Objective. The COVID-19 pandemic severely increased the stress levels in the population. The aim of present study was to investigate the impact of the lockdown measures on emotional well-being and disease activity in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) through a telemedicine approach.Methods. An on-line survey, including demographic characteristics, disease-activity and psychometric scales (Stress-related Vulnerability Scale, Resiliency scale), Zung Anxiety and Depression Self-assessment Scale), was anonymously administered to FM, RA and healthy controls (HC). Disease activities were compared to the pre-lockdown cohort referring to our centre. Results. Levels of anxiety and depression worthy of psychiatric attention were documented in 36.7% of FM, 14.6% of RA, 12.5% of HC and in 50% of FM, 17.1% of RA, 15% of HC, respectively. HC featured the highest stress scores, followed FM and then RA. RA showed higher resiliency than FM. Both anxiety and depression scores were significantly higher in FM than RA and HC. Disease severity was higher in RA patients and lower in FM patients when compared to the respective historical cohorts. Conclusion. Lockdown significantlyaffected the emotional well-being and disease activity of patients suffering from rheumatic diseases. While HC showed a higher vulnerability to stress, RA patients showed a greater resilience compared to both HC and to FM patients, especially. Emotional disturbances are greater in patients with RDs and in particular with FM. The use of a telemedicine approach to screen for severe symptoms represents a useful addition to the overall management of rheumatic patients.
Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.
Red blood cells (RBCs) are recognized to be important pathogenetic determinants in several human cardiovascular diseases (CVD). Undergoing to functional alterations when submitted to risk factors, RBCs modify their own intracellular signaling and the redox balance, shift their status from antioxidant defense to pro-oxidant agents, become a potent atherogenic stimulus playing a key role in the dysregulation of the vascular homeostasis favoring the developing and progression of CVD. Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with a significantly increased risk of cardiovascular mortality with a prevalence from two to five more likely in woman, mainly attributed to accelerated atherosclerosis. The purpose of this study was to correlate the RA disease activity and the RBCs functional characteristics. Thirty-two women (aged more than 18 years) with RA, and 25 age-matched healthy women were included in this study. The disease activity, measured as the number of swollen and painful joints (DAS-28), was correlated with 1) the expression of RBCs estrogen receptors, which modulate the RBC intracellular signaling, 2) the activation of the estrogen-linked kinase ERK½, which is a key regulator of RBC adhesion and survival, and 3) the levels of inflammatory- and oxidative stress-related biomarkers, such as the acute-phase reactants, the antioxidant capacity of plasma, the reactive oxidizing species formation and 3-nitrotyrosine. All the biomarkers were evaluated in RA patients at baseline and 6 months after treatment with disease-modifying anti-rheumatic drugs (DMARDs). We found, for the first times, that in RA patients 1) the DAS-28 correlated with RBC ER-α expression, and did not correlate with total antioxidant capacity of plasma; 2) the RBC ER-α expression correlated with systemic inflammatory biomarkers and oxidative stress parameters, as well as ERK½ phosphorylation; and 3) the DMARDs treatments improved the clinical condition measured by DAS-28 score decrease, although the RBCs appeared to be more prone to pro-oxidant status associated to the expression of survival molecules. These findings represent an important advance in the study of RA determinants favoring the developing of CVD, because strongly suggest that RBCs could also participate in the vascular homeostasis through fine modulation of an intracellular signal linked to the ER-α.
ObjectiveFibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with symptoms such as fatigue, sleep disturbances and cognitive impairment. Prevalence is higher in females but the application of the 2010/2011 and 2016 revision of the American College of Rheumatology (ACR) criteria reduced prevalence differences and the actual female:male ratio is approximately 3:1. Even if lately some studies have been conducted regarding FM gender differences, disease severity is still assessed using questionnaires, such as the Revised Fibromyalgia Impact Questionnaire (FIQR), designed and validated through a predominantly female sample.The aim of this pilot study was to compare the 21 items of the FIQR among male and female patients in order to evaluate the possible existence of a gender bias. FM (2016 ACR criteria) were asked to answer an online survey, including demographic characteristics, disease variables and the Italian version of the FIQR. Among the 544 patients that compiled the questionnaire, 78 patients, 39 males and 39 females, matched for age and disease duration, were consecutively enrolled in order to compare their FIQR scores. Methods In this case-control study, consecutive patients with a diagnosis of ResultsThe univariate analysis showed that total FIQR scores and physical function domain scores were significantly higher in females and, among the 21 items of the FIQR, the female group obtained significantly higher scores in 6 of them. Our results showed that female patients obtain significantly higher scores in the FIQR total score and physical function domain score, in particular in 5 out of the 9 sub-items of the FIQR physical function domain. ConclusionThese preliminary results indicate that the use of the FIQR as a severity index in male patients probably underestimates the disease impact in this group.
