol, growth hormone, prolactin, ACTH and thyroid stimulating hormone. Patients with fibromyalgia syndrome had loss of diurnal variation in plasma cortisol (trough levels 347.3 +/- 254.7 vs 232.8 +/- 70.0 nmol/l, p less than 0.001) compared with RA patients. Thirty-five percent (7/20) of patients with fibromyalgia syndrome and only 5 percent (1/20) of those with RA exhibited abnormal dexamethasone suppression tests (p less than 0.001). No differences were noted in the diurnal variation of other hormones tested. Beck Depression Inventory scores were similar in both groups and no patient exhibited clinical evidence of depression. These data suggest alteration in the pituitary hypothalamic axis with respect to cortisol secretion in fibromyalgia syndrome, perhaps as a consequence of chronic pain

304)         Merskey H. Physical and psychological considerations in the classification of fibromyalgia. J Rheumatol Suppl 1989; 19:72-9.:72-79.
Abstract: Several existing techniques for diagnosing psychiatric illness in the presence of physical complaints are faulty. Psychiatric illness may affect only as few as 30% of patients with fibromyalgia in some series. Selection bias overemphasizes the contribution of psychiatric illness to fibromyalgic. Much of that illness will be secondary to pain and disability. Some fibromyalgia disturbances can arise through insomnia and anxiety. Principles in the classification of fibromyalgia are discussed

305)         Moldofsky H. Sleep-wake mechanisms in fibrositis. J Rheumatol Suppl 1989; 19:47-8.:47-48.
Abstract: Patients with fibrositis experience chronophysiologic changes during sleep and when they are awake. A wide variety of factors contribute to this phenomenon. Chronobiologic research in the area of sleep-wake mechanisms need to be undertaken

306)         Moldofsky H. Nonrestorative sleep and symptoms after a febrile illness in patients with fibrositis and chronic fatigue syndromes. J Rheumatol Suppl 1989; 19:150-3.:150-153.
Abstract: This review summarizes the physiologic and clinical evidence that shows nonrestorative sleep to be associated with chronic fatigue and diffuse myalgia after a flulike illness. Such a febrile illness may trigger alteration in sleep-wake brain and immune functions in patients with fibrositis or chronic fatigue syndromes

307)         Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am 1989; 15(1):91-103.
Abstract: Chronic diffuse myalgia, localized areas of tenderness, fatigue, and unrefreshing sleep are related to a physiologic arousal disorder within sleep, that is, the alpha EEG NREM sleep anomaly. This sleep physiologic disorder, nonrestorative sleep, and symptoms of fibrositis syndrome are shown to occur with psychologic, environmental, and physiologic distress conditions. Pathogenic mechanisms that link nonrestorative sleep physiology to pain and fatigue may involve metabolic dysfunction of the brain with sleep-related alteration in immunologic and neurotransmitter functions (serotonin, substance P, endorphins). These sleep-related mechanisms have important implications for the understanding and treatment of fibrositis/fibromyalgia syndrome

308)         Naess K. [Fibromyalgia. Alternative methods in public health planning]. Tidsskr Nor Laegeforen 1989; %20;109(26):2709-2710.

309)         Nash P, Chard M, Hazleman B. Chronic coxsackie B infection mimicking primary fibromyalgia. J Rheumatol 1989; 16(11):1506-1508.
Abstract: We describe a patient with primary fibromyalgia according to Smythe's criteria who had evidence of chronic infection with Coxsackie virus over a 4-year period. We discuss the association of Coxsackie infection and myalgic syndromes and review the literature

310)         Oland G. [Symptoms and findings in chronic low back pain. Significance of symptom localization and radiographic findings]. Tidsskr Nor Laegeforen 1989; 109(12):1285-1287.
Abstract: The article presents a one-year material of 41 women and 59 men with chronic low-back disorders. Patients who had undergone back surgery and patients with inflammatory disease, fibromyalgia and somatoform disorders were excluded. Median age was 39 years, and median time off work was 16 months. Neurological deficits were found in the lower extremities in 48%. Of the 48 patients with calf symptoms, 60% had neurological deficits. Of 22 patients with thigh symptoms, 45% had neurological deficits, and such deficits were found in 30% of the 30 patients with back pain only. Relevant roentgenographic findings were obtained in 84%; decreased disc height, osteoarthritic facet joints, end-plate fracture, narrow bony canal, disc bulge and disc prolapse. It is concluded that, in the evaluation of low-back disorders, survey x-ray examination is a valuable and necessary supplement to a detailed history and thorough clinical examination

311)         Pellegrino MJ, Waylonis GW, Sommer A. Familial occurrence of primary fibromyalgia. Arch Phys Med Rehabil 1989; 70(1):61-63.
Abstract: Seventeen families of patients with primary fibromyalgia were studied for evidence of inherited primary fibromyalgia. Fifty parents and siblings were included in the analysis. Twenty-six (52%, mean age 33.5 years) had characteristic symptoms and findings of primary fibromyalgia. Eleven (22%, mean age 28 years) were asymptomatic but had clinical evidence of abnormal muscle consistency to palpation without tender or trigger points. One person had clinical evidence of lupus. Thirteen (26%) had no evidence of fibromyalgia or abnormal muscle consistency. The mode of inheritance was autosomal dominant. Identical twins are described who developed symptoms of primary fibromyalgia within six months of each other, as are two brothers who developed abnormal palpable muscle consistency years before acquiring the characteristic findings of the fibromyalgia syndrome. Primary fibromyalgia may be an inherited condition with a variable latent stage before clinical expression of the disease

312)         Pellegrino MJ, Van Fossen D, Gordon C, Ryan JM, Waylonis GW. Prevalence of mitral valve prolapse in primary fibromyalgia: a pilot investigation. Arch Phys Med Rehabil 1989; 70(7):541-543.
Abstract: Fifty patients with primary fibromyalgia and a negative cardiovascular symptom history underwent echocardiography to determine the prevalence of mitral valve prolapse (MVP). The mean age of the population was 40 +/- 13 years (14 men, 36 women). Mitral valve prolapse was detected in 75%; 33% with myxomatous mitral valve leaflets. The prevalence of MVP in this population is significantly higher (p less than 0.0001) than in the general population. Primary fibromyalgia and MVP may be part of a more generalized connective tissue abnormality characterized by distinct genetically determined variants

313)         Povedano GJ, Salaberri MJ, Corteguera CM, Garcia LA. [Fibrositis as the presenting form of non-secreting myeloma]. Rev Clin Esp 1989; 185(2):107-108.

314)         Quimby LG, Gratwick GM, Whitney CD, Block SR. A randomized trial of cyclobenzaprine for the treatment of fibromyalgia. J Rheumatol Suppl 1989; 19:140-3.:140-143.
Abstract: We attempted a randomized, double blind trial of placebo vs cyclobenzaprine (Flexeril) in 40 female patients with fibromyalgia from a private rheumatology practice in Maine. Patient reports and physician global assessments indicated that cyclobenzaprine was more effective than placebo in alleviating symptoms of fibromyalgia in a subgroup of patients. However, most patients in the study had more accurate perceptions of drug effects than had been predicted and were able to identify the test drug. How much this awareness contributed to the perceived effectiveness of cyclobenzaprine is unknown

315)         Rogers EJ, Rogers R. Pain clinic #14. Fibromyalgia and myofascial pain: either, neither, or both? Orthop Rev 1989; 18(11):1217-1224.
Abstract: Musculoskeletal pain syndromes and the accompanying physical and emotional sequelae are frequent reasons for self-medication and physician visits. Most musculoskeletal pain syndromes are self-limited, periodically flaring up and subsiding. Fibrositis and myofascial pain syndromes, which affect a significant number of patients with musculoskeletal pain, should be clinically differentiated to reduce unnecessary work-ups and improve patient management at reduced costs. The more common pain locations are reviewed, and a cost-effective, comprehensive approach to management is outlined

316)         Rollman GB. Measurement of pain in fibromyalgia in the clinic and laboratory. J Rheumatol Suppl 1989; 19:113-9.:113-119.
Abstract: Fibromyalgia involves constant aching pain throughout the body and acute pain at widely distributed tender points. This review emphasizes the different aspects of the pain experience which are assessed by verbal questionnaires, analysis of descriptive adjectives, numerical and verbal category scales and visual analogue scales. There is a need for studies which utilize ratio scale techniques to measure the different components of the pain experience and which explore a wider range of behavioral and functional measures. Laboratory data on responsiveness at tender and nontender points, examined with respect to adaptation level and hypervigilance theories, suggest that patients with fibromyalgia are overly reactive to external events which other groups, both pain free and pain suffering, find innocuous

