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What is fibromyalgia?

What is fibromyalgia?

Fibromyalgia is a chronic condition that causes pain all over the body. It can be associated with pain in multiple joints and muscles, and fatigue. It affects between 4-8% of people, and is more common in women than in men. People with a rheumatic disease such as lupus or rheumatoid arthritis are at an increased risk for developing fibromyalgia.

 

Fibromyalgia symptoms

Symptoms associated with fibromyalgia can include:

Pain

This is a diffuse, chronic and persistent pain all over, including the muscles, joints, and tendons. The pain is often described as burning, aching, stiffness, or soreness. It can vary with times of the day, weather, sleep patterns, and amount of stress. People with fibromyalgia often feel like they constantly have the flu.

Fatigue

 Fatigue is one of the hallmarks of fibromyalgia syndrome and can be severe in some people. There may be a close relationship between fibromyalgia and chronic fatigue syndrome (CFS).

Poor sleep

Most people with fibromyalgia complain of poor sleep- either difficulty falling asleep, staying asleep, or both. Poor sleep is known to aggravate fibromyalgia, so improvement of sleep quality is one of the treatments of fibromyalgia.

Mood changes

Anxiety and depression are common in people with fibromyalgia.

Abdominal pain, diarrhea, constipation

Many people with fibromyalgia also have a diagnosis of irritable bowel syndrome or spastic colon.

Bladder pain, frequent need to urinate

Interstitial cystitis is a common diagnosis in people with fibromyalgia

Headaches (tension or migraine headaches)

Memory problems

Jaw pain, temporomandibular joint (TMJ) syndrome

Tendonitis

Numbness and tingling in hands and feet

 

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. Although the pain experienced by people with fibromyalgia is very real, no abnormalities may be found on exam or lab tests. It is thought that the cause of fibromyalgia is “multi-factorial”, meaning that various physical and emotional factors (like infections, physical or emotional trauma, genetic factors, etc.) may play a role in development of fibromyalgia. Studies have pointed to a central process in fibromyalgia, which means something in the brain and the nervous system may be responsible. It is thought that people with fibromyalgia may have an impaired pain perception, and a decreased ability to lower pain. This means that the nervous system interprets a stimulus to be much more painful than it really is. For example, while a person without fibromyalgia will perceive a hug as mild pressure on their muscles, the nerves of the person with fibromyalgia may perceive a hug as a painful stimulus and will send signals to the body that will experience pain.

See next:

 

Fibromyalgia- diagnosis

 

The essentials of fibromyalgia treatment

 

 

Reference:

American College of Rheumatology http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp

Arthritis foundation  http://www.arthritis.org/

Uptodate http://www.uptodate.com/contents/fibromyalgia-beyond-the-basics?source=search_result&search=fibromyalgia+patient&selectedTitle=1%7E150

F Wolfe, DJ Clauw, MA Fitzcharles, DL Goldenberg, RS Katz, P Mease, AS Russell, J Russell, JB Winfield, MB Yunus. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research,Vol. 62, No. 5, May 2010, pp 600–610

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Systemic Lupus Erythematosus- Treatment

Lupus treatment principals

The goal in lupus treatment is to reduce inflammation and pain and to prevent organ damage. Specific lupus treatment is dependent on the symptoms and severity of the disease. Often, a combination of general measures and medications is used by a rheumatologist in lupus treatment.

General measures:

Sun-protection

In most people, sun exposure can cause a flare or worsening of the disease. The recommendations are to stay out of the sun, and wear sunscreens with UV-A and UV-B protection and a high SPF.

 

Stop smoking!

Smoking can increase the risk of developing lupus and can exacerbate its flares. The most commonly used medication in lupus, Hydroxychloroquine (Plaquenil) is less effective in smokers.

 

Exercise

Inactivity during a lupus flare can cause muscle atrophy and fatigue. It is important to stay in shape during remission and continue gentle exercises during a flare.

 

Diet

Maintain a healthy weight and a healthy diet. Many people with lupus are deficient in vitamin D (especially if avoiding the sun) and will need supplements). Vitamin supplements are ok, but be careful with herbal medications as some may interfere with your other medications.

 

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs)

Examples: Advil, Ibuprofen, Motrin, Aleve, etc.

These are effective in mild disease and for tenderness in the joints and muscles, fevers, and headaches.

 

Anti-malarials

Examples: Hydroxychloroquine (Plaquenil), Quinacrine.

These are relatively mild medications with good efficacy and generally little side effects. These drugs are usually used long term and are thought to be effective at keeping the disease inactive. Plaquenil is the one used most commonly. Its most common side effects include nausea, diarrhea, and body aches. Yearly eye exams are required to screen for injury in the retina; an extremely rare side effect.

 

Corticosteroids

Examples: Prednisone (oral), solumedrol (IV)

Oral or IV steroids are used alone or in combination with other immunosuppressive drugs during flares of lupus or when the disease is severe. Varying doses are used depending on severity of the flare and organs that may be involved. For example, lower doses of prednisone (10-30mg per day) may be used when the flare involves the skin or joints, whereas doses as high as 1000mg may be used when the brain or kidneys are involved.

 

Disease Modifying AntiRheumatic Drugs (DMARDs)

Examples: Methotrexte, Azathioprine (Imuran), Mycophenolate mofetil (Cellcept), Cyclosporin, Cyclophosphamide (Cytoxan)

These medications are used in patients with moderate to severe lupus. They are usually used in combination with anti-malarials and/or corticosteroids.

 

Biologic drugs

Examples: Belimumab (Benlysta), Rituximab (Rituxan), TNF inhibitors

Belimumab is the newest FDA-approved medication for lupus. It is a monthly IV monoclonal antibody which was approved in March 2011 for lupus patients with a positive ANA without significant brain or kidney involvement. Rituximab is also a monoclonal antibody and like Belimumab affects the B-lymphocytes, although through a slightly different mechanism. Since B-lymphocytes are thought to be the major cells involved in lupus, suppressing the B-lymphocytes is a major target in treatment of lupus. TNF inhibitors (like Enbrel, Humira, etc), which have been revolutionary in treatment of rheumatoid arthritis, have been used in treatment of lupus with caution, as they can cause exacerbation of lupus in some patients.

 

Therapies for resistance disease

Severe-organ involvement in lupus can be life-threatening, especially when the conventional lupus treatment has been ineffective. These are some less commonly used and investigational treatment approaches.

 

Stem cell transplantation

A sample of the patient’s stem cells (from bone marrow) is taken out and stored. High dose chemotherapy is then used to wipe out the rest of the stem cells. This is followed by the transplantation of the stem cell sample back through an IV. It is thought that the new generation of the lymphocytes produced by the stem cells will not have anti-self activity. This approach has been reported to have an 84% survival rate at 5 years in one study, and 62% at 48 months in another study.

 

Other drugs targeting B-lymphocytes

Atacicept and Epratuzumab are other drugs in this family currently undergoing clinical trials

 

Drugs targeting B and T lymphocytes

Abatacept (orencia)- this drug has been successfully used in patients with rheumatoid arthritis. Its efficacy in treating lupus is currently being studied.

 

Remember!

Most people with lupus can live normal lives. Successful therapies are available to us and can be tailored to address the disease in each individual person. Still, lupus is a complex disease. Frequent monitoring by a rheumatologist is usually needed to assess the disease activity and adjust the medications as needed to make sure lupus stays in remission!

 

Also read:

Systemic Lupus Erythematosus- What is it? 

Systemic Lupus Erythematosus- How is it diagnosed?

 

More information:

http://lupus.webmd.com/guide/lupus-treatment-care

 

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