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Fibromyalgia is a condition that is part of the so-called central sensitization syndromes. There is a hyperexcitation of the central nervous system with a lowered pain threshold, which causes pain to appear earlier and become more intense, longer-lasting, and more widespread.
Generalized pain is often accompanied by other symptoms, such as fatigue or sleep disturbances. It is diagnosed based on criteria that rely on symptoms and physical examination. There is no specific medical test.
Fibromyalgia is a common condition, affecting 2.4 % of the general population, and is part of the so-called central sensitization syndromes. It is mainly characterized by widespread pain. There is hyperexcitation of the central nervous system with a lowered pain threshold, causing pain to appear earlier and be more intense, longer-lasting, and more diffuse. There is an exaggerated response to painful stimuli (hyperalgesia) and pain in response to normally non-painful stimuli (allodynia). Its cause is unknown, but sometimes there are clear triggers such as physical or emotional trauma or infections.
It is a chronic condition with a fluctuating course, with periods of improvement and others of clinical worsening.
The main symptom is widespread pain, but it is often accompanied by other symptoms such as fatigue, insomnia, tingling in the limbs, headache, dizziness, memory and concentration problems, anxiety, or depression.
It usually affects middle-aged women, with a peak between 40 and 49 years, but it can affect people of all sexes and ages.
Diagnosis is based on criteria that rely on the patient’s clinical presentation, according to the presence of characteristic symptoms and signs.
There is no specific medical test.
Laboratory tests and sometimes imaging studies help rule out other conditions that are often concomitant (present at the same time).
Treatment of fibromyalgia should be based on four pillars: patient education (general information about the disease and attitude toward it), physical exercise according to tolerance, cognitive-behavioral therapy if appropriate, and pharmacological treatment.
1. Patient education and attitude toward the disease
The disease should be explained, providing general advice to improve well-being.
2. Physical exercise according to tolerance
There is evidence of its effectiveness on pain, well-being, and physical function.
It is recommended to start with low-impact aerobic exercise: walking, swimming, stationary cycling, aquagym, tai chi, or pilates.
Exercise should be performed regularly and progressively.
It is recommended to do 20–50 minutes per session, at least three days per week.
In cases of lower tolerance, start with ten minutes per session, four to six days per week, and gradually increase duration, frequency, and intensity, if possible, each month.
3. Cognitive-behavioral therapy
Provided by clinical psychologists in cases of accompanying anxiety or depression.
Although fibromyalgia is not a psychological condition, anxiety and depression can trigger and perpetuate symptoms.
4. Pharmacological treatment
Can help manage some symptoms such as pain, fatigue, or sleep disturbances, although its effectiveness is limited in a large percentage of patients.
Currently, analgesics, muscle relaxants, anticonvulsants, and some groups of antidepressants are used.
The risk/benefit and potential side effects of any medications should be carefully evaluated.
A healthy lifestyle is recommended, maintaining weight with aerobic exercise according to tolerance and a balanced diet, organizing and prioritizing daily tasks with short breaks, and avoiding physically and emotionally stressful activities.
Health advice for people with fibromyalgia is provided.
Rheumatology, Traumatology, Rehabilitation and Burns Hospital
Sjögren's Syndrome is a chronic, systemic autoimmune disease, the cause of which is unknown. Its main symptoms are a dry mouth (xerostomia) and dry eyes (xerophthalmia). In this disease, the cells making up our defence system (immune system) attack parts of the body itself, such as the glands that keep the eyes and mouth moist, and glands in other parts of the body, altering their function. Symptoms in other organs, such as the lungs, joints or nervous system, may also occur.
Patients with Sjögren's Syndrome often have other conditions related to anomalous functioning of the immune system, such as systemic lupus erythematosus, scleroderma and rheumatoid arthritis.
Patients with Sjögren's Syndrome mainly have symptoms related to a lack of tear and saliva production, which causes dryness in the mouth and eyes. The main symptoms suffered by patients are a burning, gritty sensation in the eyes, red eyes, blurred vision, the need to drink water frequently, difficulty swallowing dry food and a higher propensity for tooth decay and mouth infections. This dryness may also affect the skin and vaginal area, which causes painful sexual relationships. Other symptoms that Sjögren's Syndrome patients may show are joint or muscle pain and fatigue. Less frequently, other organs, such as the lungs, kidney and nerve endings, may be affected.