317)         Rosomoff HL, Fishbain DA, Goldberg M, Santana R, Rosomoff RS. Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain 1989; 37(3):279-287.
Abstract: Chronic intractable benign pain (CIBP) is defined as non-neoplastic pain of greater than 6 months duration without objective physical findings and known nociceptive peripheral input. To test the CIBP concept, 283 consecutive chronic pain patients were examined independently by a neurosurgeon and physiatrist and only congruent physical findings were coded. Because they did not fit the CIBP definition, patients with the following primary treatment diagnoses were eliminated: degenerative disease of the spine and spinal stenosis; degenerative disease of the hips; radiculopathy; malignancy; deafferentation pain; and miscellaneous. Eliminated, also, were patients with any one finding indicative of a root compression syndrome, leaving 90 low back and 34 neck patients. These patients had abnormal physical findings in 7 categories: tender points/trigger points; decreased ranges of motion in back or neck; non-anatomical sensory loss; rigid musculature; decreased range of hip motion; gait disturbance; and miscellaneous non-neurologic signs. Low back CIBP patients had the following distribution among the 7 categories: 0% had findings of all 7; 1.1% had 6; 13.3% had 5; 24.4% had 4; 25.6% had 3; 26.7% had 2; 8.9% had 1; and 0% had none. Neck CIBP patients, in which only the first 4 categories of physical findings were applicable had the following distribution: 2.9% had 4; 41.2% had 3; 35.3% had 2; 20.6% had 1; and 0% had none. It was concluded that CIBP patients do have abnormal physical findings indicative of musculoskeletal disease: possibly fibrositis and/or specific myofascial syndromes, as sources of peripheral nociception. These findings question the validity of the CIBP concept and point to the need for a careful, all-inclusive physical examination as a basic initial requirement in the classification of chronic pain patients

318)         Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989; 19:158-63.:158-163.
Abstract: Free plasma tryptophan levels in patients with fibrositis syndrome were measured by Moldofsky and Warsh with the view that the pathogenesis of fibrositis syndrome might involve a functional deficiency of serotonin. The hypothesis was supported by the finding of an inverse relationship between tryptophan concentration and the severity of musculoskeletal pain. Our study examined the total serum amino acid pool in fibrositis syndrome. Twenty patients with primary fibrositis syndrome and matched normal controls were evaluated clinically. After denaturation of macromolecules, serum amino acids were quantitated by automated analysis. Patients with fibrositis syndrome exhibited significantly lower levels of total serum tryptophan (p = 0.002), as well as 6 other amino acids: alanine (p less than 0.0005), histidine (p = 0.001), lysine (p = 0.02), proline (p = 0.039), serine (p = 0.028), and threonine (p = 0.013). These findings support the serotonin deficiency hypothesis for fibrositis syndrome pathogenesis but also imply a more generalized defect in amino acid homeostasis among affected individuals

319)         Russell IJ. Neurohormonal aspects of fibromyalgia syndrome. Rheum Dis Clin North Am 1989; 15(1):149-168.
Abstract: There is a growing awareness that fibrositis/fibromyalgia syndrome is a systemic disorder for which a pathogenic mechanism must be sought. A generalized deficiency of the neurotransmitter, serotonin could explain many of fibromyalgia's typical manifestations. The serotonin deficiency hypothesis is appealing because it provides a number of experimental approaches that can now be used to further study the pathogenesis of this disorder

320)         Scudds RA, Trachsel LC, Luckhurst BJ, Percy JS. A comparative study of pain, sleep quality and pain responsiveness in fibrositis and myofascial pain syndrome. J Rheumatol Suppl 1989; 19:120-6.:120-126.
Abstract: Twenty patients with fibrositis and 19 patients with myofascial pain syndrome were compared with regard to pain levels, sleep quality, general pain threshold and localized pain responsiveness at fibrositic tender points. Patients with fibrositis had significantly lower pain responsiveness (p less than 0.01), lower pain threshold (p less than 0.05) and higher pain levels (p less than 0.05) than patients with myofascial pain syndrome when differences in age between the groups were controlled. No significant difference was found for sleep quality. Regional pain levels influenced local measures of pain sensitivity. A discriminant function, developed on the 4 main study variables, resulted in an almost 80% correct classification to groups

321)         Scudds RA, McCain GA, Rollman GB, Harth M. Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline. J Rheumatol Suppl 1989; 19:98-103.:98-103.
Abstract: Thirty-six patients with fibrositis received low dose amitriptyline and placebo in a randomized double blind crossover study lasting 10 weeks. Amitriptyline was associated with significant changes on the outcome measures of pain, tender point sensitivity and patient assessment of well being. Clinically significant improvements for pain and tender point sensitivity and a statistically significant improvement in generalized pain responsiveness were found between patients who reported subjective improvement on amitriptyline and those who felt no change

322)         Smythe H. Fibrositis syndrome: a historical perspective. J Rheumatol Suppl 1989; 19:2-6.:2-6.
Abstract: This paper traces the history of disturbed sleep, deep pain and exhaustion from biblical times to the present. This historical review provides the stage for the papers that follow in this volume on fibrositis syndrome

323)         Stander PE. Polymyalgia rheumatica. Clinical features and management. Postgrad Med 1989; 86(5):131-3, 136, 138.
Abstract: Polymyalgia rheumatica is a clinical syndrome that occurs almost exclusively in older patients. It is characterized by muscle aching and stiffness and an elevated erythrocyte sedimentation rate. It must be distinguished from other common disorders, particularly polymyositis, fibromyalgia, and other chronic inflammatory or neoplastic diseases. A temporal artery biopsy should be done in patients with confirmed polymyalgia rheumatica and suspected coexistent temporal arteritis, which can have serious manifestations. Patients with polymyalgia rheumatica respond dramatically to low doses of corticosteroids, although prolonged daily treatment often may be needed

324)         Stavem P. [Fibromyalgia]. Tidsskr Nor Laegeforen 1989; %20;109(29):3039.

325)         Strosberg JM, Thomas L, Buchan AM. Fibromyalgia: another viewpoint. J Rheumatol 1989; 16(2):247-248.

326)         Tanimoto K. [Criteria for the diagnosis of primary fibromyalgia syndrome]. Ryumachi 1989; 29(3):228-230.

327)         Truta MP, Santucci ET. Head and neck fibromyalgia and temporomandibular arthralgia. Otolaryngol Clin North Am 1989; 22(6):1159-1171.
Abstract: The attentive clinician can no longer be satisfied with global diagnostic categories such as "TMJ syndrome" or "MPD syndrome." Nor can one be content with nonspecific diagnostic testing or generic referral. This article has outlined specific components of head and neck pain originating in the masticatory musculoskeletal system. Much progress has been made in recent years, particularly in regard to diagnostic imaging. The future will bring us data on long-term treatment efficacy and a better understanding of chronic pain conditions that lack discrete organic lesions. Finally, the manifestation of psychiatric or psychologic abnormalities as pain is under scientific scrutiny and a better understanding of conversion phenomena will assure proper use of available treatment modalities

328)         Turk DC, Flor H. Primary fibromyalgia is greater than tender points: toward a multiaxial taxonomy. J Rheumatol Suppl 1989; 19:80-6.:80-86.
Abstract: Primary fibromyalgia remains a controversial and puzzling condition. The diagnosis is based on subjective symptoms, exclusionary criteria and the presence of tender points. Much of the discussion of primary fibromyalgia centers on physical or psychological bases for the etiology, exacerbation and maintenance of the symptoms. An alternative to the current dichotomous way of conceptualizing primary fibromyalgia is presented based on a multiaxial perspective that integrates physical, psychosocial and behavioral factors creating an empirically derived taxonomy. The utility of this approach is illustrated from research with groups of patients with chronic pain. The implications of the multiaxial taxometric approach for understanding primary fibromyalgia and its treatment are described

329)         Vaeroy H, Sakurada T, Forre O, Kass E, Terenius L. Modulation of pain in fibromyalgia (fibrositis syndrome): cerebrospinal fluid (CSF) investigation of pain related neuropeptides with special reference to calcitonin gene related peptide (CGRP). J Rheumatol Suppl 1989; 19:94-7.:94-97.
Abstract: The cerebrospinal fluid (CSF) levels of calcitonin gene related peptide (CGRP) were 0.94 +/- 0.06 fmol/ml (mean +/- SEM), of substance P, 35.1 +/- 3.2 fmol/ml and of substance P (1-7), 10.8 +/- 1.2 fmol/ml, as measured by radioimmunoassay in 26 female patients with fibromyalgia. No correlation was found between the levels of CGRP and the substance P and substance P (1-7) levels (r = 0.316, p = 0.14). Our results show that the anatomical coexistence of pain related neuropeptides in neurons is not necessarily reflected by the levels of these peptides measured in the CSF. The presence of CGRP in the CSF could be important since it can enhance the nociceptive activity of tachykinins. This may be of importance in the pathogenesis of pain in fibromyalgia

330)         Vaeroy H, Abrahamsen A, Forre O, Kass E. Treatment of fibromyalgia (fibrositis syndrome): a parallel double blind trial with carisoprodol, paracetamol and caffeine (Somadril comp) versus placebo. Clin Rheumatol 1989; 8(2):245-250.
Abstract: Forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo. Twenty-three patients received placebo and twenty active medication. In the placebo group 56.5% of the patients used additional analgesics or nonsteroidal anti-inflammatory drugs compared to only 20% in the active treatment group (p = 0.015). Forty-three percent of the patients in the placebo group and none of the patients in the active treatment group used tricyclic antidepressants, anxiolytics or sedatives (p = 0.0008). Active treatment gave statistically significant improvement after treatment for pain (p less than 0.01), for sleep quality (p less than 0.01) and for the general feeling of sickness (p less than 0.05). In the active treatment group increased pressure pain threshold after eight weeks was found at 70% of the sites measured, while the pressure pain threshold was increased at only 30% of the sites in the placebo group. In the placebo group improvement was found for the pain and sleep quality (p less than 0.05). This improvement may in part be due to the large amounts of extra medication in this group. Thus, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia

331)         Vaeroy H, Qiao ZG, Morkrid L, Forre O. Altered sympathetic nervous system response in patients with fibromyalgia (fibrositis syndrome). J Rheumatol 1989; 16(11):1460-1465.
Abstract: Twenty-seven female patients with fibromyalgia and 29 female healthy controls underwent an auditive stimulation test and a left hand cold pressor test at 10 and 4 degrees C. The microcirculatory changes observed, indicate that, as a response to 80 dB, 1000 Hz, 2 seconds sounds and cooling with associated pain, the vasoconstrictory responses are less in patients with fibromyalgia than in normal controls. This could indicate altered sympathetic nervous activity in patients with fibromyalgia and that the cutaneous manifestations previously interpreted as Raynaud's phenomenon should be reconsidered

332)         Vitali C, Tavoni A, Rossi B, Bibolotti E, Giannini C, Puzzuoli L et al. Evidence of neuromuscular hyperexcitability features in patients with primary fibromyalgia. Clin Exp Rheumatol 1989; 7(4):385-390.
Abstract: The presence of clinical and electromyographic (EMG) features of neuromuscular hyperexcitability (NMHE) and of the commonly associated neurovegetative disturbances (NVD) were investigated in 49 patients with primary fibromyalgia (PF) and in a control group of 33 patients with rheumatoid arthritis (RA). At least two clinical features of NMHE were present in 39%, and at least three NVD in 63% of PF patients. In contrast, only 1 RA control had two NMHE features (p greater than 0.005) and three NVD (p less than 0.001). Moreover, a significant post-ischemic spontaneous EMG hyperactivity was observed in 11 PF patients, and in only 1 control with RA (p less than 0.05). Finally, in patients with PF the number of tender points were correlated with psychological tests for depression (p less than 0.02), and the number of NVD. The present study shows that in patients with PF there is a large prevalence of NMHE complaints and NVD. The potential underlying pathogenetic mechanisms are also discussed

333)         Vitali C, Taroni A. Criteria for the classification of primary fibromyalgia syndrome (fibrositis): an unsolved problem. Clin Exp Rheumatol 1989; 7(1):1-3.

334)         Vitali C, Tavoni A, Neri R, Castrogiovanni P, Pasero G, Bombardieri S. Fibromyalgia features in patients with primary Sjogren's syndrome. Evidence of a relationship with psychological depression. Scand J Rheumatol 1989; 18(1):21-27.
Abstract: The prevalence of musculoskeletal complaints suggestive of the fibromyalgia syndrome (FS) was evaluated in 30 patients with primary Sjogren's syndrome (1 degree SS) and in two control groups of patients with osteoarthritis (OA) and diabetes mellitus (DM). In addition, the presence of depressive state was investigated in patients and controls using the Hamilton rating scale and an Italian self-evaluating test. Fibromyalgia features were found in 14 1 degree SS patients (47%), in 21 OA (70%) and in 10 DM (33%) controls. 1 degree SS patients showed the highest prevalence (47%) of moderate-severe depression with respect to OA (20%) and DM (7%) groups (p less than 0.01). Furthermore, while FS features correlated closely with both tests for depression in 1 degree SS (p less than 0.001), this correspondence was absent or much less significant in the other disease groups. Finally, neither psychopathological features nor FS complaints appeared to be related to the other clinical and serological findings of 1 degree SS

335)         Wallace DJ, Bowman RL, Wormsley SB, Peter JB. Cytokines and immune regulation in patients with fibrositis. Arthritis Rheum 1989; 32(10):1334-1335.

336)         Wilke WS, Corbo DD. Fibrositis/fibromyalgia: causes and treatment. Compr Ther 1989; 15(1):47-54.

337)         Wolfe F. The design of a fibromyalgia criteria study. J Rheumatol Suppl 1989; 19:180-4.:180-184.
Abstract: Increasing recognition of the fibromyalgia syndrome together with concerns about limitations of currently available criteria led most centers engaged in fibromyalgia research in Canada and the United States to undertake a multicenter effort to define epidemiologically correct criteria for the diagnosis of fibromyalgia. Five hundred fifty-eight consecutive patients (293 with fibromyalgia and 265 controls) were recruited from 16 private practice and university centers. The study used training sessions to increase interrater reliability, and included methods to determine reliability of examination and historical data. Standardized definition and methods of data acquisition by independent, blinded assessors were employed

338)         Wolfe F. Age of death of parents of patients with rheumatoid arthritis: data from a middle class sample. J Rheumatol 1989; 16(6):735-739.
Abstract: To test the observation that was made in a largely nonwhite, lower socioeconomic class clinic sample that parents of patients with rheumatoid arthritis (RA) had an earlier age of death than control parents, we determined parental age of death in 499 patients with RA and 491 controls (381 with osteoarthritis and 110 with fibromyalgia). Patients and controls were largely white (greater than 94%) and had a mean education level greater than 12 years. Parents did not differ in survival time or age of death at the 0.05 level, but parents in our series lived 6 years longer than those studied in the lower socioeconomic community

339)         Wolfe F. Fibromyalgia: the clinical syndrome. Rheum Dis Clin North Am 1989; 15(1):1-18.
Abstract: Fibromylagia is a painful musculoskeletal disorder composed of core features that are always present (wide-spread pain and tenderness), characteristic features that are present more than 75 per cent of the time (fatigue, nonrefreshed sleep, and morning stiffness), and common features that are present more than 25 per cent of the time (for example, paresthesia, irritable bowel syndrome, functional disability). The syndrome is common, occurring in 2.1 per cent of family practice clinic patients, 5 per cent of general medical patients, and 10 to 20 per cent of rheumatic disease clinic patients. Evolving diagnostic criteria permit identification of patients for clinical and research purposes

340)         Yunus MB, Berg BC, Masi AT. Multiphase skeletal scintigraphy in primary fibromyalgia syndrome: a blinded study. J Rheumatol 1989; 16(11):1466-1468.
Abstract: Sixteen patients with primary fibromyalgia syndrome were assessed blindly by multiphase skeletal scintigraphy to detect possible subclinical synovitis and uptake abnormalities at tender point sites. Results were normal in 14 of the 16 patients. Mild and localized abnormalities were found in 2 patients and were possibly due to the trauma of overuse. Our multiphase skeletal scintigraphy study showed that synovitis, other evidence of arthritis, or abnormalities at tender point sites were not increased above normal expectation among our sample of patients studied with fibromyalgia

341)         Yunus MB. Primary fibromyalgia syndrome: a critical evaluation of recent criteria developments. Z Rheumatol 1989; 48(5):217-222.
Abstract: Although nonspecific musculoskeletal aching of nonarticular origin has been described in European literature since the 17th century under such names as muscular rheumatism, the fibrositis syndrome with generalized musculoskeletal aches or stiffness, fatigue, poor sleep, and multiple tender points as a characteristic rheumatologic entity was not described until the 1960s. Smythe first suggested criteria for this condition based on clinical experience in the 1970s. However, the first data-based criteria of "fibrositis" (appropriately called fibromyalgia) was not published until 1981. Since then other criteria have been published, and in 1989 criteria studies on fibromyalgia with appropriate design and controls were reported. This article critically evaluates current criteria developments in fibromyalgia

342)         Yunus MB, Kalyan-Raman UP. Muscle biopsy findings in primary fibromyalgia and other forms of nonarticular rheumatism. Rheum Dis Clin North Am 1989; 15(1):115-134.
Abstract: Virtually all the reports on muscle biopsy in chronic muscle pain conditions, except those of primary fibromyalgia syndrome (PFS) published recently, have inadequate methodologic information, particularly on definition of cases, and lack controlled materials, so that no firm conclusions may be made. A limited number of controlled studies of muscle biopsy in PFS suggest that results are negative by usual light microscopic, histochemical, and electron microscope examinations. The findings of abnormal rubber band-like structures and interconnecting network of reticular or elastic fibers in muscle fibers of certain PFS patients in a single study need to be confirmed by other centers by careful controlled and blinded observations. The findings that high-energy phosphate levels in tender PFS muscles are significantly reduced appear valid and important, and need to be independently confirmed by well-designed controlled and blinded studies. Finally, biopsy reports of unspecified or unclarified muscle pain syndromes should not be assumed to be those related to PFS, and such invalid references must be avoided

343)         Yunus MB. Fibromyalgia syndrome: new research on an old malady. BMJ 1989; 298(6672):474-475.

