Para médicos · reumatologia
Resumos de artigos, podcasts e newsletters sobre Fibromialgia, para atualização médica.
A newsletter discute como a obesidade atenua a resposta aos inibidores de JAK na artrite reumatoide, enfatizando que o IMC elevado é um modificador de efeito clínico relevante. O conteúdo também aborda a alta prevalência de critérios de fibromialgia em pacientes pós-COVID, a conduta expectante na artrite por parvovírus B19 e a associação genética entre regulação tireoidiana e deposição de cristais de pirofosfato de cálcio.
A newsletter discute as novas diretrizes do ACR 2025 para o lúpus eritematoso sistêmico, enfatizando a importância da ultrassonografia para identificar sinovites frequentemente subestimadas no exame clínico. O conteúdo detalha o desempenho de terapias como anifrolumabe e belimumabe em diferentes perfis de pacientes, além de abordar a aprovação do anacinra e casos de fraturas por insuficiência na artrite reumatoide.
Sex and gender shape disease presentation, diagnostic accuracy, treatment response and clinical outcomes in rheumatology, yet these dimensions remain insufficiently embedded in clinical practice. Owing to the markedly unbalanced sex prevalence ratios across many rheumatic diseases, the ‘minority’ sex is consistently under-represented in clinical studies, limiting the interpretation of long-term outcomes and treatment effectiveness. Sex-related differences in pain perception, inflammatory biomarkers and imaging patterns further complicate disease assessment, and treatment allocation and drug persistence also differ between women and men. Gender-related factors — including disparities in care-seeking behaviours, social roles and lifestyle factors — additionally modulate symptom burden and disease trajectories. Evidence remains particularly scarce for transgender, gender-diverse and intersex individuals, who are rarely captured in clinical cohorts, restricting the development of inclusive and generalizable evidence. Embedding sex-aware and gender-aware approaches into diagnostic reasoning, risk assessment and therapeutic decision-making is therefore essential for advancing precision, equity and truly personalized rheumatological care. Such integration enables clinicians to interpret disease signals more accurately, anticipate divergent multimorbidity trajectories and tailor treatment strategies to the biological and sociocultural contexts of each patient.
A newsletter destaca o benefício clínico do TENS na fibromialgia e a utilidade do ultrassom pulmonar como ferramenta portátil para monitorar a progressão da doença intersticial na artrite reumatoide. Também são discutidos a correlação entre o local das crises de reumatismo palindrômico e a cronificação articular, além do papel da disbiose oral na Síndrome de Sjögren.
A newsletter discute a necessidade de ajustar os pontos de corte dos índices CDAI e SDAI para a realidade brasileira, visando uma identificação mais precisa da remissão na artrite reumatoide e evitando o sobretratamento. Além disso, revisa as diretrizes de rastreio para doença pulmonar intersticial associada à AR e destaca o potencial condroprotetor da metformina em pacientes diabéticos com osteoartrite.
The psoriatic arthritis phenotype has evolved over the past several decades. The original description of 5 clinical patterns has been expanded into 6 domains including peripheral arthritis (which includes 3 of the patterns described by Moll and Wright namely distal, oligoarticular and polyarticular), axial disease, dactylitis, enthesitis, skin and nails. In this article we review the evolution of the PsA phenotype, from the Moll and Wright subtypes described in 1973 and how they might have changed, evolution of our understanding of axial PsA, consider race and geographic differences in disease expression, role of obesity and sex on the PsA phenotype, effect of co-expression of PsA and FM as well as OA on the phenotype, and consider difficult to treat PsA.
A newsletter destaca o estudo RESET-RA, que apresenta a estimulação do nervo vago como uma alternativa promissora para pacientes com Artrite Reumatoide de difícil tratamento. São detalhadas as atualizações das diretrizes EULAR 2025, que reforçam o uso precoce de anti-TNF na Síndrome de Behçet e simplificam o manejo da Artrite Reumatoide após falha ao metotrexato. O conteúdo ainda aborda um caso clínico de tuberculose óssea e revisões rápidas sobre fibromialgia e gota.
Objective To analyze unselected routine care patients with all rheumatic diagnoses for positive anxiety, depression, and/or fibromyalgia screening within a single MDHAQ (multidimensional health assessment questionnaire), and for pain and RAPID3 (routine assessment of patient index data) in patients with positive vs negative screens. Methods Each rheumatology patient with any diagnosis at Rush University is given an MDHAQ at each encounter to provide comprehensive medical history information, completed by most patients in 5-10 minutes and scored by a professional in <30 seconds. Frequencies of positive MDHAQ anxiety, depression, and fibromyalgia screening indices were computed in patients with 15 rheumatic diagnoses in 5 categories: inflammatory, connective tissue, non-inflammatory, bone mineral disorders, and primary fibromyalgia. Median pain 0-10 visual numeric scale (VNS) and 0-30 RAPID3 scores were compared in patients with positive vs negative screens. Results In 1,337 study patients (excluding primary fibromyalgia), 30% had positive screens for anxiety, 24% for depression, and 25% for (non-primary) fibromyalgia, and 44% any of these 3 multimorbidity screens. Positive screens in different rheumatic diagnosis categories ranged from 17%-39% for anxiety, 9%-33% for depression, 7%-31% for (non-primary) fibromyalgia, and 30%-52% for any multimorbidity screen. Median pain was 7.0/10 vs 4.0/10 and median (RAPID3) 17.0/30 vs 8.2/30 in patients with any of 3 positive vs all negative screens (p< 0.001). Conclusion Positive anxiety, depression, and/or fibromyalgia screens in 44% of routine care patients who have significantly higher pain scores agree with extensive research findings, suggesting inclusion of pragmatic screening for clinical decisions at all routine encounters.
Objectives Fatigue is a disabling symptom in Sjögren’s disease (SjD); however, its severity and related factors in associated SjD remain unclear. We compared fatigue severity among patients with primary Sjögren’s disease (pSjD), associated SjD, and systemic autoimmune rheumatic diseases (SARDs) without SjD and identified fatigue-associated clinical and patient-reported factors in patients with pSjD and associated SjD. Methods This cross-sectional study included 115 patients with pSjD, 125 with associated SjD, and 52 with SARDs without SjD. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI). Clinical and laboratory parameters were analysed. Results Fatigue was significantly more severe in pSjD and associated SjD than in SARDs without SjD (FACIT-F total: 30 vs. 36 vs. 42, p < 0.001), with no significant difference between pSjD and associated SjD. Patients with pSjD reported greater subjective symptom burden, including higher ESSPRI fatigue (7.0 vs. 5.0, p = 0.011) and dryness (7.0 vs. 5.0, p = 0.012) scores. In multivariate analysis, pain (pSjD: β –2.12, p < 0.001; associated SjD: β –0.79, p = 0.019) and dryness (pSjD: β –1.26, p = 0.002; associated SjD: β –2.07, p < 0.001) were independently related with fatigue in both groups. Fibromyalgia (β –15.4, p < 0.001) and arthritis (β –7.7, p = 0.006) were related only in pSjD, and C-reactive protein (β –1.53, p = 0.029) only in associated SjD. Fatigue was not linked with systemic disease activity (ESSDAI) in pSjD. Conclusions Fatigue is a major burden across the SjD spectrum, with similar severity in pSjD and associated SjD but distinct contributing mechanisms. Key Points • Fatigue severity was comparable between pSjD and associated SjD; however, distinct factors
A newsletter aborda o risco quase dobrado de câncer em pacientes com Síndrome VEXAS, destacando a importância da genotipagem de UBA1 e marcadores inflamatórios. Apresenta o novo guideline brasileiro para fibromialgia com recomendações atualizadas e analisa um ensaio clínico sobre o abatacepte em miopatias inflamatórias, que sugeriu benefício clínico em subtipos específicos como polimiosite e miopatia necrosante.
A newsletter destaca a importância do anticorpo anti-nucleossomo como marcador complementar no lúpus, especialmente para manifestações neuropsiquiátricas e renais onde o anti-dsDNA pode ser negativo. Além disso, aborda a segurança dos DMARDs na artrite reumatoide com doença pulmonar intersticial, indicando que biológicos não-TNF podem estar associados a um maior risco de hospitalização por pneumonia.
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease characterized by complex pain mechanisms that extend beyond inflammation. Although inflammatory nociceptive pain — primarily mediated by pro-inflammatory cytokines — represents the classic pathway and therapeutic target, many patients continue to experience pain despite suppression of inflammation. This residual pain often reflects non-inflammatory processes, including nociplastic and neuropathic pain. Central sensitization, a key mechanism of nociplastic pain, contributes to pain amplification and poor response to treatment. Fibromyalgia, considered the typical phenotype of nociplastic pain, can co-occur with axSpA and is associated with increased symptom burden and reduced efficacy of anti-inflammatory therapies. Neuropathic pain, albeit less common, can result from structural complications and requires targeted therapeutic approaches. In addition, biological sex differences further influence pain perception and treatment outcomes: female patients report more widespread pain, show higher rates of central sensitization and have a worse response to biologic therapies than male patients. Current treatment paradigms are effective for inflammation-driven symptoms but often fail to address the broader spectrum of pain phenotypes in axSpA. Future work should include the development of biomarkers to differentiate pain mechanisms, the refinement of assessment tools and the evaluation of multimodal therapies that target both inflammation and pain processes. This evolving understanding necessitates a shift from an inflammation-centric to a mechanism-informed approach to pain management in axSpA.