BackgroundFibromyalgia (FM) is a chronic syndrome clinically characterized by widespread musculoskeletal pain associated with symptoms like fatigue, sleep disturbances and cognitive impairment. Prevalence is higher in females but the 2010/2011 and 2016 revisions of the American College of Rheumatologist (ACR) criteria reduced prevalence differences and the actual female:male ratio is approximately 3:1. Even if in the last years some studies have been conducted regarding gender differences in FM, disease severity is still assessed using questionnaires, such as the Revised Fibromyalgia Impact Questionnaire (FIQR), designed for female patients and validated through a predominantly female sample.ObjectivesAim of this pilot study was to compare the 21 items of the FIQ-R among male and female patients in order to evaluate the possible existence of a gender bias.MethodsIn this case control study, all the consecutive patients with a diagnosis of FM (2016 ACR criteria) referring to our out-patientsFibromyalgia Clinicbetween May 2020 and December 2022 were asked to answer an online survey, including demographic characteristics, disease variables and the Italian version of the FIQR. Among the 544 patients that compiled the questionnaire, 78 patients, 39 males and 39 females matched for age and disease duration, were consecutively enrolled in order to compare their total FIQR score and the different domains scores.ResultsThe univariate analysis of the FIQR scores, taking account of the total score and of the different domains of FIQR, showed that total scores and physical function domain scores were significantly higher in females compared to males. No significant differences emerged between the two groups regarding overall impact domain score and symptoms domain score. Among the 21 items of the FIQR, the female group obtained significantly higher scores answering the questions FIQR1 (brush or comb your hair), FIQR4 (vacuum, scrub, or sweep floors), FIQR5 (lift and carry a bag full of groceries), FIQR7 (change bed sheets), FIQR9 (go shopping for groceries) and FIQR21 (sensitivity to loud noises, bright lights, odors, cold).ConclusionThe results of our pilot study showed that female patients obtain significantly higher scores in the FIQR total score and in the physical function domain score, in particular in 5 out of the 9 sub-items of the FIQR physical function domain. These preliminary results indicate that the use of the FIQR as a severity index in male patients probably underestimates the disease impact in this group. In order to confirm these results the sample needs to be increased but it seems reasonable to conclude that the assessment of disease impact should be diversified, taking gender differences into account.References[1]Marques A.P., Santo A.S.D.E, Berssaneti A.A., Matsutani L.A., Yuan S.L.K. Prevalence of fibromyalgia: literature review update.Rev Bras ReumatolEngl Ed.2017,57,356-363.[2]Galvez-Sánchez C.M., Reyes Del Paso G.A. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives.J Clin Med.2020,9, 1219.[3]Cabo-Meseguer A., Cerdá-Olmedo G., Trillo-Mata J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs.Med Clin (Barc).2017,149,441-448.[3]Branco J.C., Bannwarth B., Failde I., AbelloCarbonell J., Blotman F., Spaeth M., Saraiva F., Nacci F., Thomas E., Caubère J.P., Le Lay K., Taieb C., Matucci-Cerinic M. Prevalence of fibromyalgia: a survey in five European countries.Semin Arthritis Rheum.2010,39, 448-53.Table 1.Significant differences in FIQR total, domains and single question scores based onsexScoreM (39)F (39)p-valueFIQR Total58.8 (23.5)70.3 (14.7).035FIQR Physicalfunction14.8 (8.2)20.1 (5.1).003FIQR1 Brush or comb your hair2.4 (3.3)4.3 (2.9).006FIQR4Vacuum, scrub, or sweep floors5.2 (3.6)7.5 (2.2).005FIQR5Lift and carry a bag full of groceries6.4 (3.1)8.3 (1.6).002FIQR7 Change bed sheets4.7 (3.6)7.1 (2.7).001FIQR9 Go shopping for groceries4.9 (3.3)6.7 (2.4).012FIQR21Sensitivity to loud noises, bright lights, odors, cold6.2 (2.7)7.9 (1.6).005Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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