344)         Yunus MB, Masi AT, Aldag JC. Short term effects of ibuprofen in primary fibromyalgia syndrome: a double blind, placebo controlled trial. J Rheumatol 1989; 16(4):527-532.
Abstract: Therapeutic effects of ibuprofen were evaluated in 46 patients with primary fibromyalgia syndrome in a double blind, placebo controlled study for 3 weeks and in an open trial for another 3 weeks. Several features of primary fibromyalgia syndrome, including number of pain sites, fatigue, swelling feeling, and tender points significantly improved over time in both groups. However, no significant differences were found between the ibuprofen and placebo groups. Improvements in fibromyalgia features might have occurred as a result of physician or study interactions (i.e., an intervention effect). An important observation in our blinded study was that tender point sites among patients with fibromyalgia were significantly (p less than 0.001) consistent at 3 as well as 6 weeks when compared with the baseline

345)         Yunus MB, Masi AT, Aldag JC. Preliminary criteria for primary fibromyalgia syndrome (PFS): multivariate analysis of a consecutive series of PFS, other pain patients, and normal subjects. Clin Exp Rheumatol 1989; 7(1):63-69.
Abstract: Primary fibromyalgia syndrome (PFS) is a common form of nonarticular rheumatism with chronic and generalized musculoskeletal aching and stiffness, accompanied by tender points at characteristic sites in the absence of an underlying condition. No satisfactory criteria for its diagnosis, based on appropriate controlled studies, have yet been proposed. We undertook such a study which included a consecutive series of clinically diagnosed PFS and compared them with 3 control groups--mild rheumatoid arthritis, localized fibromyalgia secondary to trauma and normal controls. Multivariate statistical analysis plus clinical judgement identified 6 historical features and 7 pairs of tender points that best discriminated PFS from the control groups. The criteria, derived from a combination of these historical features and tender points, provided greater than 90% sensitivity and specificity. In an independent and consecutive sample of 45 PFS patients, the criteria yielded a sensitivity of 89%. The present study indicates that a combination of historical features and TP's will likely provide effective PFS criteria

346)         Yunus MB, Masi AT, Aldag JC. A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes. J Rheumatol Suppl 1989; 19:62-71.:62-71.
Abstract: One hundred and thirteen patients with primary fibromyalgia syndrome, 77 with rheumatoid arthritis (RA) and 67 healthy controls without significant aches or pains were studied by protocol to determine clinical features of primary fibromyalgia syndrome and to assess the possible association of primary fibromyalgia syndrome with common functional disorders compared with the control groups. Previously reported common features of primary fibromyalgia syndrome are confirmed in this controlled study. In addition the extent of cutaneous hyperemia on palpation was found to be greater in patients with primary fibromyalgia syndrome than in normal controls. All the 3 functional syndromes evaluated, e.g., irritable bowel, chronic functional headache and primary dysmenorrhea, were significantly (p less than 0.005) more common in primary fibromyalgia syndrome, compared with RA and normal control groups. These data suggest that primary fibromyalgia syndrome is a characteristic clinical condition that overlaps with other well recognized functional syndromes

347)         Yunus MB, Kalyan-Raman UP, Masi AT, Aldag JC. Electron microscopic studies of muscle biopsy in primary fibromyalgia syndrome: a controlled and blinded study. J Rheumatol 1989; 16(1):97-101.
Abstract: Trapezius muscle biopsy was carried out in 21 patients with primary fibromyalgia syndrome (PFS) and 11 healthy controls, and assessed blindly by electron microscopy. Common findings in both the PFS and control groups were mild myofibrillar separation, papillary projections and subsarcolemmal accumulation of glycogen. However, the differences between the 2 groups were not statistically significant in any of the findings

348)         [1990 classification criteria of fibromyalgia from the American College of Rheumatology. Report of the Multicenter Criteria Committee]. Union Med Can 1990; 119(5):272.

349)         [Primary fibromyalgia syndrome]. Ned Tijdschr Geneeskd 1990; %19;134(20):1015-1016.

350)         Appelboom T, Schoutens A. High bone turnover in fibromyalgia. Calcif Tissue Int 1990; 46(5):314-317.
Abstract: This paper seeks to determine if patients with a fibromyalgic syndrome have specific abnormalities of skeletal homeostasis. Radioisotopic evaluation of skeletal remodeling showed higher Fogelman index and increased 24-hour pyrophosphate retention in the group of fibromyalgics (n = 28) when compared to the control group (n = 16). Bone density (lumbar vertebrae and femoral neck) was not significantly different from control subjects. These data might suggest an accelerated bone metabolism in these patients

351)         Bengtsson A, Cederblad G, Larsson J. Carnitine levels in painful muscles of patients with fibromyalgia. Clin Exp Rheumatol 1990; 8(2):197-198.

352)         Bengtsson A, Ernerudh J, Vrethem M, Skogh T. Absence of autoantibodies in primary fibromyalgia. J Rheumatol 1990; 17(12):1682-1683.
Abstract: Sera from patients with primary fibromyalgia (223 sera, 210 women; 13 men) were analyzed, by immunofluorescence microscopy, for the presence of antibodies directed against cell nuclei (ANA), smooth muscle, mitochondria and other tissue antigens present in cryostat sections of rat organs (liver, kidney and stomach). Sera from blood donors (255 sera, 75 women; 180 men) served as a comparative group. The occurrence of serum autoantibodies in patients with fibromyalgia did not differ significantly from the reference group. Our results differ from those of others, who have suggested a relation between fibromyalgia and inflammatory rheumatic diseases

353)         Boulware DW, Schmid LD, Baron M. The fibromyalgia syndrome. Could you recognize and treat it? Postgrad Med 1990; 87(2):211-214.
Abstract: Many of your patients may complain of innumerable "aches and pains." One possible diagnosis for these symptoms is the fibromyalgia syndrome, a common musculoskeletal condition. This article provides information to help you increase your ability to recognize, understand, and treat this condition

354)         Brier SR. Lyme disease. J Manipulative Physiol Ther 1990; 13(6):337-339.
Abstract: A 29-year-old male tennis player was examined for neck pain, limited mobility, and right elbow pain. The patient was treated for cervical facet syndrome by chiropractic manipulative therapy (CMT) for a period of 6 weeks. After this time the patient had a relapse of cervical pain, spinal myofascitis, dermatitis and migratory arthropathy. Several specialists were consulted throughout the case including a rheumatologist, and a tentative diagnosis of psoriatic arthritis and fibromyalgia was made. A follow-up blood evaluation led to a new diagnosis of Lyme disease

355)         Buskila D, Gladman DD, Langevitz P, Urowitz S, Smythe HA. Fibromyalgia in human immunodeficiency virus infection. J Rheumatol 1990; 17(9):1202-1206.
Abstract: Tenderness was assessed by point count and by scored palpation in 51 patients with human immunodeficiency virus (HIV) infection as well as 51 patients with rheumatoid arthritis (RA) and 50 patients with psoriatic arthritis (PsA). Fifteen of 51 (29%) patients with HIV infection met criteria for fibromyalgia, based on the presence of 10 tender (of 14) "fibrositic" points. Similar results were observed among patients with PsA (24%). The prevalence of fibromyalgia was higher among patients with RA (57%). Patients with HIV and PsA were less tender than patients with RA. Fibromyalgia in patients with HIV was significantly associated with myalgia and arthralgia, but not with age, duration of HIV infection, stage of HIV disease, or zidovudine therapy

356)         Calabozo RM, Llamazares Gonzalez AI, Munoz Gallo MT, Alonso-Ruiz A. [Fibromyalgia syndrome (fibrositis): as frequent as it is unknown]. Med Clin (Barc ) 1990; 94(5):173-175.
Abstract: Fibromyalgia syndrome is characterized by generalized musculoskeletal pain and abnormal sensitivity to palpation of characteristic myofascial areas. We evaluated its prevalence in the 673 patients seen as first consultations in a hospital rheumatological outpatient clinic during one year, and we made an automatized review of the Spanish literature about this condition in the last 17 years. We found 70 cases (10.4%) of fibromyalgia syndrome, none of which had been referred to the hospital with this diagnosis. We report their clinical features. In our bibliographical search we found only one article describing this condition. We conclude that it is a common clinical syndrome, unknown in nonspecialized milieus. Generally, the patients are inadequately diagnosed and treated, and/or referred to hospital

357)         Caruso I, Sarzi PP, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990; 18(3):201-209.
Abstract: A double-blind, placebo-controlled study of the efficacy and tolerability of 5-hydroxytryptophan (5-HTP) was conducted in 50 patients with primary fibromyalgia syndrome. All the clinical parameters studied were significantly improved by treatment with 5-HTP and only mild and transient side-effects were reported. Further controlled studies are required to define properly the value of 5-HTP in patients with primary fibromyalgia syndrome

358)         Cohen MD, Ginsburg WW. Polymyalgia rheumatica. Rheum Dis Clin North Am 1990; 16(2):325-339.
Abstract: Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle. The aching should be present for greater than one month. Polymyalgia rheumatica may be more common than reported. The etiology remains unknown. There is generally little found pathologically in this disease. The physical examination is often not impressive. Synovitis may be a main contributing factor to many of the symptoms seen in patients with polymyalgia rheumatica. Symptoms often do not correlate with physical findings. Polymyalgia rheumatica must be differentiated from many conditions since the diagnosis remains entirely clinical. Osteoarthritis, flu syndromes, inflammatory myopathies, fibromyalgia, and depression all have features that may mimic polymyalgia rheumatica. Malignancies and infections may also be difficult to separate from polymyalgia rheumatica. Polymyalgia rheumatica may also be extremely difficult to differentiate from seronegative rheumatoid arthritis in patients older than 50 years. Although some patients with polymyalgia rheumatica have underlying giant cell arteritis, the majority apparently do not. The distinction between polymyalgia rheumatica and giant cell arteritis cannot be made on the basis of laboratory studies and relies solely on clinical symptoms and physical findings. Although nonsteroidal antiinflammatory medications may control symptoms in patients with mild disease, most patients with polymyalgia rheumatica require low-dose corticosteroids. The tapering schedule for the corticosteroids is contingent upon the response of symptoms and laboratory parameters. Polymyalgia rheumatica usually follows a benign course with almost complete response to an adequate treatment program. Recently, there have been several studies suggesting that the course of polymyalgia rheumatica may not be as short and simple as once proposed. Nevertheless, many patients may be completely weaned from corticosteroids. Other agents have been used in this disease, but for the most part their use remains somewhat controversial. Patients must be monitored carefully. Most patients do well, and treatment is effective

359)         Colquhoun D. Re-analysis of clinical trial of homoeopathic treatment in fibrositis. Lancet 1990; 336(8712):441-442.