Fibromyalgia (FM) is a chronic condition classified by widespread pain, fatigue, and associated symptoms. Patients with FM are frequently referred to physical therapists, whose knowledge of assessment criteria and management strategies is critical for timely recognition and effective care. Early diagnosis has been shown to improve outcomes, whereas delayed recognition often leads to prolonged suffering and increased healthcare costs. The objective of this study was to examine the knowledge, perceptions, and attitudes of physical therapists in the United Arab Emirates (UAE) with respect to the diagnosis and management of FM. A cross-sectional self-reported survey was distributed electronically to practicing physical therapists across the UAE. The survey collected demographic data, as well as information on confidence in determining and managing FM, awareness of international guidelines, perceptions of other healthcare providers roles, and knowledge of the risk factors. A total of 300 physical therapists were invited, and 240 completed the survey and met the inclusion criteria (response rate of 80%). The results revealed a predominantly female workforce, with 73.8% of participants identifying as female. The age of most respondents ranged between 23 and 42 years. Almost half of the participants had less than five years of experience. Nearly two-thirds of participants expressed confidence in diagnosing and managing FM cases. Most participants were unaware of any of the international FM practice guidelines (1990 ACR, 2010 ACR, 2012 Canadian). The findings of this study underscore a concern for a lack of confidence and awareness among physical therapists in the UAE regarding the diagnosis and management of FM cases. Despite a significant proportion of participants reporting experience in managing FM cases, the majority were not familiar with recent FM practice guidelines, indicating potential gaps in
While awareness of Fibromyalgia (FM) has evolved across healthcare and social settings, individuals with FM continue reporting poor understanding of their condition in the everyday. To explore the lived experiences and subjective illness narratives of individuals with FM, focusing on personal understandings of FM, outlook on healthcare, and perceived attitudes of surrounding peers. We carried out four online focus groups with individuals diagnosed with FM. Participants were recruited from a pool of patients in a pain management centre in the Southwest of England, UK, that previously took part in a FM management course, 'Body Reprogramming Course' (BRC). Discussion topics included the personal understanding of FM (illness identity, timeline, causes, consequences, and controllability), history with FM diagnosis and treatment, attitudes of family and friends towards FM, as well as personal attitude towards medication. Audio recordings from focus groups were transcribed and analysed by two primary coders, using a reflexive thematic analysis approach. Codes were iteratively discussed and refined with two additional coders. 20 individuals with FM took part in four focus groups, aged between 25 and 67 years. Analysis of the data revealed 5 overarching themes and 10-subthemes related to lived experiences of FM: 1) The individual journey; 2) FM in healthcare; 3) FM in social context; 4) FM in personal context; 5) Experiences with BRC. Although participants felt that there has been some positive societal shift towards FM, most discussions concerned personal struggles with conveying to family and healthcare professionals the impact of the condition. Participants described a significant emotional toll of dealing with hidden struggles. Many expressed disappointment with prior care, describing it as fragmented, and some expressed strong opposition to medication-based treatments. Reflecting on the BRC, participants liked
Fibromyalgia (FM) is a chronic condition characterized by widespread pain and cognitive dysfunction, with pharmacological treatments offering limited efficacy. Although Pain Neuroscience Education (PNE) and therapeutic exercise are evidence-based interventions, accessibility and adherence remain major challenges particularly in underserved regions such as Latin America. This trial investigates the effectiveness of a 12-week tele-rehabilitation program (FIBROIA) that integrates Artificial Intelligence (AI)-guided exercise with PNE to enhance access to comprehensive multimodal care. This multicentre, randomized, assessor-blinded, parallel-group controlled trial will enroll fifty adults meeting the 2016 ACR criteria for FM. Participants will be randomly assigned (1:1) to either the intervention group or enhanced usual care. The intervention consists of three personalized exercise sessions per week delivered through the Rehbody AI platform, which provides real-time biomechanical feedback, along with a weekly PNE module designed to reconceptualize pain. The primary outcome is the change in pain intensity, measured using the Visual Analogue Scale (VAS), at week 13 (±7 days), immediately following completion of the 12-week program. Secondary outcomes include the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), lower-limb strength assessed by the 30-Second Sit-to-Stand test, and health-related quality of life measured with the EQ-5D-3L. Statistical analyses will follow an intention-to-treat (ITT) framework. The FIBROIA protocol addresses the urgent need for scalable, evidence-based interventions in resource-limited settings. By combining AI-driven biomechanical feedback with cognitive reappraisal through PNE, this study seeks to reduce fear-avoidance behaviors and improve exercise adherence. This integrative approach aims to overcome the limitations of passive tele-rehabilitation by simulating asynchronous professional supervision, thereby ensuring both safety and technical precision in movement execution. If effective, this protocol will offer a robust, technology-enabled framework for remote FM management. The results could help establish a new clinical standard for
To investigate the clinical, immunological, and metabolomic factors associated with fibromyalgia (FM) in patients with idiopathic inflammatory myopathies (IIM) who are in clinical remission or complete response. In this cross-sectional, 49 patients with IIM meeting remission and/or complete clinical response criteria were evaluated with the PROMIS Pain Interference Short Form 8a as an initial screening tool and patients with clinically significant pain interference subsequently underwent assessment with the 2016 ACR criteria. Clinical data, flow cytometry of peripheral blood mononuclear cells, multiplex cytokine assays, and untargeted metabolomic profiling by GC-MS were performed. Multivariate logistic regression was used to identify variables associated with FM. The prevalence of FM in this IIM cohort was 40.8%. FM was associated with higher patient global assessment scores, increased muscle damage, current prednisone use, and elevated serum levels of IL-6 and MCP-1. Immunophenotyping revealed reduced numbers of non-classical monocytes, CD8+ T cells, and B lymphocytes in FM patients. Metabolomic analysis identified lower concentrations of tryptophan and nonanoic acid in the FM group, suggesting altered pathways of immune regulation and nociplastic pain. Patients with IIM in remission and/or complete clinical response can present with clinical significant FM, which is associated with immune dysregulation and metabolic alterations. These findings highlight the need for routine FM screening in IIM and support the use of patient-reported outcomes to distinguish between inflammatory and nociplastic symptoms in clinical practice.
Case reports (CRs) are essential in physiotherapy, yet reporting remains heterogeneous and insufficiently standardised. The 2013 CAse REport (CARE) guideline improves transparency but lacks physiotherapy-specific detail. This study aimed to develop a consensus-driven extension of the CARE reporting guideline to support structured reporting of physiotherapy CRs, encompassing physiotherapy-specific assessments and interventions. An e-Delphi consensus process study following the ACcurate COnsensus Reporting Document (ACCORD) guidelines. Online. Forty-four international experts in physiotherapy practice, research and education, along with six core committee members. Experts objectively scored items for relevance (5-point Likert scale) and provided open-ended responses for each item of the drafts. Scores and responses were analysed to facilitate iterative refinement of the Physiotherapy CAse REport (PhyCARE) reporting guidelines. Consensus was predetermined at over 70% agreement. Round 1 had the majority of items achieving ≥70% agreement, except two items that did not meet the threshold were revised and replaced with an alternative. Five new items addressing physiotherapy-specific reporting needs were added, and 10 items were relocated. In round 2, all 35 items across 13 domains achieved 84%-100% agreement. The nomenclature of one domain was revised to 'Outcomes and Follow-up'. Following two e-Delphi rounds, consensus was achieved, and suggestions from online meeting, piloting led to item rephrasing, after which the PhyCARE guidelines were finalised. The PhyCARE guidelines have the potential to provide a physiotherapy-specific extension of CARE to support structured, transparent and reproducible reporting of physiotherapy CRs.
For individuals with fibromyalgia, movement is experienced as both beneficial and risky. Patient-centered rehabilitation could validate pacing, formalize existing self-management strategies, and offer tailored, supported pathways to sustainable activity.
Prescription digital therapeutics (PDTx) represent an emerging frontier in healthcare, leveraging software-based solutions to treat or manage specific medical conditions. However, despite rising interest and encouraging evidence of clinical benefits, the policy landscape remains fragmented. Jurisdictions vary widely in their regulatory approaches, reimbursement pathways and processes for clinical integration, thus creating uncertainties for developers, payers and healthcare providers. This protocol outlines an eDelphi study to develop and validate a comprehensive policy maturity framework guiding systematic assessment of national or regional readiness for PDTx adoption. We will conduct an e-Delphi study with up to three rounds to refine and validate a PDTx policy maturity framework. Experts will be recruited purposively from six stakeholder groups (regulators, healthcare providers, payers/health economists, developers, researchers and patient advocates), prioritising Europe while seeking variation across health system types and levels of economic development; a small number of non-European experts may be invited to broaden perspectives. An optional pilot round will gather initial feedback on the prototype framework, followed by iterative rounds to assess and revise domains, scoring criteria and maturity thresholds. A 5-point Likert scale (from 'strongly disagree' to 'strongly agree') will collect quantitative data, while open-text prompts will capture qualitative insights. Consensus will be defined as ≥70% agreement and/or an IQR ≤1 for critical items. Quantitative summaries and thematic analysis will guide iterative revisions of the model. This Delphi protocol aims to produce a consensus-driven framework that captures the essential elements of PDTx policy development and implementation. If validated, the framework can serve as a reference for policymakers, industry leaders, healthcare providers and researchers seeking to benchmark or advance the adoption of PDTx within health systems. Ethical approval for this study was obtained from the
Abstract Fibromyalgia is a widespread chronic condition. Although Clinical Practice Guidelines for fibromyalgia currently exist, their application in diagnostic and therapeutic settings faces significant implementation challenges across healthcare systems. This has led to a persistent gap between knowledge and clinical practice, a phenomenon yet to be explored in the Danish context. A cross-sectional study was conducted to investigate the level of knowledge and adherence to Clinical Practice Guidelines for fibromyalgia among Danish physical therapists, throughout a questionnaire consisting in the selection of the elements that they would consider for the adequate assessment, treatment, and expected duration of the therapeutic approach, to classify professionals as adherent, partially adherent, or non-adherent based on their selection of assessment and treatment components, and to evaluate their responses to 24 statements on a 5-point Likert scale reflecting their alignment with recommendations from Clinical Practice Guidelines. A total of 149 physiotherapists (mean age 39.26 ± 11.50, and gender-balanced) participated, amongst which 35 (23.49%) were classified as ‘adherent’, and 46 subjects (30.87%) were labelled as ‘partially adherent’ to Clinical Practice Guidelines. Participants’ assessment and therapeutic tools selection was generally aligned with the Clinical Practice Guidelines’ extolled recommendations, except for tender points examination and massage therapy. A number of 14 out of the 24 statements exceeded the predefined 70% agreement threshold. The current study reflects an adequate level of knowledge and adherence amongst physiotherapists in Denmark. Further research and targeted implementation strategies are needed to reduce the evidence-to-practice gap.
