Fibromyalgia: Harth M

Harth M, Nielson WR. · No affiliation provided · J Rheumatol. · Pubmed #17477475 links to  free full text

This publication has no abstract.

Nielson WR, Harth M. · No affiliation provided · J Rheumatol. · Pubmed #15088282 links to  free full text

This publication has no abstract.

Brosseau L, Wells GA, Tugwell P, Egan M, Wilson KG, Dubouloz CJ, Casimiro L, Robinson VA, McGowan J, Busch A, Poitras S, Moldofsky H, Harth M, Finestone HM, Nielson W, Haines-Wangda A, Russell-Doreleyers M, Lambert K, Marshall AD, Veilleux L, Anonymous00378. · Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. · Phys Ther. · Pubmed #18497302 links to  free full text

Abstract: BACKGROUND AND PURPOSE: The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria. METHODS: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. RESULTS: There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit. DISCUSSION AND CONCLUSION: The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

Brosseau L, Wells GA, Tugwell P, Egan M, Wilson KG, Dubouloz CJ, Casimiro L, Robinson VA, McGowan J, Busch A, Poitras S, Moldofsky H, Harth M, Finestone HM, Nielson W, Haines-Wangda A, Russell-Doreleyers M, Lambert K, Marshall AD, Veilleux L, Anonymous00377. · Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. · Phys Ther. · Pubmed #18497301 links to  free full text

Abstract: BACKGROUND AND PURPOSE: The objective of this study was to create guidelines for the use of aerobic fitness exercises in the management of adult patients (>18 years of age) with fibromyalgia, as defined by the 1990 American College of Rheumatology criteria. METHODS: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 13 randomized control trials and 3 controlled clinical trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. RESULTS: There were 24 positive recommendations: 10 grade A, 1 grade B, and 13 grade C+. Of these 24 positive recommendations, only 5 were of clinical benefit. DISCUSSION AND CONCLUSION: The Ottawa Panel recommends aerobic fitness exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

White KP, Harth M. · Department of Medicine, University of Western Ontario, K289, 268 Grosvenor Street, P.O. Box 5777, London, Ontario N6A 4V2, Canada. · Curr Pain Headache Rep. · Pubmed #11403735 No free full text.

Abstract: Fibromyalgia (FM), also known as fibromyalgia syndrome (FMS) and fibrositis, is a common form of nonarticular rheumatism that is associated with chronic generalized musculoskeletal pain, fatigue, and a long list of other complaints. Some have criticized the classification of FM as a distinct medical entity, but existing data suggest that individuals meeting the case definition for FM are clinically somewhat distinct from those with chronic widespread pain who do not meet the full FM definition. Clinic studies have found FM to be common in countries worldwide; these include studies in specialty and general clinics. The same is true of general population studies, which show the prevalence of FM to be between 0.5% and 5%. Knowledge about risk factors for FM is limited. Females are at greater risk, and risk appears to increase through middle age, then decline. Although some authors claim that an epidemic of FM has been fueled by an over-generous Western compensation system, there are no data that demonstrate an increasing incidence or prevalence of FM; moreover, existing data refute any association between FM prevalence and compensation. Claims that the FM label itself causes illness behavior and increased dependence on the medical system also are not supported by existing research. This article reviews the classification, epidemiology, and natural history of FM.

White KP, Carette S, Harth M, Teasell RW. · Department of Medicine, University of Western Ontario, London, Canada. · Semin Arthritis Rheum. · Pubmed #10707989 No free full text.

Abstract: OBJECTIVES: The primary objective is to review current research with respect to the role of trauma in fibromyalgia (FM). A secondary objective is to hypothesize which steps need to be taken, first to determine whether such an association truly exists, and second to clarify what such an association might mean. METHODS: An extensive literature review was undertaken, including Medline from 1979 to the present. RESULTS: The strongest evidence supporting an association between trauma and FM is a recently published Israeli study in which adults with neck injuries had greater than a 10-fold increased risk of developing FM within 1 year of their injury, compared with adults with lower extremity fractures (P= .001). Several other studies provide a hypothetical construct for such an association. These include studies on (1) postinjury sleep abnormalities; (2) local injury sites as a source of chronic distant regional pain; and (3) the concept of neuroplasticity. There are, however, several primary arguments against such an association: (1) FM may not be a distinct clinical entity; (2) FM may be a psychological, rather than physical, disease; (3) the evidence supporting any association is limited and not definitive; (4) the Israeli study, itself, has some methodological limitations; and (5) other factors may be more important than the injurious event in determining chronic symptoms after an acute injury. CONCLUSIONS: Although there is some evidence supporting an association between trauma and FM, the evidence is not definitive. Further prospective studies are needed to confirm this association and to identify whether trauma has a causal role.

White KP, Harth M. · Department of Medicine, London Health Sciences Center, Ontario, Canada. · Baillieres Best Pract Res Clin Rheumatol. · Pubmed #10562368 No free full text.