360)         Cueni M. [A case from practice (157). Generalized tendomyopathy (fibrositis syndrome)]. Schweiz Rundsch Med Prax 1990; 79(1-2):23-24.

361)         Dailey PA, Bishop GD, Russell IJ, Fletcher EM. Psychological stress and the fibrositis/fibromyalgia syndrome. J Rheumatol 1990; 17(10):1380-1385.
Abstract: The relationship of stress and social support to the fibrositis/fibromyalgia syndrome (FS) was investigated by administration of 4 questionnaire instruments to 28 patients with FS, 20 patients with rheumatoid arthritis (RA) and 28 pain-free normal controls. FS showed higher levels of stress as measured by daily "hassles" than did RA or controls. However, on a measure of major life stress, they reported lower levels. No differences were found between groups with regard to daily "uplifts" or social support. Correlations between those measures of stress and social support with their scores on the Arthritis Impact Measurement Scale showed that the Hassles Scale was significantly related to the AIMS Psychological component

362)         Doherty M, Abawi J, Pattrick M. Audit of medical inpatient examination: a cry from the joint. J R Coll Physicians Lond 1990; 24(2):115-118.
Abstract: We undertook an audit of 200 general medical inpatients in a teaching hospital to investigate how often the locomotor system is omitted from routine medical clerking, and the impact this may have on patient care. The 104 men and 96 women (mean age 66; range 16-91 years) were interviewed and examined in the non-critical phase of admission; 42.5% had locomotor symptoms and 53.5% locomotor signs. Common problems were small or large joint osteoarthritis (39%), soft tissue lesions (9%), cervical and lumbar spondylosis (5.5%) and fibromyalgia (5%); 12% had more than one locomotor diagnosis. However, locomotor symptoms and signs (positive or negative) were recorded in their hospital notes in only 14.5% and 5.5% respectively. This compared poorly with recorded examination of other systems and regions (eg cardiovascular 100%; respiratory 99.5%; abdomen 99%; nervous system 77%; skin 13%; female breasts 13%); 92% of rheumatic lesions had been missed and treatment of symptomatic patients was omitted or considered inadequate in 94%. It is apparent that, despite a high frequency of locomotor disorders, locomotor system screening is often omitted from routine medical clerking. Many missed conditions are both significant and eminently treatable. Such discrepancy compared with screening of other systems requires consideration during planning of undergraduate training

363)         Drake ME, Jr., Pakalnis A, Andrews JM, Bogner JE. Nocturnal sleep recording with cassette EEG in chronic headaches. Headache 1990; 30(9):600-603.
Abstract: Many headache patients complain of poor sleep, and sleep disturbance has been shown to play a role in chronic pain. We recorded nocturnal sleep with a 4-channel cassette EEG monitoring device in 10 common migraine patients, 10 individuals with muscle contraction (tension) headache, and 10 chronic tension-vascular headache sufferers. Migraine patients had essentially normal sleep, although rapid eye movement (REM) sleep and REM latency were increased. Patients with tension headache had reduced sleep time and sleep efficiency, decreased sleep latency but frequent awakenings, increased nocturnal movements, and marked reduction in slow wave sleep, without change in REM sleep or latency. Mixed-element headaches with both tension and vascular features were associated with reduced sleep, increased awakening, diminished slow wave sleep, and REM sleep that was decreased in amount and reduced in latency. The findings suggest that patients with intermittent migraine may have minimal sleep disturbance, while chronic headache may be worsened by chronically poor sleep. Muscle contraction headache may be associated with frequent awakenings and decreased slow wave sleep similar to the sleep changes of fibrositis, while chronic tension-vascular headache may have a depressive substrate. Four-channel sleep recording may miss contributory sleep apnea, but nonetheless cassette EEG may facilitate outpatient evaluation of refractory headaches

364)         Drewes AM. [Primary fibromyalgia]. Nord Med 1990; 105(3):78-81.
Abstract: Primary fibromyalgia is probably a frequent disregarded disease, making differential diagnostic problems towards other kinds of rheumatologic diseases. The clinical manifestations, pathogenesis and treatment of primary fibromyalgia are discussed and the literature reviewed

365)         Eisinger J, Ayavou T. Transketolase stimulation in fibromyalgia. J Am Coll Nutr 1990; 9(1):56-57.

366)         Enestrom S, Bengtson A, Lindstrom F, Johan K. Attachment of IgG to dermal extracellular matrix in patients with fibromyalgia. Clin Exp Rheumatol 1990; 8(2):127-135.
Abstract: Deposits of IgG localized to collagen bundles/extracellular matrix components occurred in skin biopsies from patients with primary fibromyalgia (PF). None of these patients demonstrated a positive lupus band test. Control skin biopsies from healthy controls were negative but showed intense reactivity for IgG after collagenase treatment. PF-skin attached both homologous and heterologous serum IgG in indirect immunofluorescence, which may point to a qualitative alteration of dermal matrix components in PF. Skin from patients with systemic lupus erythematosus and rheumatoid arthritis showed a lower dermal fluorescence intensity than in PF patients. The cause of the presence of IgG in dermal tissue from PF patients is unclear. It may be caused by a non-specific attachment of IgG to the extracellular matrix related, for example, to tissue hypoxia and/or increased capillary leakage due to an increased number of mast cells in the PF-skin

367)         Fasmer OB. [Do antidepressive agents have analgesic effects?]. Tidsskr Nor Laegeforen 1990; 110(18):2370-2372.
Abstract: Patients with chronic pain are often depressed, and antidepressants have been widely used in the treatment of these patients. Well controlled clinical studies have shown that antidepressants have analgesic effects, apparently independent of changes in mood, and in lower doses than used in the treatment of depression. Good results have been reported for several types of chronic pain, especially headache and facial pain, arthritis, fibromyalgia and neuralgias. In addition, antidepressants have also an indirect analgesic action by relieving a depressive condition associated with chronic pain

368)         Ferraccioli G, Cavalieri F, Salaffi F, Fontana S, Scita F, Nolli M et al. Neuroendocrinologic findings in primary fibromyalgia (soft tissue chronic pain syndrome) and in other chronic rheumatic conditions (rheumatoid arthritis, low back pain). J Rheumatol 1990; 17(7):869-873.

369)         Finestone DH, Ober SK. Fluoxetine and fibromyalgia. JAMA 1990; 264(22):2869-2870.

370)         Fisher P, Huskisson EC, Turner P, Belon P. Homoeopathic treatment of fibrositis. Lancet 1990; 336(8720):954.

371)         Forslind K, Fredriksson E, Nived O. Does primary fibromyalgia exist? Br J Rheumatol 1990; 29(5):368-370.
Abstract: Twenty-one of 25 consecutive primary fibromyalgia or fibrositis patients, identified during a 5-year period in a tertiary care day-ward for pain syndromes, were re-examined. Fifteen fulfilled criteria for fibromyalgia but unexpectedly, all cases had either psychiatric disturbance or thyroid dysfunction. Of the four patients not seen at follow-up, two had developed neurological diseases, another rheumatoid arthritis and one other hypothyroidism. Thus, after 5 years no patient fulfilled the criteria for primary fibromyalgia. Women occupied as manual workers were over-represented. Most patients reported beneficial effects of physiotherapy. None of the patients has been able to return to full time work

372)         Freundlich B, Leventhal LJ. Comment on the 1990 American College of rheumatology criteria for fibromyalgia. Arthritis Rheum 1990; 33(12):1863-1864.

373)         Gam F. [Primary fibromyalgia--a new disease?]. Nord Med 1990; 105(5):143.

374)         Gamstorp I. [Fibromyalgia is a syndrome not a diagnosis]. Nord Med 1990; 105(5):143.