Objective Nociplastic pain is pain primarily driven by the central nervous system and, unlike nociceptive pain conditions, is thought to be refractory to peripherally directed therapies. Nociplastic pain is also associated with hypersensitivity to painful and other sensory stimuli (such as visual stimuli). Nonpainful sensory measures have not been well studied in nociceptive pain conditions nor directly compared with traditional pain sensitivity measures for their discriminative value. The current study aimed to investigate visual sensitivity across multiple chronic pain conditions, particularly in the context of analgesic treatment responsivity. Methods We compared sensitivity with experimental visual stimulation among individuals with chronic nociceptive pain, including hip osteoarthritis, chronic pelvic pain, rheumatoid arthritis, and psoriatic arthritis. Individuals with fibromyalgia, the prototypical nociplastic condition, and pain‐free controls were included for reference. Lack of analgesic response 6 months after surgery in participants with osteoarthritis and chronic pelvic pain served as a model for nociplastic pain. Results Participants across all pain conditions reported greater perceived brightness in response to visual stimulation compared with controls. Higher self‐reported fibromyalgia symptom severity predicted lack of response to arthroplasty and hysterectomy. Notably, increased visual sensitivity independently predicted nonresponsiveness to surgery, whereas experimental pressure pain sensitivity did not. Visual sensitivity and fibromyalgia symptom severity together predicted greater variance in responder status than either measure alone. Conclusion These findings emphasize the potential value of assessing visual sensitivity to identify pain mechanisms across different diagnostic categories.
A newsletter analisa o estudo ESTIVAL, que avaliou a estimulação do nervo vago na osteoartrite erosiva, demonstrando melhora funcional e analgésica em pacientes com sinovite exuberante, apesar de um desfecho primário global negativo. Discute também como a ativação do sistema complemento (especialmente C3dg) prediz a progressão radiográfica na espondiloartrite axial independentemente do controle da PCR. Por fim, destaca atualizações sobre o FRAX 2.0 e o manejo da doença relacionada à IgG4.
A newsletter aborda estratégias terapêuticas para reduzir a carga cumulativa de corticoides na arterite de células gigantes e alerta para a osteopatia induzida por metotrexato como causa de fraturas de insuficiência. Também discute o papel prognóstico de telômeros curtos na doença pulmonar intersticial da artrite reumatoide e a segurança comparável entre inibidores da JAK e anti-TNF.
A newsletter explora o papel emergente dos agonistas de GLP-1 na reumatologia, evidenciando melhorias em marcadores inflamatórios e desfechos clínicos, apesar da necessidade de estudos com maior robustez metodológica. Destaca-se também o uso da ultrassonografia para diferenciar fenótipos inflamatórios de quadros de sensibilização central na Artrite Psoriásica difícil de tratar, além de evidências que favorecem o uso de prednisona em relação à colchicina na artrite por pirofosfato de cálcio.
OBJECTIVE: To assess the prevalence and persistence of self-reported depression and its associated factors in patients with systemic lupus erythematosus (SLE), using a patient-reported outcome measure in a large, multicentre, prospective cohort. METHODS: We conducted a longitudinal analysis of patients enrolled in the RELESSER-PROS registry who responded to item 7 (“I was depressed”) of the Lupus Impact Tracker questionnaire (LITQ7) over five annual visits. Self-reported depression was defined as any response other than “none of the time.” Covariates assessed at each visit included: age, disease duration, SELENA-SLEDAI (S-SLEDAI), glucocorticoid (GC) use, SLICC/ACR Damage Index (SDI), fibromyalgia, Charlson index, BMI, smoking status, menopause, sedentary lifestyle, marital and employment status. Generalized estimating equation (GEE) models were used to examine longitudinal associations. RESULTS: Of 1463 patients (mean age 55 years; 90% female), 89.9% reported depressive symptoms at least once; 26.5% reported feeling depressed “most of the time” at all five visits. Patients with self-reported depression in LIT accumulated significantly more damage over time (p = 0.009). In multivariable analysis, fibromyalgia (OR 2.90; 95% CI: 1.58–5.33) and GC use (OR 1.85; 95% CI: 1.17–2.93) were independently associated with self-reported depression. CONCLUSIONS: Self-reported depression is highly prevalent and often persistent among patients with SLE. Its association with potentially modifiable factors such as GC use and fibromyalgia highlights the value of integrating patient-reported outcomes such as LIT into longitudinal care, potentially contributing to improve emotional well-being.
Chronic pain involves complex mechanisms that remain poorly understood. To address this, the International Association for the Study of Pain introduced the Chronic Primary Pain (CPP) framework in ICD-11 to reflect advances in pain research. In this pre-registered systematic review and meta-analysis, we examined the neural substrates of CPP compared to pain-free individuals during provoked pain. A literature search identified 48 whole-brain fMRI studies (N = 2052) involving experimental pain stimulation in CPP patients (e.g., migraine, fibromyalgia, irritable bowel syndrome), with or without pain-free controls. A conjunction meta-analysis revealed robust activation in the dorsal anterior insula, mid-cingulate gyrus, and medial frontal gyrus during provoked pain across 39 within-subject experiments. Using cluster- and voxel-level corrections, we observed consistent activity in the mid-cingulate and medial frontal gyrus, with the dorsal anterior insula and mid-cingulate gyrus implicated in pain processing in CPP. PERSPECTIVE: This study indicates the need for a new generation of methodologically harmonised studies integrating within- and between-subject effects before the CPP framework can be translated into a clinical tool. Achieving this translation requires significant methodological consistency in neuroimaging research to precisely identify the CPP neural substrates and advance diagnosis.
ObjectivePatients with systemic lupus erythematosus (SLE) often have concomitant fibromyalgia (FM) or similar symptoms including chronic pain, fatigue, or depression. This study explored whether Patient-Reported Outcomes Measurement Information System (PROMIS) measures provide richer information than 2016 American College of Rheumatology (ACR) FM criteria survey.MethodsPatients with SLE in our convenience cohort were categorized into groups: (1) concurrent FM chronic pain, (2) concurrent non-FM chronic pain, and (3) no chronic pain using 2016 ACR FM Survey. Based on PROs in the FM Survey, we captured comparable PROMIS measures (e.g., depression, fatigue). Associations by pain group were tested using Kruskal-Wallis rank sum test, Shapiro-Wilk normality test, chi-squared test, or Fisher's exact test. Violin plots explored differences across groups.ResultsThe cohort (n = 181) included 31 patients with FM pain, 23 with non-FM chronic pain, and 127 with no chronic pain. Median PROMIS symptom scores (fatigue, sleep disturbance, pain intensity and interference, depression) were highest and cognitive function lowest in the FM group, despite 13% being in remission. There were significant differences on 4 PROMIS measures (cognitive function, fatigue, pain intensity, pain interference) between FM pain and non-FM pain groups (p < .02), the former being worse. There were no significant differences in SLE Disease Activity Index (SLEDAI) score.ConclusionSLE patients with non-FM chronic pain have similar symptoms to FM compared with SLE patients without chronic pain; however, symptoms are not as severe as those meeting FM criteria. PROMIS measures may be used to classify severity more precisely for disease categorization and management.
Difficult to manage (D2M) axial spondyloarthritis (axSpA) is an evolving clinical concept. We aimed to assess the prevalence, predictors and long-term outcomes of D2M axSpA. Prospective single center cohort study of axSpA patients starting targeted agents (01/01/2007 until 28/02/2024). The ASAS criteria were applied to classify D2M. Baseline parameters were assessed as predictors of D2M development by multivariate logistic regression models. To identify comorbidity clusters and their contribution to D2M, a K-means cluster analysis on binary indicators of most prevalent chronic illnesses was performed. Long-term functional evolution and adverse events' rate were compared between D2M and non-D2M. Out of 434 patients, 50 (11.5%) developed D2M disease. Compared to non-D2M, they had higher disease activity at baseline (p = 0.01) and failed to improve at 6 months (p < 0.0001), while dyslipidemia, osteoarthritis and fibromyalgia were more prevalent (p < 0.0001). Independent predictors for developing D2M axSpA were the presence of fibromyalgia (OR 3.55), osteoporosis (OR 5.67) and dyslipidemia (OR 2.70), while two clusters of comorbidities ("chronic pain syndromes" and "metabolic") significantly contributed to D2M (OR 2.52 and OR 3.30; p = 0.010 and 0.013 respectively). During a total follow-up period of 2312 patient-years, D2M patients developed higher functional impairment and had more serious adverse events and hospitalizations (p = 0.016) compared to non-D2M patients. 11.5% of axSpA patients developed D2M disease and showed adverse long-term outcome compared to non-D2M. While D2M patients had at baseline higher disease's burden, comorbidities mostly related to chronic pain syndromes predicted D2M development, supporting their significance for D2M axSpA evolution.