Abstract: A major problem with estimating the impact of chronic generalized pain is that the term remains undefined. It appears to encompass several distinct clinical entities, including rheumatoid arthritis and fibromyalgia, which can exist alone or together in a given individual. Nonetheless, chronic generalized pain appears to have a sizable impact on both the individual and society. Although little is known about causal relationships, demographic risk factors for chronic generalized pain are female sex, age in the forties and fifties, lower income, lower education, and being divorced or separated. Chronic generalized pain affects the individual in several ways, including physical and psychological distress, losses of function, quality of life, employment and income, and prolonged litigation for many. Its impact on society includes increased utilization of health care resources, loss of work productivity, disability and insurance costs, costs of litigation and social policy. Future research into the impact of chronic generalized pain must begin by defining this term in a way that is both valid in construct and convenient to use. Research is also warranted to develop and validate diagnostic tools that may better distinguish various subsets of chronic generalized pain, both to better understand the pathological processes involved and to allow for estimates of the relative contribution of each subset to societal costs.

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. · University of Western Ontario, London, Ontario, Canada. · Arthritis Rheum. · Pubmed #12115155 links to  free full text

Abstract: OBJECTIVE: To determine if assigning the label of fibromyalgia (FM) to individuals with chronic widespread pain has a significant effect on long-term health status, function, and health service utilization.METHODS: In the London Fibromyalgia Epidemiology Study, 100 individuals with FM were identified by screening 3,395 non-institutionalized adults. Only 28 of the 100 had been previously diagnosed with FM; for 72, the diagnostic label was new. All 28 with prediagnosed FM were female compared with 58 of the 72 newly diagnosed cases. In a prospective, within-group comparison, we compared previously non-labeled FM cases at study entry (prelabeling) and at 18 and 36 months followup (postlabeling) with respect to general health status, fibromyalgia-related symptoms, and all items from the Fibromyalgia Impact Questionnaire (FIQ) (including total FIQ score, and several measures of health service utilization) to see if health status, function, and health services utilization had changed, using paired t-tests. We also compared percentage reporting work disability at baseline and 18 months using Pearson's chi(2).RESULTS: Fifty-six (78%) of the original 72 newly diagnosed FM cases were available for reassessment at 18 months, and 43 (60%) at 36 months. Although physical functioning decreased slightly over time, there also was a statistically significant improvement in satisfaction with health, and newly diagnosed FM cases reported fewer symptoms and major symptoms over the long term. No other differences in clinical status or health service use occurred over time.CONCLUSION: The FM label does not have a meaningful adverse affect on clinical outcome over the long term. Further research is necessary to document the short- and long-term effect of labeling in the chronic pain patient.

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #11908578 No free full text.

Abstract: OBJECTIVE: To estimate the severity of depression, anxiety, and other symptoms of psychological distress in a representative general population sample of fibromyalgia (FM) cases (FC) compared to pain controls (PC), and to identify strong correlates of depression and anxiety. METHODS: We compared the severity of depression, anxiety, and other symptoms of psychological distress between 2 representative community samples: (1) 74 confirmed FC, and (2) 48 adults with chronic widespread pain (PC) who did not meet the 1990 ACR criteria for FM. Psychological distress was measured using the Centre for Epidemiological Studies Depression (CES-D) Scale, the State-Trait Anxiety Inventory (STAI), and other measures of psychological distress from the literature. Using cutoff scores for CES-D and trait anxiety, we compared demographic and clinical characteristics in those above and below each cutoff score. Simple linear regression was performed to identify factors strongly and independently correlated with depression and trait anxiety. RESULTS: Compared to PC, FC were more symptomatic on virtually all measures of psychological distress. Similarly, individuals who scored above cutoff scores for depression and anxiety had more physical symptoms and had poorer function than those below. Depression and trait anxiety were highly correlated (r = 0.86). In a simple regression model, the best predictors for both depression and trait anxiety were the total number of symptoms and a physical disability score. CONCLUSION: Depression and anxiety are common and frequently severe even among community cases of FM.

Huisman AM, White KP, Algra A, Harth M, Vieth R, Jacobs JW, Bijlsma JW, Bell DA. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #11708429 No free full text.