375)         Gaston-Johansson F, Gustafsson M, Felldin R, Sanne H. A comparative study of feelings, attitudes and behaviors of patients with fibromyalgia and rheumatoid arthritis. Soc Sci Med 1990; 31(8):941-947.
Abstract: The purpose of this explorative study was to administer a battery of questionnaires related to a broad number of psychosocial factors in patients with fibromyalgia syndrome (FS). By doing this, psychological factors associated with the consequences of chronic pain in patients with FS could be identified and studied in more depth. Thirty-one patients with FS were compared to 30 patients with rheumatoid arthritis (RA) with regard to feelings about self, pain/ache preoccupation, support from significant others, psychosomatic symptoms, activities of daily living, job satisfaction, and future expectations. The results of the study showed that patients with FS had significantly more negative feelings toward themselves, were more preoccupied with thinking about their pain/ache, received more practical help from significant others, experienced more limitations with regard to activities of daily living, and experienced more negative feelings about employment than patients with RA. Patients with FS were also more pessimistic about future employment than RA patients

376)         Goldenberg DL, Simms RW, Geiger A, Komaroff AL. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum 1990; 33(3):381-387.
Abstract: We administered a standardized history questionnaire and performed a tender point examination on 27 patients with debilitating fatigue of at least 6 months duration, seen in a primary care practice, as well as on 20 patients with fibromyalgia. Sixteen of the 27 patients with chronic fatigue met the full criteria for the working case definition of chronic fatigue syndrome (CFS). Eight patients with chronic fatigue denied having any current persistent, diffuse musculoskeletal pain, and their tender point scores were similar to those in 10 normal control subjects. In contrast, 19 patients with chronic fatigue (70%) had persistent, diffuse musculoskeletal pain. The results of their tender point examinations were similar to those of the patients with fibromyalgia. Thus, the majority of these patients with debilitating chronic fatigue, including those who met criteria for CFS, met the historical and tender point diagnostic criteria for fibromyalgia. The presence of current musculoskeletal pain will identify those CFS patients who have fibromyalgia

377)         Guedj D, Weinberger A. Effect of weather conditions on rheumatic patients. Ann Rheum Dis 1990; 49(3):158-159.
Abstract: In a one month prospective study of 62 rheumatic patients--16 with rheumatoid arthritis (RA), 24 with osteoarthritis (OA), 11 with inflammatory arthritis, 11 with fibromyalgia joint pain--swelling and everyday activity was compared with changes in daily weather conditions. In most patients weather changes increased arthritic symptoms. Women were more sensitive to weather than men (62% v 37%). Pain was affected positively by barometric pressure and temperature in RA, by temperature, rain, and barometric pressure in OA, and by barometric pressure in fibromyalgia. These results support the belief of most rheumatic patients that weather conditions significantly influence their day to day symptoms

378)         Guyatt GH, Heyting A, Jaeschke R, Keller J, Adachi JD, Roberts RS. N of 1 randomized trials for investigating new drugs. Control Clin Trials 1990; 11(2):88-100.
Abstract: Presently, in the process of new drug development, large sample parallel group randomized trials are often begun without the detailed knowledge of optimal dose, most responsive patient group, and optimal outcomes which would be desirable. We propose that randomized trials in individual subjects (N of 1 RCTs) could be used to elucidate these issues at an early stage of drug development. In appropriate conditions N of 1 RCTs can be used to define the rapidity with which a drug begins and ceases its clinical action, the likely range of the optimal drug dose, and the optimal outcomes on which subsequent trials should focus. N of 1 RCTs can also generate initial estimates of the proportion of patients who respond to a new agent and for determining sample size, inclusion criteria, and dosage regimen(s) for subsequent parallel group trials. We provide an example of 14 N of 1 RCTs of amitriptyline in fibrositis that illustrate the ways in which N of 1 RCTs can elucidate these issues. The multiple uses of N of 1 RCTs suggest that the method has immense potential for use in the early phases of drug development programs

379)         Hissink MW. [Treatment of primary fibromyalgia using Rheumajecta and Vasolastine; results of a randomized, placebo-controlled, double-blind study]. Ned Tijdschr Geneeskd 1990; 134(27):1321-1322.

380)         Hooker RS, Brown JB. Rheumatology referral patterns. HMO Pract 1990; 4(2):61-65.
Abstract: The authors studied the characteristics of patients referred for rheumatology consultation in a group model HMO. Six hundred twelve patients were evaluated in 1986. The ages ranged from 3 to 85 years, with an average of 52 years. Female patients outnumbered male patients almost 3:1. Only 44% of referrals had a presumptive diagnosis and more than one half of these diagnoses were changed by the consulting rheumatology specialist, suggesting a high value added from the HMO rheumatologic consultation. Internists referred at a slightly higher rate than family practitioners, and pediatricians referred children at one tenth of the adult rate. Comparison with other published data on fee-for-service rheumatology practices indicates that in one group model HMO, which prohibits patient self-referral, rheumatologic specialists see a higher percentage of patients with vague or difficult-to-manage conditions such as the connective tissue diseases and fibromyalgia and a lower percentage of osteoarthritis and gout. This finding suggests that the structure and incentives of HMOs alter medical referral and practice patterns in significant ways

381)         Houvenagel E, Forzy G, Leloire O, Gallois P, Hary S, Hautecoeur P et al. [Cerebrospinal fluid monoamines in primary fibromyalgia]. Rev Rhum Mal Osteoartic 1990; 57(1):21-23.

382)         Hrynkiewicz Z, Lukianiuk-Gorbacz M, Sulik M. [A case of "fibrositis" syndrome]. Wiad Lek 1990; 43(19-20):984-987.
Abstract: A case is described of a syndrome of pains in the lower extremities in a young man. After a number of diagnostic procedures the more common disease entities were excluded and "fibrositis" was accepted as the cause. The diagnosis was confirmed by EMG investigation, histological examination of dermomuscular specimens, positive effect of treatment and a 6-month follow-up

383)         Hug C, Gerber NJ. [Fibromyalgia syndrome, a frequently misdiagnosed entity]. Schweiz Med Wochenschr 1990; 120(12):395-401.
Abstract: Fibromyalgia syndrome is a frequent condition. It mainly affects middle-aged women, who complain of diffuse pain in the proximal limb girdles and trunk, morning stiffness, unrefreshing sleep, tiredness, and fear, without abnormal physical findings on examination. This review considers the currently evaluated diagnostic criteria and recent research data, which suggest that fibromyalgia in fact is most probably primarily a brain disturbance involving neurohormonal abnormalities and impaired deep sleep. Effective and ineffective therapies are discussed

384)         Jacobsen S, Hoyer-Madsen M, Danneskiold-Samsoe B, Wiik A. Screening for autoantibodies in patients with primary fibromyalgia syndrome and a matched control group. APMIS 1990; 98(7):655-658.
Abstract: Primary fibromyalgia syndrome (PFS) is a non-articular rheumatic condition characterized by chronic muscular pain. We have performed screening for autoantibodies in 20 women with PFS and in 19 age-matched healthy women. Fifty-five percent of the PFS patients had anti-smooth muscle antibodies and 40% had anti-striated muscle antibodies. None of the control subjects had any muscle antibodies. There was no significant difference in frequency of the remaining autoantibodies between the groups investigated. The present study indicates autoimmune responses in PFS against antigens of the diseased tissue itself, a finding which may be secondary to the disease or have relevance to the still obscure pathogenesis of the syndrome

385)         Jacobsen S, Jensen LT, Foldager M, Danneskiold-Samsoe B. Primary fibromyalgia: clinical parameters in relation to serum procollagen type III aminoterminal peptide. Br J Rheumatol 1990; 29(3):174-177.
Abstract: Serum concentrations of procollagen type III aminoterminal peptide have previously been reported to be low in some patients with primary fibromyalgia and the aim of this study was to determine if such patients differ clinically from primary fibromyalgia patients with normal levels of procollagen type III aminoterminal peptide. Subjective symptoms, tender points and dynamic muscle strength in 45 women with primary fibromyalgia were related to serum concentrations of procollagen type III aminoterminal peptide. Patients with low serum concentrations of procollagen type III aminoterminal peptide had more symptoms, a higher frequency of tender points and lesser quality of sleep compared to patients with normal serum concentrations of procollagen type III aminoterminal peptide (P less than 0.05). They also had a lower dynamic muscle strength (P less than 0.0005). We conclude that the serum concentrations of procollagen type III aminoterminal peptide of primary fibromyalgia patients are connected to the disease impact

386)         Jarvinen P, Aho K. Fibromyalgia in a pair of identical twins. Clin Exp Rheumatol 1990; 8(6):615-616.

387)         Johnson JL, Collo MB, Finch WR, Felicetta JV. Fibromyalgia syndrome. J Am Acad Nurse Pract 1990; 2(2):47-53.
Abstract: Fibromyalgia is a chronic rheumatologic disorder. The primary symptoms include musculoskeletal pain and aching, disturbed sleep, fatigue, morning stiffness, and local tenderness. It is frequently misdiagnosed, despite being a fairly common, chronic disorder in most primary care clinics. Failure to make this diagnosis often leads to unnecessary medical and surgical treatment. The treatment of fibromyalgia syndrome is multifaceted. Goals include reassurance, education about pain management and modification, and symptom reduction. Exercise may be beneficial. Amitriptyline is effective in reducing certain symptoms of fibromyalgia, such as pain and lack of restful sleep. Narcotics, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided

388)         Kohler J. [Lyme borreliosis in neurology and psychiatry]. Fortschr Med 1990; 108(10):191-193.
Abstract: Neurological manifestations of Lyme disease are as multifarious as the entire spectrum of this common infection. In stage I, fibromyalgia and, more rarely, painful muscular fasciculation, dominate the clinical picture. In the individual case, mild psychic abnormalities may already be observed. Characteristic of the 2nd stage is lymphocytic meningopolyneuritis. Involvements of the CNS are expressed not so much in focal deficits, as in diffuse psychopathological disorders. In stage 3, CNS manifestations are characterized by chronic, in part multifocal, encephalitides and encephalomyelitides, isolated transverse myelitides and cerebral vasculitic disorders. The clinical symptomatology may be dominated by severe psychiatric syndromes. Connatal and subclinical latent infections of the nervous system with Borrelia represent special forms

389)         Leemput-Dankaart E. [Treatment of primary fibromyalgia with Rheumajecta and Vasolastine]. Ned Tijdschr Geneeskd 1990; 134(31):1515-1516.