Rheumatic and musculoskeletal diseases (RMDs) profoundly affect health-related quality of life (HRQoL), imposing a significant distinct burden on physical and mental well-being. Given the high prevalence and long-term disability associated with RMDs, understanding their impact is essential for informing public health priorities. This study aims to delineate the multifaceted impact of RMDs on HRQoL across diverse disease categories and examine how the impact on HRQoL varies by diagnosis and time since diagnosis. This cross-sectional study (July 2023 - July 2024) employed a mixed sampling approach, combining a stratified sample of participants from clinical settings with an open call through online channels to reach a broader population of individuals with RMD in Cyprus. Physical (PCS) and Mental Component Scores (MCS) of the SF-12 questionnaire were used to assess HRQoL. Demographic and clinical variables, including age, gender, marital status, smoking status, and time since diagnosis were recorded. Multivariable regression analyses were used to explore differences in HRQoL scores by disease group and time since diagnosis, adjusting for demographic characteristics. The study enrolled 789 participants (mean age 55.4 ± 13.2 years, 76.6% female). Among participants, 57.4% reported low PCS (< 40) and 38.7% reported low MCS (< 40). Fibromyalgia demonstrated the most pronounced HRQoL impairments, with significantly lower scores, compared to inflammatory diseases, for both physical (B = - 11.45; 95% CI: - 15.06, - 7.83) as well as mental components of HRQoL (B = - 12.31; 95% CI: - 16.18, - 8.4). Notable reductions in PCS and MCS were also recorded among patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) reflecting the systemic and psychological burden of these conditions. Marked HRQoL reductions were recorded among participants in early disease stages (0-2 years), while those with a longer time since diagnosis
Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome predominantly affecting women, suggesting possible links with reproductive and hormonal factors. Although reproductive history has been associated with various long-term health conditions, its role in FM remains insufficiently explored. This study aimed to investigate the association between parity, age at first pregnancy, and the presence of fibromyalgia among women of reproductive age. This cross-sectional observational study included 260 women aged 18-50 years with at least one prior live birth, recruited from Physical Medicine and Rehabilitation, Rheumatology, and Gynaecology Outpatient Clinics between March and December 2024. Demographic, clinical, and reproductive data were collected through structured interviews and medical records. FM diagnosis was based on the 2016 revised criteria of the American College of Rheumatology (ACR) using Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores; the Global Symptom Score (GSS) was defined as their sum. Statistical analyses included independent-sample t-tests, chi-square tests, and multivariate logistic regression adjusting for age, body mass index, comorbidities, and educational level. FM was diagnosed in 104 participants (40%). Women with three or more live births had a significantly higher prevalence of FM compared with those with fewer births (p=0.006). In multivariate analysis, grand multiparity remained independently associated with FM (adjusted OR = 2.46, 95% CI = 1.28-4.72, p=0.006). No significant association was found between age at first pregnancy and FM (p>0.05). FM-diagnosed participants reported significantly higher WPI, SSS, and GSS scores (p=0.001 for all), with strong correlations between WPI and both GSS (r=0.782) and SSS (r=0.472). Grand multiparity was independently associated with fibromyalgia, suggesting that cumulative hormonal and physiological stress from multiple pregnancies may contribute to chronic pain susceptibility. No association was found between age at first
This study aimed to assess and compare the level of kinesiophobia between women with fibromyalgia syndrome (FMS) and healthy controls, and to examine its correlation with fatigue, disease activity, and emotional well-being. This clinical, cross-sectional, and controlled study was conducted at the Physical Medicine and Rehabilitation outpatient clinic in a single tertiary care hospital. The study included 74 women: 37 patients newly diagnosed with FMS according to the 2016 ACR criteria who were previously untreated, and 37 age-matched healthy female volunteers. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia. Fatigue was measured with the Fatigue Severity Scale, while pain was assessed using the Visual Analog Scale. Disease impact was evaluated with the Fibromyalgia Impact Questionnaire, and depression and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. Compared to healthy controls, the FMS group had significantly higher scores for kinesiophobia (p = 0.020), and fatigue, pain, anxiety, and depression (p < 0.001 for all). Within the FMS group, kinesiophobia was significantly correlated only with depression (r = 0.385, 95% CI [0.078, 0.622], p = 0.019); no significant correlation was found with other clinical parameters (p > 0.05). In newly diagnosed and untreated women with FMS, the significant association between kinesiophobia and depression, rather than with pain or disease activity, suggests that fear of movement is a fundamental, early-stage psychological feature of the syndrome. Therefore, early depression screening is crucial for the initial clinical management of FMS to prevent the entrenchment of activity avoidance. Key Points • In women with a new diagnosis of FMS who had not previously received any treatment for this diagnosis, kinesiophobia shows a significant correlation with depression, but not with pain intensity or disease activity. • The relationship between fear of movement and depression appears to
Empathic communication is essential for high-quality healthcare, yet patients must often interpret subtle and ambiguous interpersonal cues during healthcare encounters. In such contexts, prior experiences and cognitive-affective processes may shape interpretations in biased ways. In Fibromyalgia Syndrome (FMS), a frequently stigmatised and 'invisible' condition, such biases may influence how patients perceive unclear messages from healthcare professionals. While interpretation bias for pain-related information has been explored, bias in interpreting social-emotional information has not. This study investigated interpretations of ambiguous social-emotional cues from healthcare professionals in individuals with FMS (n = 65), compared with those with other chronic pain conditions (n = 51) and pain-free controls (n = 77). Participants completed a novel scenario-based task assessing the perceived likelihood of positive, neutral, and negative interpretations of ambiguous clinical situations. Validated self-report measures of psychological distress and perceived clinical empathy were also administered. Results showed that individuals with FMS were significantly more likely to endorse negative interpretations and less likely to endorse positive ones relative to both comparison groups, even after controlling for depression, anxiety, and stress. The FMS group also reported greater psychological distress and lower perceived empathy. Moreover, negative interpretation bias was associated with greater distress and lower perceived clinical empathy, while positive bias showed the opposite pattern. These findings suggest that individuals with FMS interpret ambiguous healthcare communication through a distinct cognitive-affective lens. This highlights that patient-provider interactions are not experienced uniformly across chronic pain populations, and that interpretative biases should be considered to improve healthcare communication. PERSPECTIVE: We explored how individuals with fibromyalgia (compared to other chronic pain and pain-free groups) interpret empathy-related ambiguous cues from healthcare professionals. Controlling for psychological distress, the fibromyalgia group showed a stronger negative
Remission and low-disease activity are recommended targets in systemic lupus erythematosus (SLE), yet many patients fail to achieve them, underscoring the need to identify contributing barriers. We explored whether comorbidities-some of which share genetic risk with lupus-and their specific patterns influence target accomplishment. Retrospective cohort of 347 patients with active SLE receiving treatment intensification at inclusion. Comorbidities (n=140), disease activity, treatments and organ damage were monitored (median follow-up 5 years). Mixed-effects assessed relationships between comorbidities and definitions of remission in SLE/lupus low disease activity state (DORIS/LLDAS). Random forests ranked comorbidities according to the strength of associations. Despite the relatively young age (median 46 years) and short disease duration (median 9 months), patients with SLE exhibited high comorbidity burden (comorbidities count, Rheumatic Disease Comorbidity Index, Elixhauser, Charlson), which increased longitudinally and was associated with reduced attainment of DORIS (ORs: 0.77-0.87, p<0.05) and LLDAS (ORs: 0.74-0.91, p<0.01). Obesity, dyslipidaemia, hypertension, stroke, depression, fibromyalgia and thyroid disorders emerged as the most influential. Presence of ≥1 of these conditions (n=238 [68.6%]) was linked to 55-60% lower likelihood of durable DORIS/LLDAS (≥50% time). Marginal structural models (MSMs) confirmed an independent comorbidities-targets association, regardless of prior achievement, explained by smouldering activity and delayed glucocorticoid tapering. While immunosuppressant/biologic use was comparable, comorbid patients received lower glucocorticoid doses during high disease activity. Comorbidities were also associated with greater damage accrual (IRR: 1.38, 95% CI 1.11 to 1.71), attenuated in patients with sustained DORIS/LLDAS. Patients with SLE manifest high comorbidity burden, with distinct patterns linked to reduced target attainment. In these patients, vigilant monitoring and treatment adjustments are essential to sustain disease control and prevent damage.
We aimed to evaluate the effects of GLP-1 receptor agonists (GLP-1RA) on symptom burden and opioid use in patients with fibromyalgia using real-world data. We conducted a retrospective cohort study using the TriNetX Research Network. Patients with fibromyalgia (≥2 diagnostic encounters) were divided into two groups: those with and without ≥2 prescriptions for GLP-1RA. Propensity score matching at a 1:1 ratio for age, sex and key comorbidities, including diabetes mellitus, obesity, osteoarthritis, inflammatory arthritis, ischemic heart disease, sleep disorders, migraine and medication use, was performed. Outcomes were assessed over a five-year follow-up period. This included opioid use, diagnostic codes for pain, fatigue and disability, body mass index and haemoglobin A1C. Statistical analysis included odds ratios, risk differences and t tests. After propensity score matching, there were 48 025 patients in each cohort. Baseline characteristics were well matched, though BMI and Haemoglobin A1c were higher in the GLP-1RA cohort than in non-GLP-1RA users. GLP-1RA use was associated with significantly reduced odds of opioid prescription (OR 0.65), pain diagnostic codes (OR 0.79) and fatigue diagnostic codes (OR 0.68) (all P < 0.001). There was no significant difference in disability-related diagnostic codes. BMI and HbA1C remained higher in patients on GLP-1RA. GLP-1RA use was associated with reduced opioid prescription and a reduction in the use of ICD-10 codes related to fibromyalgia, potentially reflecting lower symptom burden. Further studies using validated outcome measures are needed to confirm these findings.
Expectations shape therapeutic outcomes, yet their systematic assessment remains limited in clinical and research settings. To address this gap, we developed and validated the Brief Instrument for the Assessment of Treatment Expectations in Chronic Pain (BITEC) using Item Response Theory. The study comprised four phases. (I) Twenty-one items were generated from expectation constructs and refined to 11 through a Delphi review (≥ 80% agreement). (II) Comprehensibility was tested in 30 women with fibromyalgia, and the scale was applied to 484 chronic pain patients; items (0-10) were recoded into four categories, and IRT reduced them to nine. (III) The final version was administered to 1127 adults with chronic pain (79.3% fibromyalgia; 20.7% nociceptive/neuropathic), and latent-class modelling defined low-high expectation cutoffs. (IV) Construct validity was assessed via discriminant analyses in calibration (n = 1127) and validation (n = 242) samples to evaluate whether BITEC levels differentiated diagnostic groups, pain impact and catastrophizing. (V) We developed a bedside app to support expectation-level classification. The nine-item BITEC showed discrimination between high and low expectations (AUC 0.915; 95% CI 0.897-0.933; sensitivity 79%, specificity 96%). Across both samples, BITEC demonstrated construct validity, distinguishing expectation categories based on symptom severity, catastrophizing and pain burden. Expectation levels varied across pain phenotypes, decreasing from nociceptive pain (56.1%) to fibromyalgia (42.7%) and multiple pain conditions (26.9%). Higher symptom severity was associated with higher expectations. BITEC is a brief, reliable, theory-grounded instrument for stratifying treatment expectations in chronic pain; applicability across treatment modalities and clinical contexts warrants further investigation. Expectations strongly shape therapeutic outcomes but remain difficult to measure. The BITEC, a brief IRT-based tool, offers a reliable way to classify treatment expectations in chronic pain, supporting personalised care and improving clinical decision-making.
