Objective: To develop evidence based recommendations for the management of fibromyalgia syndrome (FMS). Methods: A multidisciplinary fibromyalgia task force was formed consisting of rheumatologists, pain specialists, experts in rehabilitation, a neurologist, an occupational therapist, a bio-scientist, psychiatrist, epidemiologist and a patient representing eleven European Countries: UK, Ireland, Portugal, Sweden, Germany, Italy, Turkey, Israel, Denmark, Poland and France. (more…)

B lymphocytes are an essential component of the adaptive immune response. The surface antigen CD20 is expressed throughout B cell differentiation except at the very earliest and plasma cell stages. It is thought to act as a cross membrane calcium ion channel and to play a key role in B cell activation. In consequence it has been hypothesised that targeting CD20 may prove therapeutic in the management of diseases like lupus that are largely B cell mediated. B cell depletion using rituximab, a chimeric human-mouse monoclonal antibody, was first utilized for the treatment of non-Hodgkin’s lymphoma in 1997. For the past six years my colleagues and I have been treating patients with severe SLE who have failed conventional immunosuppressive therapy (N=40) and although our studies remain open label the results have been extremely encouraging. Our preferred therapeutic regime is 1g rituximab IV, 750mg of cyclophosphamide IV and 250mg of Methylprednisolone IV - each infusion is given on two occasions two weeks
apart. Our results (1,2) have indicated that this combination of drugs will achieve B cell depletion in virtually every case and that mean period of B cell depletion is approximately six months. (more…)

Therapy of lupus nephritis can be divided into an induction phase and a maintenance phase. Initial treatment is usually more aggressive and aims at inducing remission of nephritis while maintenance therapy is needed to prevent renal flares. Mycophenolate mofetil (MMF) has been shown by randomized controlled trials to be superior to, or at least as effective as, oral or intravenous pulse cyclophosphamide (CYC) as induction therapy for severe lupus nephritis. Adverse effects such as amenorrhoea and major infections are less frequent with MMF than CYC. (more…)

Systemic lupus erythematosus (SLE) is a complex autoimmune rheumatic disease whose outlook has improved significantly from the 1950’s when 50%, 4 year survival was noted, to the present when around 80%, 15 year survival is generally recorded. However significant numbers of patients continue to die early from lupus and its morbidity is also significant in some patients. In a cohort of 442 patients with lupus followed up in the Centre for Rheumatology at University College London between 1978 and 2005, 65 patients died with an average age of 47.1 years. The major causes of death were infection, cancer and atherosclerosis. We have recorded deaths in several young teenagers and others in their early twenties. Thus, although the outlook for patients with lupus is much improved and newer, principally biological agents, now offer the prospect of far more focussed and appropriate treatment for this disease, there is a continuing need to understand rather better its precise aetiopathogenesis. (more…)

‘Disease Activity’ in rheumatoid arthritis is a concept that attempts to capture, in some quantitative sense, the energy of pathological processes that result in the damage of rheumatoid arthritis. Rheumatologists speak of disease that is more or less ‘active’, of persistent ‘disease activity’ resulting in ‘joint damage’. Given that the thrust of RA therapy is ‘disease control’, clinicians need some measure of ‘disease activity’. Disease activity is the target of antirheumatic
therapy but how can we know whether treatment is ‘adequate’ if we cannot measure the target of our therapy? (more…)

Musculoskeletal complaints among patients undergoing hemodialysis are commonly encountered. These appear to be major limiting factors in the quality of life in long term survivors. It might be considered a trade off for prolonged lifespan of patients kept on chronic hemodialysis that bone abnormalities are considered important in clinical management of these patients.
The variation as to the nature and type of bone disease is related to patient’s age, duration of renal disease, variation of the pathogenic processes involved, type of therapy, differences in diet, and type and duration of dialysis therapy.Abnormal metabolism or action of vitamin D is responsible for defective mineralization of bone in renal failure. (more…)

Prevalence of hyperuricemia and gout among Taiwan Aborigines. Two major studies have been conducted on gout in Taiwan Aborigines. Chou et al. spent one year examining 342 indigenous people of the Atayal tribe in aboriginal villages in central Taiwan. Gout was confirmed in 40 subjects, 95% of whom were male. We found the prevalence of hyperuricemia and gout in Atayal Aborigines to be 41.4% and 11.7%, respectively. Of the 40 gouty patients, 54% had tophi and 35% of their first-degree relatives had gout. The other epidemiological study focusing on the prevalence and risk factors of gout was completed by Chang et al. Unlike Chou’s study, the sample Aborigines in Chang’s study were older than 40 years and originated from 3 different tribes (Atayal, Paiwan, Bunun, and mixed). The findings showed 15.2% of males and 4.8% of females had gout, did not differ much from Chou’s study. Of the 3 tribes studied by Chang et al, prevalence was highest in Bunun men (28.1%), followed by Atayals (12.5%) and Paiwans (5.5%). In this study, no data regarding the hyperuricemia of different tribes was collected. However, in a previous study, Chang et al. showed 27% to 45% of aboriginal boys and 13% to 41% of aboriginal girls had hyperuricemia. Taken together, Chou and Chang confirmed the hypothesis that hyperuricemia and gout were frequent among indigenous people. (more…)

This brief talk is aimed at the general physician whose opinion has been sought about a patient with joint pains. Rheumatology is a clinical specialty. There are a limited number of ways that a joint can react to noxious stimuli, and the answers to questions generated by the history and physical examination will nearly always point you in the right direction, and examples of the common entities will be given. The exceptions are those rare periodic syndromes (palindromic rheumatism and FMF, for example) where the joints and back movements may look normal at the first visit. The joints will also look normal in the common, but distressing, fibromyalgia, in some viral syndromes and in statin-related myalgia. (more…)

Read the entire 2008 MedWatch Safety Summary, including a link to the FDA Recall notice regarding this issue at:

http://www.fda.gov/medwatch/safety/2008/safety08.htm#Vibe