390)         Leroux JL, Vendrell JP, Guillot B, Blotman F. [Is fibrositis an immuno-rheumatologic disease?]. Rev Rhum Mal Osteoartic 1990; 57(7-8):513-516.
Abstract: An attempt was made to test the hypothesis that immunological dysfunction occurs in primary polyenthesopathy (PP) by studying skin immunofluorescence, capillary microscopy, photoplethysmography and the lymphocyte populations in PP patients defined according to the usual criteria of Yunus. Skin immunofluorescence in 15 PP patients (14 women, 1 man, average age 50.9 years) failed to reveal any deposit of IgG, A, M, Clq, or C3c either at the dermoepidermal junction or in the vessels. 26 patients (24 women, 2 men, average age 50.5 years) were studied using capillary microscopy and 12 using digital photoplethysmography. The microvascularization abnormalities observed were mild and non specific. A study of the lymphocyte populations using Coulter flux cytometry in 35 PP patients (32 women, 3 men, average age 46 years) did not show any modification in the number of CD4 and CD8 lymphocytes by comparison with the controls. These results do not agree with the data given in the literature and this is probably due to the heterogeneity of the patients studied, with some studies showing a low concentration of antinuclear factors and an abnormal frequency of dry symptoms which, in the opinion of the authors, is considered as an exclusion criterion in the diagnosis of PP. In the author's view, polyenthesopathy is not an immune disease

391)         Lurie M, Caidahl K, Johansson G, Bake B. Respiratory function in chronic primary fibromyalgia. Scand J Rehabil Med 1990; 22(3):151-155.
Abstract: Since patients with severe chronic primary fibromyalgia (CPF) report effort dyspnoea, respiratory function was studied in 87 consecutive women with CPF according to Yunus' criteria. Bernstein spirometry, maximum inspiratory (MIP) and expiratory (MEP) pressures were obtained in patients, and in a reference group of 61 healthy women. MIP was considerably lower in patients than in controls (3.6 +/- 2.0 vs. 8.0 +/- 2.2 kPa, p less than 0.0001), as was MEP (3.1 +/- 2.1 vs. 8.3 +/- 2.2 kPa, p less than 0.0001). Patients who had previously reported dyspnoea at a bicycle exercise test showed significantly lower values of respiratory pressures than patients without dyspnoea. Respiratory pressures were reproducibly low in CPF patients. Spirometric values were normal among patients and controls. We conclude that maximum expiratory and inspiratory pressures are low in CPF, a finding which may indicate respiratory muscle dysfunction in this syndrome

392)         Martin-Du-Pan R. [Chronic fatigue syndrome, fibromyalgia and depression]. Rev Med Suisse Romande 1990; 110(10):923-928.

393)         Mau W, Raspe HH. [Fibromyalgia syndrome. Current contributions to the etiology, diagnosis and therapy of so-called "soft tissue rheumatism"]. Wien Med Wochenschr 1990; 140(12):343-348.
Abstract: The fibromyalgia syndrome (FMS) is an extraarticular rheumatic disease. Typical features are the chronic, polytopic pain in the musculoskeletal system and the provocation of pain by pressure on defined tender points. Mainly medium age women are affected by the disease. In histomorphological studies of muscle tissue non-specific changes were demonstrated, which were thought to be due to ischemia. Furthermore, sleep disturbance and a reduced pain threshold, which may be related to psychological factors, are discussed in the etiology. In FMS a primary and a secondary form related to other diseases can be differentiated. The treatment consists mainly of behaviour therapy and physiotherapy

394)         Mengshoel AM, Forre O, Komnaes HB. Muscle strength and aerobic capacity in primary fibromyalgia. Clin Exp Rheumatol 1990; 8(5):475-479.
Abstract: Twenty-six women with primary fibromyalgia were tested for muscle strength and for aerobic capacity and fatigue. Grip strength was measured with a manometer. In the patient group the grip strength was 58 +/- 22 kPa (mean +/- SD) versus 97 +/- 17 kPa in healthy matched controls (p less than 0.01). The patients performed a mean of 10 +/- 6 repetitions with maximal grip pressure (dynamic endurance work), while the controls performed 13 +/- 6 repetitions (p less than 0.01). The upper extremity was kept in a fixed position for 152 +/- 147 seconds in the patient group versus 413 +/- 244 seconds in the control group (static endurance work), p less than 0.004. Normal aerobic capacity (O2 ml/kg min) was found in the patient group. Expected fatigue values were determined by Borg's rating scale for perceived exertion according to the heart rate in a cycle ergometer test. There was a significantly higher mean fatigue score in the patient group as compared to the expected values (p less than 0.0001)

395)         Muller W, Lautenschlager J. [Generalized tendomyopathy. I: Clinical aspects, follow-up and differential diagnosis]. Z Rheumatol 1990; 49(1):11-21.
Abstract: Generalized tendomyopathy (GTM), or fibromyalgia, is a disorder characterized by diffuse pain in the musculoskeletal apparatus which usually begins at a single site, e.g., as low-back pain or cervical syndrome, and develops into generalized pain over months or years. It is accompanied by increased tenderness at characteristic tender points, although the pain threshold on the whole is reduced. In addition to the main symptoms (pain in the musculoskeletal system, tenderness at the tender points), autonomic and functional symptoms are almost invariably present and are often accompanied by pathological psychological findings such as neuroses and depression. To date, no reliable laboratory parameters or pathognomonic histological findings have been identified. The disorder affects primarily women, beginning around the age of 35 and reaching its peak during or after the menopause. It also affects young people and those over age 60, although it is much less common in these cases. Secondary forms are observed particularly in rheumatoid arthritis. The differential diagnosis must first distinguish primary GTM from the secondary forms. There must also be further differentiation between internal and psychiatric disorders and primary GTM. This can be achieved in many cases by careful clinical diagnosis, although a more complete examination is sometimes required

396)         Muller W, Lautenschlager J. [Generalized tendomyopathy. II: Pathogenesis and therapy]. Z Rheumatol 1990; 49(1):22-29.
Abstract: Many factors are known to play a role in the pathogenesis of generalized tendomyopathy (GTM), or fibromyalgia. While the secondary forms develop along with known diseases, particularly rheumatoid arthritis, the cause of primary GTM is often not well understood. The fact that this disorder usually appears first at a single site, e.g., as low-back pain or cervical syndrome in which poor posture or malformation of the spine can be observed, gives rise to the theory that local changes in the spine or the joints are particular underlying causes of the initial manifestation. As the disorder becomes generalized, however, psychological causes predominate. Psychosocial factors in particular seem to further the process of generalization. Therapy can take many forms. Above all, it calls for an understanding attitude on the part of the managing physician and, whenever, possible, elimination of likely causal factors. Analgesics and antiinflammatories are often inadequate; antidepressants and neuroleptics provide more effective relief. Moreover, intensive physiotherapy and psychotherapy are necessary. GTM in many cases is resistant to treatment despite intensive management, although it often subsides naturally after age 60. Recognizing GTM is of great importance in order to initiate appropriate treatment promptly, avoid incorrect diagnoses and their consequences, e.g., repeat surgery, and to prevent premature disability

397)         Ortiz MF. [Fibrositis as the form of presentation of a nonsecreting myeloma]. Rev Clin Esp 1990; 187(1):45-46.

398)         Pellegrino MJ. Atypical chest pain as an initial presentation of primary fibromyalgia. Arch Phys Med Rehabil 1990; 71(7):526-528.
Abstract: Four patients with atypical chest pain initially believed to be cardiac in origin were subsequently found to have primary fibromyalgia. All patients had characteristic findings of this condition, and the diagnosis was confirmed by demonstrating muscle tender and trigger points which reproduced the chest symptoms. None were found to have significant cardiac conditions, and all improved after a specific treatment program. Primary fibromyalgia should be suspected in patients with atypical chest pain. Appropriate treatment can result in optimal medical management and avoidance of costly medical tests

399)         Potts MK, Silverman SL. The importance of aspects of treatment for fibromyalgia (fibrositis). Differences between patient and physician views. Arthritis Care Res 1990; 3(1):11-18.
Abstract: Thirty-five individuals with fibromyalgia (fibrositis), 22 of their physicians, and 49 rheumatologists on an Arthritis Foundation referral list rated the importance of 24 aspects of fibromyalgia treatment. These encompassed symptom control, psychosocial factors, information, and physical therapy. Respondents with fibromyalgia rated their satisfaction with the way each aspect of treatment had been managed by their physician, and each completed a health status questionnaire. Fibromyalgia patients viewed 8 of the 24 aspects of treatment as significantly more important than did their own physician, and 18 of the 24 as significantly more important than did area rheumatologists. Satisfaction with the way treatment had been managed was generally low. Some evidence suggested that patients' health status was affected positively by the extent to which their physician viewed certain aspects of treatment as important. The results are expected to be useful in the design of fibromyalgia education programs for both lay and health professional audiences

400)         Quintner J. Fibrositis/fibromyalgia syndrome. Med J Aust 1990; 153(5):302-303.