In fibromyalgia syndrome (FMS), current guidelines recommend combining pharmacological treatments such as duloxetine with exercise interventions. This randomized controlled trial aimed to evaluate the effectiveness of a home-based postural exercise program as an adjunct to pharmacological treatment in individuals with FMS. Fifty-one patients diagnosed with FMS according to the 2016 American College of Rheumatology criteria were randomly assigned to an exercise group (EG, n = 26) or a control group (CG, n = 25). Both groups received duloxetine therapy, while the EG additionally performed a home-based postural exercise program three times per week for four weeks. Outcomes included pain intensity, pressure pain threshold (PPT), sleep quality, anxiety and depression, quality of life, and trunk range of motion (ROM). Significant improvements over time were observed in pain intensity, psychological symptoms, sleep quality, quality of life, and PPT in both groups (p < 0.05). Significant group × time interactions favored the EG for sleep quality assessed using the Pittsburgh Sleep Quality Index (F = 11.07, p = 0.002, η²=0.184), the physical component of the Short Form-12 (F = 4.31, p = 0.043, η²=0.081), trunk flexion (F = 20.85, p < 0.001, η²=0.299), trunk extension (F = 8.34, p = 0.006, η²=0.146), and global trunk ROM (F = 35.10, p < 0.001, η²=0.417). No significant group × time interactions were observed for pain intensity, anxiety, depression, mental quality of life, or PPT (p > 0.05). Adding a home-based postural exercise program to pharmacological treatment may provide short-term additional benefits in sleep quality, physical quality of life, and spinal mobility in individuals with FMS; however, these findings should be interpreted cautiously due to the short intervention duration and absence of follow-up assessment.
This study aimed to evaluate the prevalence of suspected fibromyalgia using the Fibromyalgia Rapid Screening Tool (FiRST) and its impact on disease burden, disability, TNF inhibitor (TNFi) initiation, and treatment retention over 10 years in patients with axial spondyloarthritis (axSpA) from the DESIR cohort. The FiRST questionnaire was administered annually from year 7 to year 10. Missing FiRST data were imputed using longitudinal multiple imputation. Patients were classified as suspected fibromyalgia-positive at baseline if they were FiRST-positive (FiRST ≥5/6) at least twice after multiple imputation. Associations with disease outcomes over the 10-year period were assessed using mixed models for repeated measures, adjusted for TNFi use. TNFi initiation and retention over 10 years were compared using Kaplan-Meier analyses. The estimated prevalence of suspected fibromyalgia was 21.7% (144/663; 95% CI: 18.6-25.1). At baseline, suspected fibromyalgia was associated with a lower prevalence of HLA-B27 positivity and radiographic sacroiliitis, but similar rates of magnetic resonance imaging sacroiliitis and elevated C-reactive protein. Over 10 years, suspected fibromyalgia was consistently associated with higher self-reported disease activity, poorer health-related quality of life, and greater disability. Permanent disability at 10 years occurred more frequently in patients with suspected fibromyalgia (26.4% vs 9.4%; P < .001). TNFi initiation was more frequent (64.4% vs 46.1%), but treatment persistence at 1 year was significantly lower (42.0% vs 64.2%) in this group. Suspected fibromyalgia is common and clinically relevant in axSpA. It is associated with higher disease burden, increased biologic use, and poorer treatment persistence.
The current study evaluates the effects of individualized cognitive-behavioral therapy (CBT), administered alongside routine treatment, on anxiety, depression, sleep quality, hopelessness, and disease severity in patients with fibromyalgia syndrome (FMS). This is a randomized, controlled, single-blind clinical trial was conducted in a tertiary physical therapy and rehabilitation clinic. Seventy patients who met the 2016 American College of Rheumatology diagnostic criteria were randomized in a 1:1 ratio into an intervention group (n = 35) and a control group (n = 35). The intervention group received a 10-week individualized CBT program administered by a psychologist in addition to routine treatment, while the control group received only routine treatment. Outcomes were assessed using the hospital anxiety and depression Scale (HADS), comprising the anxiety subscale (HADS-A) and the depression subscale (HADS-D), Jenkins sleep scale (JSS), fibromyalgia impact questionnaire (FIQ), and Beck hopelessness scale (BHS) before and after the intervention. A total of 57 patients completed the study, with 23 in the intervention group and 34 in the control group. No significant differences were found between the groups in baseline demographic characteristics and scale scores (p > 0.05). The intervention group demonstrated statistically significant improvements in all scales following treatment: the HADS-A median score decreased from 13.00 to 10.00 (p < 0.001), the FIQ median score decreased from 71.80 to 51.52 (p < 0.001), and the BHS median score decreased from 7.00 to 4.00 (p < 0.001). In contrast, the control group showed no significant changes on any scale (p > 0.05). Individualized CBT, added to routine treatment, addresses anxiety, depression, sleep quality, disease impact, and other issues in FMS patients. Integrating individualized CBT protocols into clinical practice for fibromyalgia management should be encouraged.
This systematic review and meta-analysis investigated the effect of Mindfulness Based Stress Reduction (MBSR) on pain severity, quality of life, pain catastrophising, and depression for people living with Fibromyalgia (FM) at short and long term follow up. MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, WHO Trial Registry, CINAHL and PsychInfo were searched from inception to December 2025 for English language full papers. Randomised and non-randomised trials were included where MBSR was compared with no treatment, usual care or any active control; online MBSR interventions were excluded. The search identified 566 records, of which 11 original trials and 1153 participants were included, 1097 of whom were women. A predefined risk of bias tool was used to assess included studies. Fixed effect model meta-analysis showed improvements in favour of MBSR compared with active controls at long term follow up in quality of life (SMD -0.2635 [95% CI -0.4725, -0.0545]) and pain catastrophising (SMD -0.5375 [95% CI -0.8323, -0.2428]). Significant effects on pain severity (SMD -0.2966 [95% CI -0.4939, -0.0992]) and depression (SMD -0.4452 [95% CI -0.6502, -0.2402]) were only present at short term follow up versus passive control. Grading of Recommendations Assessment, Development and Evaluation (GRADE) determined the certainty of outcomes ranging from very low to moderate. MBSR improves pain catastrophising and quality of life in people with FM at short and long term follow up; pain severity and depression were not significantly alleviated versus active control. OSF Registration: DOI 10.17605/OSF.IO/TJ5HX. This meta-analysis reveals that, among individuals living with fibromyalgia, mindfulness based stress reduction does not significantly reduce pain severity, updating the guidance from the last review in 2013. Mindfulness based stress reduction does however have a small positive effect on quality of life compared
Chronic musculoskeletal pain (CMP) involves autonomic dysregulation quantifiable with heart rate variability (HRV), but findings are heterogeneous and the influence of HRV protocols and clinical characteristics remain unclear. This study aimed to quantify autonomic imbalance in CMP and identify methodological and clinical moderators of between-study heterogeneity. A systematic review, meta-analysis, and multilevel meta-regression following PRISMA was conducted. Electronic databases were searched for studies comparing resting-state HRV between adults with CMP and healthy controls. Effect sizes (Hedges g) were pooled with random-effects models. Individual HRV indices were meta-analyzed and then aggregated into functional domains (vagal, global, sympathovagal balance) for multilevel meta-regression including recording duration, pain condition, posture, and sex distribution as moderators. Twenty-six studies (3641 participants: 1207 CMP, 2434 controls) were included. Patients showed reduced vagal indices and global variability and higher sympathovagal balance across time, frequency, and nonlinear domains. Domain-aggregated effects indicated impaired vagal modulation (g = -0.52, 95% CI -0.67 to -0.37), reduced global variability, and elevated sympathovagal balance, with substantial heterogeneity. Multilevel meta-regression identified a significant recording duration × condition interaction (β = 0.154, P < 0.001): in fibromyalgia, longer recordings were associated with greater vagal impairment (β = -0.078, P < 0.001), whereas regional pain conditions were adequately characterized by shorter protocols. CMP is characterized by consistent HRV reductions, most prominently vagal withdrawal. Heterogeneity across studies reflects condition-specific autonomic phenotypes: fibromyalgia shows systemic dysregulation detectable with extended recordings, whereas regional pain conditions display more localized HRV alterations. Protocol standardization must be condition-tailored rather than universal.
Sleep and circadian rhythms play critical roles in pain regulation, yet the influence of chronotype remains underexplored. This systematic review and meta-analysis synthesized evidence across 43 studies (cross-sectional, cohort, and Mendelian randomization designs) investigating associations between chronotype and pain outcomes. Participants ranged from small clinical cohorts to large-scale biobanks and represented diverse pain conditions, including fibromyalgia, temporomandibular disorders, migraine, musculoskeletal pain, and rheumatoid arthritis. Qualitative synthesis indicated that evening chronotypes were more frequently associated with adverse pain outcomes, including higher pain prevalence, greater intensity, and increased interference. These associations were particularly consistent in musculoskeletal pain and headache disorders, although some studies reported worse outcomes in morning types or bimodal chronotypes. A meta-analysis of 10 studies revealed that evening chronotypes had significantly higher odds of reporting chronic pain than non-evening types (odds ratios = 1.67, 95% confidence intervals: 1.40-1.99). In contrast, pooled results for pain intensity across 6 studies showed only a nonsignificant trend toward greater pain in evening chronotypes, with substantial heterogeneity and sensitivity to influential studies. Certainty of evidence was graded as moderate for pain prevalence and low for pain intensity. Findings support chronotype as a relevant circadian marker of pain vulnerability, likely mediated by circadian misalignment, sleep disturbance, and affective dysregulation. Future research should integrate objective circadian phase measures, longitudinal designs, and disorder-specific chronobiological profiles. Recognizing evening chronotype and misalignment as modifiable risk factors may inform tailored interventions, such as light therapy or behavioral schedule adjustments, to reduce pain burden.