Above all, the disease affects women aged between 40 and 60. It is calculated that the incidence is between 0.5% and 3% of the population.
There is no single test enabling diagnosis of Sjögren's Syndrome. Diagnosing Sjögren's Syndrome in a patient referred with dry eyes and mouth is based on tests that confirm the existence of a deficit in tear and saliva production and that prove that the dryness is associated with an imbalance in the immune system.
Treatment of Sjögren's Syndrome is essentially based on measures that alleviate the feeling of dryness shown by the patient. The treatment includes the use of artificial tears, eye gels, eye drops, nebulisers and tablets to stimulate saliva production. Particular patients may be given treatment to stimulate glandular secretion. In serious cases, where there are symptoms in organs other than the glands (lungs and peripheral nerves, etc) it may be necessary to administer medication that acts to decrease immune system activity (immunosuppressant drugs).
Patients with Sjögren's Syndrome must undergo a series of eye tests, blood and urine tests and, on certain occasions, it is necessary to do a small biopsy of lip mucous to confirm the existence of inflammation in the glands producing saliva.
Sindrome-Sjogren
Sociedad Española de Medicina Interna
American College of Rheumatology: Síndrome de Sjögren
Rheumatic polymyalgia is an inflammatory rheumatic disease, of unknown origin, that mainly affects people over 50 and causes pain and rigidity in the shoulder and hip areas (shoulder and pelvic girdles). Between 15% and 30% of cases can be linked to giant cell arteritis. In the immense majority of cases it is accompanied by an increase in the erythrocyte sedimentation rate (ESR), analytic proof that, in general, indicates that an inflammatory process is active in our body.
The symptoms usually begin with symmetrical pain in the shoulders, and difficulty raising the arms and doing everyday tasks like combing hair or washing. If it affects the hips, the patient usually has difficulty getting up from a chair without using their hands. Less frequently, it may affect the neck and lower back. Pain and rigidity are more intense after long periods of rest, such as getting up in the morning.
Everyday activities such as getting up from a chair or the toilet, turning over in bed, combing hair or getting dressed become difficult and, in many cases, help is needed.
On some occasions it is accompanied by other, less specific symptoms, such as fever, loss of appetite or weight loss. All these changes usually appear in a relatively short space of time, either within a few weeks or months.
Rheumatic polymyalgia typically appears in over 50 year-olds. 50 out of every 100,000 people over this age suffer from it each year. It is twice as common in women than in men and is most frequent in white people.
The exact cause is unknown. Its appearance in the elderly leads to thought of some factor (unknown) linked to ageing, along with genetic factors and anomalies in the individual’s immune system.
With regard to genetic factors, it is known that familial aggregation exists. That is to say, it is more frequent in members of the same family.
There is no single test to diagnose this disease. The diagnosis is reached using the combination of the symptoms, physical examination by the rheumatologist and blood test results, where all this is presented in people over 50.
The most significant discovery in the blood test is the increase in ESR, which occurs in the majority of patients. It is worth pointing out that this change in the blood is not specific to this disease as it is elevated in any inflammatory or infectious process occurring in the body. In general, ESR is considered normal up to 15mm in the first hour in men, and up to 20mm/hr in women, but this increases with the age of the individual. In the event that there is Rheumatic polymyalgia, these figures reach much higher values, generally above 50mm/hr.
In the same way, C-reactive protein (CRP) is also a marker that serves to detect inflammation and is usually found to be high.
The basis for treatment of rheumatic polymyalgia is corticosteroids. Corticosteroids are given in low doses (between 10mg and 20mg per day), preferably taken in a single dose in the morning. The symptoms effectively improve quickly (usually in the first 24-48 hours), the pain and stiffness disappear, and function and autonomy are recovered.
Once the symptoms have disappeared, the dose prescribed by the rheumatologist will be progressively decreased in order to find the lowest possible dosage to control the disease. For controls, EST and CRP values are also taken into account as they usually go back to normal as the symptoms disappear, which demonstrates response to the treatment.
Polimialgia-Reumatica-y-Arteritis-de-celulas-gigantes
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