401)         Rasmussen JO, Smidth M, Hansen TM. [The incidence of fibromyalgia in patients admitted to a rheumatology department]. Ugeskr Laeger 1990; 152(21):1520-1522.
Abstract: One hundred patients admitted consecutively to Kong Christian X Hospital for rheumatic conditions were examined for symptoms of fibromyalgia. 47% of the patients had not only histories of pain in three or more anatomically separate regions but also presence of at least seven tender points in the soft tissues on palpation of 15 sites of predilection for tender points. This investigation suggests a high incidence of secondary fibromyalgia in patients admitted on account of various rheumatic conditions

402)         Reilly PA, Littlejohn GO. Fibrositis/fibromyalgia syndrome: the key to the puzzle of chronic pain. Med J Aust 1990; 152(5):226-228.

403)         Reilly PA, Littlejohn GO. Current thinking on fibromyalgia syndrome. Aust Fam Physician 1990; 19(10):1505-2, 1516.
Abstract: Fibromyalgia (fibrositis) syndrome (FS) is a common and chronically painful form of non articular rheumatism. A high count of tender points is characteristic, but there are no confirmatory laboratory tests--the diagnosis is clinical. The cause is unknown, although a number of recognised factors are important in the expression of the condition

404)         Robbins JM, Kirmayer LJ, Kapusta MA. Illness worry and disability in fibromyalgia syndrome. Int J Psychiatry Med 1990; 20(1):49-63.
Abstract: Fibromyalgia (FM) is a common syndrome of functional somatic symptoms. This article examines whether an amplifying somatic style (increased body awareness and illness worry) might explain the distress and disability expressed by FM patients. Twenty FM patients were compared to twenty-three rheumatoid arthritis (RA) patients on measures of depressive and somatic symptomatology, pain, disability, and amplifying somatic style. FM patients reported greater somatic symptomatology, equivalent levels of pain, and less physical disability than did RA patients. No differences were observed between groups on body awareness or illness worry. Illness worry correlated highly with symptomatology for both groups but with physical disability only among FM patients. Results suggest that disability in functional somatic syndromes may be determined by patients' worry about having a serious disease. Feelings of vulnerability and apprehension about having an illness of unknown origin may contribute to FM sufferers' activity limitations, inability to sustain a work effort, and varied somatic distress

405)         Romano TJ. Clinical experiences with post-traumatic fibromyalgia syndrome. W V Med J 1990; 86(5):198-202.
Abstract: Fibromyalgia syndrome (FS) is a musculoskeletal problem that has become more and more widely recognized. There are three types: primary (PFS idiopathic), secondary (associated with another disorder), and post-traumatic (PTFS). The latter condition, PTFS, is especially intriguing since quite often litigation is involved, and doubt is cast as to whether the patient is actually suffering. Accusations of malingering have been made. A retrospective chart review of 14 PTFS patients was made in an effort to ascertain the likelihood of malingering. Over the past two years, 14 patients (three male, 11 female) were treated for PTFS. The mean age was 37 years for both men and women. All had classic PTFS with a chronic musculoskeletal problem that started immediately after a traumatic event, classic myofascial tender points, poor sleep, and normal standard laboratory tests. Twenty-three per cent went to trial; 77 per cent settled out of court. All were given a monetary award. The vast majority (77 per cent) returned to a rheumatologist for continued treatment, suggesting that patients who meet strict FS criteria are not malingering and are indeed in need of medical help

406)         Rotes J. [Fibromyalgia. An old syndrome in search of its identity]. Med Clin (Barc ) 1990; 95(14):540-541.

407)         Serratrice G. [Does fibromyalgia exist?]. Rev Rhum Mal Osteoartic 1990; 57(3 ( Pt 2):260-266.
Abstract: The term fibromyalgia, though often used, is not justified since no fibrosis has been shown on the histological level. The aim of this article is to make a critical analysis of the semiology usually attributed to fibromyalgias, to cite the main related syndromes whose nosology is often unclear (benign myalgic encephalomyelitis, epidemic neuromyasthenia, diffuse idiopathic multifocal pain syndrome, chronic fatigue, AMP desaminase deficiency, etc.), to prefer the purely descriptive term of "persistent, diffuse myalgia with no recognized organic etiology". According to the author's experience, a psychological etiology is detectable in only 25% of the cases. Morphological or functional muscular abnormalities are sometimes found, but their significance is not well known. A real multifactorial vicious circle partly explains the physiopathological complexity

408)         Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med 1990; 88(6):577-581.
Abstract: PURPOSE AND PATIENTS AND METHODS: Lyme disease is a major clinical problem in a number of endemic areas in the United States. In areas where anxiety about the disease is high, patients and physicians often ascribe clinical concerns to Lyme disease. Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy). This report summarizes the cases of the first 100 patients referred to the Lyme Disease Center at Robert Wood Johnson Medical School. RESULTS: In only 37 of the patients referred was Lyme disease, either current or preceding, the explanation for the complaints. Many of the patients had another definable arthropathy. Twenty-five of the patients had fibromyalgia, which has not previously been reported in Lyme disease. Three of these patients had active Lyme disease at the time of evaluation, and 17 had a history suggesting preceding Lyme disease. Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted. CONCLUSIONS: Anxiety about possible late manifestations of Lyme disease has made Lyme disease a "diagnosis of exclusion" in many endemic areas. Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy. Attention to patient anxiety and increased awareness of these musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated Lyme disease

409)         Simons DG. Familial fibromyalgia and/or myofascial pain syndrome? Arch Phys Med Rehabil 1990; 71(3):258-259.

410)         Singsen BH. Rheumatic diseases of childhood. Rheum Dis Clin North Am 1990; 16(3):581-599.
Abstract: Development of diagnostic criteria for juvenile rheumatoid arthritis, systemic lupus erythematosus, a juvenile dermatomyositis, as well as advances in molecular biology, have assisted epidemiologic study of the rheumatic disorders of childhood. It may be misleading to extrapolate the incidence and prevalence of pediatric forms of arthritis from population studies of adults. Additional study of the frequency of childhood musculoskeletal disorders is very much needed. Classification criteria for Kawasaki syndrome, fibrositis in children, and the juvenile spondyloarthropathies are also desirable

411)         Smythe HA, Sheon RP. Fibrositis/fibromyalgia: a difference of opinion. Bull Rheum Dis 1990; 39(3):1-8.

412)         Stojan B. [Primary fibromyalgia (fibrositis) syndrome (PFS)]. Schweiz Rundsch Med Prax 1990; 79(11):311-313.

413)         Thompson JM. Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia, and myofascial pain syndrome. Mayo Clin Proc 1990; 65(9):1237-1248.
Abstract: Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes "tension myalgia" as a term that unifies these separate diagnoses under one conceptual framework. Because the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications

414)         Tyber MA. Lithium carbonate augmentation therapy in fibromyalgia. CMAJ 1990; 143(9):902-904.

415)         Uveges JM, Parker JC, Smarr KL, McGowan JF, Lyon MG, Irvin WS et al. Psychological symptoms in primary fibromyalgia syndrome: relationship to pain, life stress, and sleep disturbance. Arthritis Rheum 1990; 33(8):1279-1283.
Abstract: Twenty-five subjects with primary fibromyalgia syndrome and 22 subjects with rheumatoid arthritis were compared on measures of psychological distress, pain, health status, life stress, sleep disturbance, and coping strategies. Higher levels of psychological distress were found in the primary fibromyalgia syndrome group, but the degree of life stress was shown to be a significant covariate

416)         Van Linthoudt D, Roth D, Ott H. [Fibromyalgia associated with thyroid adenoma and brucellosis]. Presse Med 1990; %20;19(34):1587.

417)         Wallace DJ. Genitourinary manifestations of fibrositis: an increased association with the female urethral syndrome. J Rheumatol 1990; 17(2):238-239.
Abstract: Six of 50 female patients with fibromyalgia (fibrositis) but none of 50 rheumatic disease controls fulfilled accepted definitions for the female urethral syndrome. Genitourinary manifestations of this condition and its relationship to fibrositis are reviewed

418)         Wigley RD. Chronic fatigue syndrome, ME and fibromyalgia. N Z Med J 1990; 103(895):378.

419)         Wolfe F. Fibromyalgia. Rheum Dis Clin North Am 1990; 16(3):681-698.
Abstract: There has been confusion surrounding regional medical conditions, primary psychological conditions, and fibromyalgia in practice and in the literature. Confusing terminology and inappropriate use of diagnostic criteria have contributed to this problem. Use of the 1990 ACR Criteria for the Classification of Fibromyalgia together with the symptom and physical examination definitions in that report should go far to correct these problems. Problems of selection and identification bias filter patients with the syndrome, and almost all reports concerning the disorder have been obtained from subspecialty clinics. Almost nothing is known about fibromyalgia in the community, and characteristics of patients noted in the clinic may be a primary function of these biases. In general, in the clinic, about 90% of patients are women of a mean age slightly less