Brief self-administered screening tools have been developed to facilitate rapid recognition of fibromyalgia (FM) features. This study evaluated the diagnostic performance of three commonly used screening tools. In this cross-sectional study, consecutive female patients with chronic multisite pain completed three FM screening tools, respectively the Fibromyalgia Rapid Screening Tool (FiRST), the Nociplastic-Based Fibromyalgia Features (NFF) tool, and the Self-Administered Fibromyalgia Screening (SIFIS) questionnaire. Patients were dichotomised in FM (2016 ACR criteria) and non-FM controls, including patients with common non-inflammatory musculoskeletal pain conditions. Discriminative ability was evaluated using the Area Under the Receiver Operating Characteristic Curve (AUC-ROC) analysis and Decision Curve Analysis (DCA) quantified net clinical benefit across probability thresholds. Among 205 patients, 106 (51.7%) met criteria for FM. SIFIS demonstrated the highest discriminative performance (AUC=0.941) with sensitivity 82.1%, specificity 91.8%, and accuracy 86.8% at a cut-off ≥4. FiRST (cut-off ≥5) achieved AUC=0.827, sensitivity 75.5%, specificity 69.4%, accuracy 77.0%. NFF (cut-off ≥4) achieved AUC=0.829, sensitivity 80.2%, specificity 69.4%, accuracy 75.0%. Differences between SIFIS and the other tools were statistically significant (p<0.001). DCA showed that SIFIS provided the highest net clinical benefit across a broad range of thresholds. In patients with chronic multisite musculoskeletal pain, SIFIS exhibits superior diagnostic accuracy and clinical utility compared with FiRST and NFF. Integration of ROC and DCA demonstrates that SIFIS not only discriminates FM effectively but also offers meaningful clinical benefit, supporting its role as a practical screening tool in routine clinical practice.
Fibromyalgia (FM) and post-traumatic stress disorder (PTSD) share key clinical features, including sleep disturbance, fatigue, cognitive symptoms and affect dysregulation, yet they are classified as distinct disorders. We examined whether FM and PTSD represent separable phenotypes or overlapping stress-related symptom profiles using a distributional similarity approach. In an international cross-sectional online survey of adults aged 18-65 years, participants with a self-reported clinical diagnosis of FM or PTSD, and healthy controls, completed validated measures of somatic symptom burden, trauma-related symptoms, psychological vulnerability traits, comorbidities, and emotional activation patterns (EASEL-3). Case definitions were operationalised using established thresholds for polysymptomatic distress and PTSD symptom severity. To address unequal group sizes and reduce case-definition circularity, we applied adaptive sub-sampling with bootstrap resampling and quantified between-group similarity using Hellinger distance, complemented by stability analyses. Across somatic, psychological and affective domains (threat, drive and soothing systems), FM and PTSD showed substantial overlap with limited discriminatory capacity, while both differed clearly from healthy controls. Nearly half of participants meeting criteria for one condition also met criteria for the other, indicating high co-occurrence. These findings question the strict nosological separation of FM and PTSD and are compatible with a spectrum model of stress-related disorders. They further suggest that systematic trauma assessment and integrated, mechanism-based treatment strategies should be considered in the management of both conditions.
Fibromyalgia (FM) is a nociplastic pain condition characterised by widespread pain, fatigue, cognitive dysfunction and multisystem involvement. Increasing evidence implicates the microbiota-gut-brain axis (MGBA) as a potential contributor to its complex pathophysiology. This scoping review maps contemporary evidence (2020-2026) on MGBA alterations in FM across microbial, metabolic, neuroimmune and translational dimensions. This review was conducted following the Arksey and O'Malley framework, as refined by Levac et al. and the Joanna Briggs Institute, and reported in accordance with PRISMAScR guidelines. A systematic search of PubMed/MEDLINE, EMBASE, Web of Science and Scopus identified studies published between January 2020 and March 2026. Eligible studies included primary clinical, translational and preclinical investigations evaluating microbiota composition, microbial metabolites, intestinal permeability, neuroimmune signalling, or microbiometargeted interventions in FM. Narrative and systematic reviews were used only to contextualise findings and were not counted among the included studies. Of 1,365 records identified, 39 studies were included in the final synthesis. Across studies, findings were heterogeneous but most frequently described alterations in gut microbiota composition, including reduced diversity and depletion of butyrate-producing taxa such as Faecalibacterium prausnitzii, along with shifts in Bifidobacterium and Prevotella. Key metabolic perturbations encompassed reduced short-chain fatty acid production and dysregulated tryptophan metabolism. Increased intestinal permeability and activation of neuroimmune pathways were additionally documented. Microbiota profiles were associated with clinically relevant outcomes including pain intensity, fatigue, and cognitive dysfunction. Interventional evidence remains limited but suggests emerging therapeutic potential. The MGBA represents a biologically plausible and integrative framework for FM, linking peripheral and central mechanisms. Current evidence remains heterogeneous and largely associative. Future research should prioritise longitudinal, mechanistically driven studies to advance microbiome-informed diagnostic and therapeutic strategies.
Fibromyalgia is a hidden chronic condition characterised by persistent pain and fatigue, disproportionately affecting women. Because its symptoms are invisible and unpredictable, those living with it frequently encounter scepticism from others, as well as self-doubt. This study examines the experience of women with fibromyalgia participating in a structured multidisciplinary intervention, tracing their journey from non-acceptance toward coping and adjustment across personal and family domains. Sixteen Israeli women diagnosed with fibromyalgia participated in a 30-week multidisciplinary fibro-therapy intervention. Following the program, in-depth interviews were conducted with each participant. Data were analysed qualitatively using Grounded Theory methodology to identify emerging themes related to illness perception, acceptance, and adaptive coping. Participants described a meaningful shift in how they related to their diagnosis. After completing the intervention, women reported accepting fibromyalgia as an integrated part of their lives and reframing their understanding of the illness and its consequences. Key themes included movement from denial and isolation toward self-compassion, redefined identity, and more proactive coping strategies within both personal and family contexts. Because fibromyalgia presents no outward signs and follows an unpredictable course, women with the condition are particularly vulnerable to social scepticism and self-doubt. Participation in a comprehensive, multidisciplinary therapeutic intervention can facilitate disease acceptance and cultivate a more proactive and compassionate approach to living with fibromyalgia. These findings underscore the value of structured, long-term psychosocial support for this population.
Fibromyalgia (FM) is a chronic pain disorder marked by widespread pain and significant impairment of daily life. Despite evolving diagnostic criteria and recognition as a primary chronic pain condition, current treatments yield limited success, and underlying mechanisms remain under investigation.This narrative review focuses on oxygen-ozone autohaemotherapy (O2-O3-AHT) as a potential intervention for FM, evaluating its biological rationale and possible mechanisms of action. The therapeutic interest in O2-O3-AHT centres on its capacity to activate the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, reduce oxidative stress, improve mitochondrial function, and address small fibre pathology. The review employed a structured narrative synthesis, adhering to SANRA guidelines to ensure methodological rigor and transparency. Comprehensive literature searches included peer-reviewed articles published in English from 2015 to 2025.Evidence suggests that O2-O3-AHT may provide multi-target benefits for FM patients by modulating redox balance, enhancing mitochondrial resilience, and potentially alleviating neuropathic components related to small fibre dysfunction. Clinical studies, though limited and often heterogeneous, report improvements in pain, sleep quality, fatigue, and overall functional status in FM patients treated with O2-O3-AHT. Biomarker analyses further support reduced oxidative stress and inflammatory mediators post-intervention. However, the variability in treatment protocols, sample sizes, and outcome measures across studies complicates definitive conclusions about efficacy and safety.O2-O3-AHT represents a promising, mechanism-based approach to FM management, particularly for patients unresponsive to conventional therapies. Its ability to target central and peripheral biological processes aligns with the complex pathophysiology of FM. However, the current evidence base is restricted by methodological inconsistencies and a paucity of large, high-quality randomised trials. Future research should prioritise standardised protocols, robust clinical endpoints, and long-term safety assessment to validate the role of O2-O3-AHT in FM treatment. Until then, its use
Oxygen-ozone autohaemotherapy (O2-O3-AHT) has gained clinical interest as an adjunctive treatment for fibromyalgia (FM) based on its anti-inflammatory and anti-oxidative properties. However, comprehensive data on safety and adverse events remain limited. This scoping review aimed to systematically evaluate documented adverse events associated with O2-O3-AHT and assess risk stratification. Following PRISMA-ScR guidelines, we searched Medline, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science, TRIP, Clinical Evidence, and ROAD databases for relevant articles published in the last decade. Search terms included "ozone autohaemotherapy," "GAET," "autologous blood transfusion," "systemic ozone therapy," combined with "adverse effects," "side effects," "contraindications," and "iatrogenic complications." Studies involving local injections, hyperbaric oxygen therapy, veterinary applications, or non-systemic routes were excluded. The literature search identified predominantly case reports documenting rare but potentially serious adverse events. Major categories included: haemolysis and renal failure (associated with excessive ozone concentrations >60 μg/mL), hyperkalaemia in patients with complex comorbidities (hypertension, diabetes, chronic kidney disease), myocardial infarction and ischaemic events (attributed to vasoconstrictive and pro-thrombotic effects), cerebral gas embolism in patients with patent foramen ovale, autonomic reactions related to rapid reinfusion rates, anaphylactic reactions (linked to equipment materials), and infectious complications due to protocol breaches. The overall incidence of serious adverse events cannot be reliably quantified given the absence of prospective registries and reliable denominator data: A frequent cited historical low estimation of uncertain methodology should be interpreted with considerable caution. Most safety data were derived from mixed clinical populations and not specifically from fibromyalgia cohorts, although they are relevant for clinical decision-making in this setting. Current evidence does not identify a pattern of frequent serious unexpected harm when standardised protocol is followed. Key safety measures include mandatory glucose-6-phosphate dehydrogenase screening, adherence to recommended
Fibromyalgia (FM) is a multisystem disorder frequently associated with functional gastrointestinal disorders, particularly irritable bowel syndrome (IBS). Diet-related factors and gut microbiota alterations, key elements in IBS pathophysiology, may disrupt the gut-brain axis, promoting immune activation, altered pain processing, and peripheral nerve dysfunction, including small fibre involvement, which has been consistently reported in FM. The study investigated whether IBS symptom severity in FM is associated with clinical and psychological features and with neuropathological evidence of small fibre involvement. In this monocentric cross-sectional observational study, 89 FM patients underwent clinical and psychological assessments. IBS severity was assessed using the IBS Severity Scoring System (IBS-SSS). Skin biopsy with quantification of intraepidermal nerve fibre density (IENFD) at proximal and distal sites was performed in 57 patients. Patients were classified into mild-moderate and severe IBS groups. Between-group differences were analysed using Mann-Whitney U and χ² tests. Spearman's rank correlation served to assess associations between IBS severity, clinical variables, and IENFD. Severe IBS symptoms were present in 47.1% of patients. Compared with patients with mild-moderate IBS, those with severe IBS showed higher widespread pain index (WPI) and symptom severity scale (SSS) scores, indicating greater fibromyalgia severity, as well as increased anxiety and depressive symptoms, reduced sleep duration, and greater functional impairment (all p<0.05 after FDR correction). Skin biopsy revealed a higher prevalence of reduced IENFD, particularly at proximal sites, in severe IBS patients. Notably, IBS-SSS scores were negatively correlated with proximal IENFD (r=-0.34, p=0.01). IBS severity identifies a clinically more severe FM phenotype with small fibre pathology. These findings are consistent with a possible interaction between gastrointestinal dysfunction and peripheral nerve involvement in FM, although mechanistic pathways require further investigation.
Fibromyalgia syndrome (FMS) is a common but frequently overlooked cause of chronic pain in patients with chronic kidney disease, particularly those undergoing hemodialysis (HD). In addition to its impact on quality of life (QoL), FMS may be associated with oxidative stress pathways involved in chronic kidney disease pathophysiology. However, the relationship between FMS and thiol/disulfide homeostasis in HD patients remains unclear. This study examined the association between FMS, QoL, and thiol/disulfide parameters in a multicenter HD population. In this multicenter cross-sectional study, 126 HD patients (66 with FMS and 60 without FMS) from 2 dialysis centers in Turkey were evaluated between July and December 2024. FMS was diagnosed using the 2016 American College of Rheumatology criteria. Demographic data, laboratory parameters, QoL measures (short form-36 [SF-36], Fibromyalgia Impact Questionnaire [FIQ], Brief Illness Perception Questionnaire), and oxidative stress markers (native thiol, total thiol, disulfide, and related ratios) measured by automated spectrophotometry were analyzed. Group comparisons were performed using appropriate statistical tests. Correlations were assessed using Spearman analysis. Multivariable binary logistic regression was conducted to identify variables independently associated with FMS. Post hoc power analysis demonstrated adequate statistical power (87.3%, α = 0.05). Native thiol (242.35 ± 40.45 vs 225.36 ± 40.01 μmol/L, P = .019), total thiol (284.39 ± 46.60 vs 264.76 ± 46.29 μmol/L, P = .019), and disulfide (21.02 ± 3.74 vs 19.70 ± 3.62 μmol/L, P = .047) levels were higher in patients with FMS, whereas thiol/disulfide ratios did not differ between groups. FMS patients had significantly higher FIQ scores and lower SF-36 domain scores, indicating poorer QoL. Weak correlations were observed between native thiol and FIQ (r = 0.202) and between total thiol and SF-36 mental health (ρ = -0.242). In multivariable analysis, total thiol remained independently associated with FMS (OR = 1.009, P = .023), although explained variance was modest (Nagelkerke R2 = 0.058). FMS in HD
The Central Sensitization Inventory (CSI) assesses central sensitization-related symptoms, but its 25-item length may limit its use in large-scale research or routine clinical practice. Therefore, the aim was to develop a short version of the CSI, using a large international sample of 7862 participants across 23 countries. A multi-step Rasch analysis was applied to the 25-item version of the CSI using a training-validation paradigm to identify the subset of items that best fit a unidimensional model. Then, an expert committee reviewed the face-content validity of each item. A 7-item solution was ultimately developed (Chi-Square Value = 794.728, df = 20; p-value < 0.001; CFI = 0.96; TLI = 0.96; RMSEA = 0.09, 90%CI [0.09-0.10]; SRMR= 0.05). Internal consistency was adequate for both the CSI-25 (α = 0.93; ω = 0.93) and CSI-7 (α = 0.85; ω = 0.85). Both versions demonstrated strong discriminative validity in identifying subgroups with presumed different levels of central sensitization-related symptoms. As expected, CSI-25 and CSI-7 scores increased progressively from healthy control participants (who scored lowest) to single-site non-spinal chronic pain, chronic spinal pain, multi-site chronic pain, and fibromyalgia (who scored highest). CSI-7 Receiver Operating Characteristic curves showed excellent sensitivity and specificity, particularly in differentiating fibromyalgia from healthy control participants (area under the curve = 0.98; sensitivity of 92% and specificity of 93%). CSI-7 severity levels were empirically derived to aid clinical interpretation. To sum up, the CSI-7 offers an efficient, unidimensional, and internally consistent alternative to the CSI-25 for international use. PERSPECTIVE: The CSI-7 offers a brief, clinically useful screening tool for identifying central sensitization-related symptoms across diverse pain conditions. Derived from international data, it retains the psychometric strength of the full CSI while reducing
In March 2016, the Centers for Disease Control and Prevention (CDC) released the CDC Guideline for Prescribing Opioids for Chronic Pain, a set of voluntary recommendations for initiating and managing opioid treatment in the ambulatory setting. This scoping review examined guideline effects on patients, providers and health systems. A scoping review was conducted with a preregistered protocol. Comprehensive searches of PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature were conducted in April 2025. Reports published between 2016 and 2025 that explored the effects of the CDC guideline were included. No restrictions on language or country of study origin were applied, though all retrieved reports were published in the USA and in English. Two authors independently screened titles, abstracts and full-text reports. Data were extracted by healthcare setting, study aims and design, sample size, study population, participant characteristics and study findings and outcomes. Reports were characterised as empirical studies that evaluated guideline effects or implementation studies that assessed uptake. Study findings were presented descriptively and by evidence maps. Ninety-four studies met the inclusion criteria: 75 empirical studies and 19 implementation studies. Eighty-eight per cent measured changes in opioid prescribing; all but one found significant reductions in at least one prescribing measure, often among people receiving ≥50-90 morphine mg equivalents per day. Effects occurred across specialties and populations, including groups not targeted by the guideline. Studies found increased rates of tapering, with mixed findings on opioid-benzodiazepine coprescription. Legal analyses showed widespread policy adoption at the state level. Implementation studies described expanded risk-mitigation strategies, sometimes beyond guideline text. Few studies reported patient-centred outcomes, participant race or ethnicity or equity measures. This voluntary federal guideline had significant intended and unintended effects.
Fibromyalgia is a functional syndrome characterized by musculoskeletal pain and a variety of associated symptoms. Previous research has shown that close relatives are at a higher risk of developing the syndrome compared to the general population. Previous findings also suggest that symptoms tend to decrease with age. Our primary objective is to examine whether having a close relative with fibromyalgia is associated with greater symptom severity among patients in primary care. In addition, we assess the relationship between age and symptom severity. The study is based on a cross-sectional design. The data were collected at the Nokia Health Centre, Finland, in 2016. Patients meeting the ACR 2010 criteria were included in this study (n = 91). We used three validated questionnaires to assess disease severity (PSD, FIQ and EQ-VAS) and patient-reported information on fibromyalgia in a close relative. The independent-samples t-test was used to examine the association. Participants were divided into four age groups, and differences in symptom severity between age groups were assessed using one-way analysis of variance (ANOVA). There were no statistically significant differences between family history and symptom severity, nor age groups and symptom severity. Furthermore, there was no statistically significant linear association between age and symptom severity, nor between symptom severity and family history of fibromyalgia. These findings remained unchanged after adjusting for family history. However, given the lack of statistical significance and our small sample size, these observations should be interpreted cautiously. Symptom severity and functional limitations appeared broadly similar across age groups in our sample, which may suggest that increasing age is not necessarily associated with substantial symptom relief. However, these findings should be interpreted with caution given the cross-sectional design and small sample
Fibromyalgia is a chronic pain syndrome traditionally perceived as a predominantly female condition, although growing evidence suggests that this view may partly reflect diagnostic and sociocultural biases rather than true epidemiological differences. This perspective critically examines fibromyalgia in men as an underrecognized and understudied clinical entity. The authors propose an integrative conceptual framework in which the invisibility of men with fibromyalgia emerges from the interaction between sociocultural barriers to healthcare-seeking, clinician-related diagnostic bias, and heterogeneous symptom expression influenced by biological and psychosocial factors. Men may delay seeking medical care due to cultural expectations of masculinity and frequently encounter skepticism regarding symptoms such as diffuse pain, fatigue, and psychological distress. Although core symptoms are shared across sexes, men may differ in coping strategies, illness perception, and healthcare interaction. Emerging evidence also suggests possible neurophysiological and functional alterations, including small fiber pathology, reduced muscular strength, gait impairments, and psychological comorbidities. However, current evidence remains limited by small samples and methodological heterogeneity. The article argues that understanding fibromyalgia in men is essential not to establish rigid sex-specific phenotypes, but to improve diagnostic sensitivity, promote biopsychosocial and gender-sensitive care, and expand the understanding of heterogeneity within chronic pain disorders.
Fibromyalgia is a polysymptomatic central sensitisation disorder characterised by widespread pain, fatigue, sleep disturbances and neuropsychiatric features. Hyperbaric oxygen therapy modulates neuroinflammation, mitochondrial function and neuroplasticity, thereby yielding analgesic and functional benefits. Evaluate the efficacy and optimal timing of hyperbaric oxygen therapy as an adjunct to standard care for fibromyalgia. This single-centre, randomised, cross-over group, assessor-blinded clinical trial was conducted in the Department of Rheumatology at the University Hospital of the Federal University of Juiz de Fora, Juiz de Fora, Brazil, and adhered to Consolidated Standards of Reporting Trials (CONSORT) guidelines. Women (18-70 years) with a diagnosis of fibromyalgia for ≥2 years were randomised 1:1 to early hyperbaric oxygen therapy plus standard care or standard care alone (delayed group). Intention-to-treat (ITT) analysis was conducted with all 56 participants (mean age: 51.0±9.8 years; mean body mass index: 30.5±5.1 kg/m²). Standardised care (education, exercise and pharmacotherapy) plus hyperbaric oxygen therapy was delivered at 2.3 atmospheres absolute for 90 min, five times per week, over 8 weeks (total 32-40 sessions). The early group received hyperbaric oxygen therapy during weeks 0-8, while the delayed group received it during weeks 8-16, following the same protocol. Primary endpoints included the Fibromyalgia Impact Questionnaire-Brazilian Portuguese (FIQR-Br), the pain visual analogue scale (VAS) and the Symptoms Assessment Scale-40 (EAS-40) for psychopathology. Secondary endpoints included the 12-Item Short-Form Health Survey (SF-12) physical and mental components and adverse effects. Assessments were conducted at baseline, 8 weeks and 16 weeks, and analysed using a mixed-design 2×3 analysis of variance (group: early vs delayed; time: baseline, 8 weeks and 16 weeks) with Greenhouse-Geisser corrections as needed, followed by Bonferroni post hoc tests. Missing data were assessed using Little's missing completely at random (MCAR), and
Systemic Lupus Erythematosus (SLE) presents a significant diagnostic challenge for clinicians due to its diverse clinical manifestations and overlap with other autoimmune conditions. Large Language Models (LLMs) are currently regarded as having the potential to assist clinicians in expediting decision-making. This study aimed to evaluate the performance of four LLMs in differentiating SLE from clinically mimicking conditions. A retrospective diagnostic accuracy study was conducted involving 100 patients at a rheumatology center: 50 patients with confirmed SLE and 50 non-SLE patients with conditions including rheumatoid arthritis, systemic sclerosis, axial spondyloarthritis, psoriatic arthritis, myositis, ANCA-associated vasculitis, mixed connective tissue disease, undifferentiated connective tissue disease, and fibromyalgia. Four LLMs were evaluated: Deepseek, ChatGPT 4.0, Claude Sonnet 4, and Gemini. The 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) classification criteria were applied. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), and Area Under the Receiver Operating Characteristic Curve (AUC) were calculated. IBM SPSS Statistics version 25 was used for all analyses. Gemini achieved the highest performance score, with an accuracy of 96% (95% CI: 91.2-100.0%), sensitivity of 94% (95% CI: 89.3-98.7%), specificity of 98% (95% CI: 93.1-100.0%), and an AUC of 0.960. ChatGPT 4.0 and Claude Sonnet 4 exhibited comparable accuracy. Deepseek recorded the lowest performance score. Gemini demonstrated significant potential to assist clinicians in differentiating SLE from mimicking conditions. Nevertheless, prospective validation in real-world clinical settings is required before these tools can be reliably integrated into clinical practice.
Previous research indicates that individuals with chronic widespread pain (CWP) have an excess risk of cardiovascular disease. Given the high global prevalence of CWP, this association may have substantial public health implications. Our objective was to summarise the current evidence on the association between CWP and incident cardiovascular disease in a systematic review and meta-analysis. We searched major databases (MEDLINE, Embase, Web of Science, and Cochrane) and included studies based on predefined eligibility criteria. We identified 18 studies reporting associations between CWP (n = 80,021) and atherosclerotic diseases or cardiovascular mortality (n events = 33,799). In the meta-analysis, we removed studies that analysed identical outcomes in the same population. Individuals with CWP had an almost doubled risk of atherosclerotic diseases, RR 1.94 (95% confidence interval [CI]: 1.56-2.41), and for cardiovascular mortality, the RR was 1.61 (95% CI: 1.24-2.08) in the minimally adjusted models. In the maximally adjusted model, the RR for atherosclerotic diseases was 1.53 (95% CI: 1.27-1.86) vs RR 1.12 (95% CI: 0.93-1.34) for cardiovascular mortality. The heterogeneity was high and potential publication bias was indicated for the mortality analysis. This meta-analysis, although based on relatively few studies with high heterogeneity, shows that CWP is consistently associated with incident atherosclerotic disease. Evidence for an association with cardiovascular mortality is less conclusive. Individuals with CWP may represent an underrecognized high-risk group for atherosclerotic diseases that could benefit from proactive cardiovascular risk assessment and intensified prevention. Further high-quality studies are warranted to confirm the strength and causality of the association.
Juvenile fibromyalgia (JFM) is a complex and disabling chronic pain condition for which treatment options are limited. The objective of this randomized controlled trial was to compare the relative efficacy of 3 group-based interventions: cognitive-behavioral therapy (CBT) alone, graded aerobic exercise (GAE) alone, or CBT combined with specialized neuromuscular exercise (Fibromyalgia Integrative Training [FIT] Teens), in reducing pain-related disability for adolescents with JFM. Patients with JFM (ages 12-17) who experienced moderate-to-severe pain and pain-related disability were eligible. A total of 317 adolescents (86.4% girls, 84.2% White, mean age 15.8 years) were randomized to receive 8 weeks (16 sessions) of CBT (N = 110), GAE (N = 104), or FIT Teens (N = 103), followed by 4 booster sessions. Our primary hypothesis that the FIT Teens intervention would be superior to CBT or GAE was not supported. Rather, participants in all treatments showed significant reduction in disability with no differences between groups at the 3-month primary endpoint (main effect estimate = -3·94 [95% CI: -6·62 to -1·26]) and at 6-, 9-, and 12-month follow-up (main effect estimate = -4·52 [95% CI: -7·35 to -1·68]; -4·21 [95% CI: -7·13 to -1·29]; and -4·76 [95% CI: -7·84 to -1·68], respectively). Pain intensity was significantly improved at 9- and 12-month follow-up. Although the overall magnitude of improvement in disability was small, approximately 1 in 4 patients in the FIT and CBT groups had clinically remarkable improvement. Cognitive-behavioral and exercise-based treatments are promising for the management of JFM. Further research is needed to examine the characteristics of treatment responders and the mechanisms of improvement.
Development and psychometric evaluation of a disease-specific, paediatric-targeted multidimensional questionnaire for the assessment of juvenile fibromyalgia syndrome (JFS) in routine clinical practice. The Juvenile Fibromyalgia Multidimensional Assessment Report (J-FiMAR) includes three domains: numerical rating scales to measure the severity of JFS- related symptoms (widespread pain, fatigue, sleep quality, depression, anxiety, cognitive impairment, headache and abdominal pain); a self-report questionnaire to assess physical functioning (PF) and health-related quality of life (HRQoL); and patient rating of disease severity and course. Validation analyses included assessment of construct validity, discriminant validity and responsiveness to change. The J-FiMAR was administer to 51 JFS patients (F 43, median age 16 years). Each patient completed the J-FiMAR at study entry and at each follow-up visit for a total of 194 visits. All patients found the questionnaire clear, easy to complete and quick. Correlations between J-FiMAR components and physician global assessment of patient's health status, and validated instruments for mood and sleep disorders were at least moderate. J-FiMAR discriminated well between patients who exhibited improvement and those who did not improve at follow up visits. JFS patients reported worse pain, fatigue, mood disorders, PF and HRQoL than patients with juvenile idiopathic arthritis (p<0.05). The majority of the items included in the J-FiMAR exhibited satisfactory responsiveness to change, with standardised response mean values exceeding 0.6. The J-FiMAR is an accurate clinical tool for routine monitoring of disease course and has the potential to be successfully integrated into both outpatient clinics and research settings.
Nociplastic pain, characterised by altered central pain processing, is associated with increased healthcare utilisation. This study investigated the relationship between nociplastic pain, based on clinical diagnoses of fibromyalgia, chronic pain, or myofascial pain, and hospital outcomes in patients. A retrospective cohort study was conducted using hospital records of hospitalised patients. Patients aged ≥18 years with a diagnosis of fibromyalgia, chronic pain, or myofascial pain were classified as the research group, while a comparison group of hospitalised patients without these diagnoses was selected. Outcomes included length of stay (LOS) for the index hospitalisation, recurrent hospitalisations within 6 months, Opioid use disorder (OUD), and 5-year mortality. Statistical analyses included t-tests, Wilcoxon tests, linear and Poisson regressions, adjusting for age and sex. Of 18,393 patients, 3,326 (18.1%) were in the research group. The research group was older (mean age 62.35 vs. 50.57 years, p<0.001) and had a higher proportion of females (72.7% vs. 56.6%). Adjusted analyses showed longer LOS in the research group (mean 6.89 vs. 5.59 days, p=0.002), higher recurrent hospitalisations (p<0.001), and increased OUD (87.5% of cases in the research group, p<0.001). Surprisingly, 5-year mortality risk was lower in the research group (HR 0.523, p<0.001). Nociplastic pain diagnoses are associated with prolonged hospitalisations, increased readmissions, and OUD, but lower long-term mortality. These findings highlight the need for targeted pain management strategies.
To estimate prevalence and associated factors of comorbid fibromyalgia in axial spondyloarthritis (axSpA), and to explore discriminative capacity (for discerning fibromyalgia) of algometry-assessed pain sensitivity measures. AxSpA patients from the population-based SPARTAKUS cohort evaluated for fibromyalgia (1990 ACR criteria) were included (n = 243; r-axSpA/nr-axSpA = 165/78). Factors associated with fibromyalgia were cross-sectionally analyzed by logistic/linear regression, and discriminative potential of algometry-assessed measures estimated by ROC-curve analysis. A fibromyalgia prevalence of 9% was demonstrated, with a higher frequency in female than male patients (17%/2%;adjusted p < 0.001) and more than a doubling in frequency per 5-unit BMI increase (adjusted p < 0.002). Fibromyalgia was associated with several disease/work outcomes, including higher disease activity, lower quality-of-life, and less employment although without association to swollen joints/CRP. Additionally, patients with (versus without) fibromyalgia had higher bDMARD exposure (19%/5% had tried ≥ 3 bDMARDs; adjusted p = 0.009), and were more often on opioids (62%/16%;adjusted p < 0.001). Algometry-assessed measures displayed a sensitivity/specificity of 79%/70% (pain threshold) and 71%/83% (pain tolerance) for fibromyalgia differentiation (positive/negative predictive values 16%/99% and 23%/98%, respectively). Fibromyalgia is a frequent comorbidity in axSpA, more common in female patients/patients with higher BMI, and associated with worse levels of patient-reported disease/work outcomes. Our findings highlight the challenge of assessing axSpA disease activity when fibromyalgia is present and suggest a role for algometry as a complementary, evaluator-independent assessment tool, potentially useful for fibromyalgia rule-out but less so for rule-in. The results further suggest that fibromyalgia may be associated with DMARD overtreatment, reflecting a need for earlier and more precise targeting.