Abstract: OBJECTIVE: Many patients with systemic lupus erythematosus (SLE) and fibromyalgia (FM) may spend less time exposed to the sun than healthy individuals and thus might have low vitamin D levels. It is known that hydroxychloroquine (HCQ) inhibits conversion of 25(OH)- to 1,25(OH)2-vitamin D both in vitro and in patients with sarcoidosis. We assessed winter serum 25(OH)- and 1,25(OH)2-vitamin D levels in patients with SLE and FM. METHODS: We recruited 25 consecutive female SLE and 25 female FM patients in London, Ontario, between January and March 2000. Subjects completed a brief questionnaire. Serum levels of 25(OH)-, 1,25(OH)2-vitamin D, and parathyroid hormone (PTH) were measured. RESULTS: In SLE patients mean 25(OH)-vitamin D was 46.5 nmol/l and mean 1,25(OH)2-vitamin D was 74.4 pmol/l. In FM patients these means were 51.5 nmol/l and 90.1 pmol/l, respectively. Serum 25(OH)-vitamin D levels did not significantly differ between SLE and FM patients, nor after adjusting for age and vitamin D, milk consumption, and sun block use. In 14 of the SLE patients and 12 of the FM patients 25(OH)-vitamin D levels < 50 nmol/l were found. SLE patients not using vitamin D supplements had lower 25(OH)-vitamin D levels than those who did. 1,25(OH)2-vitamin D tended to be lower in the SLE compared to the FM patients. This difference could be attributed to HCQ use: HCQ users (n = 17) had lower 1,25(OH)2-vitamin D levels than nonusers (n = 33); the mean adjusted difference was 24.4 pmol/l (95% CI 2.8-49.9). CONCLUSION: Half the SLE and FM patients had 25(OH)-vitamin D levels < 50 nmol/l, a level at which PTH stimulation occurs. Our data suggest that in SLE patients HCQ might inhibit conversion of 25(OH)-vitamin D to 1,25(OH)2-vitamin D.

White KP, Harth M, Speechley M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Ontario, Canada. · J Rheumatol. · Pubmed #11093453 No free full text.

Abstract: OBJECTIVE: To assess the distribution and predictive ability of fibromyalgia (FM) tender points (TP) in adults with chronic widespread pain. METHODS: Using published classification criteria, we confirmed 100 FM cases and 76 controls with widespread pain not meeting the 1990 American College of Rheumatology (ACR) classification criteria for FM (pain controls) in a survey of 3,395 adults screened for widespread musculoskeletal pain in a general population survey. RESULTS: At each of the 18 FM tender points, FM cases were more likely than pain controls to have tenderness, and the likelihood ratio (LR) was statistically greater than 1.0 for 13 of 18 points. However, the LR for individual points ranged from 4.0 to as low as 1.2. Females were more likely to have TP, especially at lower body points; however, lower body points were more discriminatory in males. CONCLUSION: TP differ in their ability to predict FM among adults in the general population with chronic widespread pain.

White KP, Ostbye T, Harth M, Nielson W, Speechley M, Teasell R, Bourne R. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #10743826 No free full text.

Abstract: OBJECTIVE: To determine which factors physicians consider important in patients with chronic generalized posttraumatic pain. METHODS: Using physician membership directories, random samples of 287 Canadian general practitioners, 160 orthopedists, 160 physiatrists, and 160 rheumatologists were surveyed. Each subject was mailed a case scenario describing a 45-year-old woman who sustained a whiplash injury and subsequently developed chronic, generalized pain, fatigue, sleep difficulties, and diffuse muscle tenderness. Respondents were asked whether they agreed with a diagnosis of fibromyalgia (FM), and what factors they considered to be important in the development of chronic, generalized posttraumatic pain. RESULTS: More-recent medical school graduates were more likely to agree with the FM diagnosis. Orthopedists (28.8%) were least likely to agree, while rheumatologists (83.0%) were most likely to agree. On multivariate analysis, 5 factors predicted agreement or disagreement with the diagnosis of FM: (1) number of FM cases diagnosed by the respondent per week (p < 0.0001); (2) patient's sex (p < 0.0001); (3) force of initial impact (p = 0.003); (4) patient's pre-collision psychiatric history (p = 0.03); and (5) severity of initial injuries (p = 0.03). The force of initial impact and the patient's pre-collision psychiatric history were both negatively correlated with agreement in diagnosis. Patient related factors (personality, emotional stress, pre-collision physical, mental health) were considered more important than trauma related factors in the development of chronic, widespread pain. CONCLUSION: Future studies of the association between trauma and FM should identify potential cases outside of specialty clinics, and baseline assessments should include some measurement of personality, stress, and pre-collision physical and mental health.

White KP, Speechley M, Harth M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Canada. · Scand J Rheumatol. · Pubmed #10722257 No free full text.

Abstract: OBJECTIVE: To determine the proportion of adults with fibromyalgia syndrome (FMS) in the general population who also meet the 1988 Centre for Disease Control (CDC) criteria for chronic fatigue syndrome (CFS). METHODS: Seventy-four FMS cases were compared with 32 non-FMS controls with widespread pain and 23 with localized pain, all recruited in a general population survey. RESULTS: Among females, 58.0% of fibromyalgia cases met the full criteria for CFS, compared to 26.1% and 12.5% of controls with widespread and localized pain, respectively (p=0.0006). Male percentages were 80.0, 22.2, and zero, respectively (p=0.003). Compared to those with FMS alone, those meeting the case definitions for both FMS and CFS reported a worse course, worse overall health, more dissatisfaction with health, more non-CFS symptoms, and greater disease impact. The number of total symptoms and non-CFS symptoms were the best predictors of co-morbid CFS. CONCLUSIONS: There is significant clinical overlap between CFS and FMS.

White KP, Speechley M, Harth M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #10405948 No free full text.

Abstract: OBJECTIVE: To identify demographic and clinical features that distinguish fibromyalgia (FM) from other chronic widespread pain. METHODS: We identified 100 confirmed FM cases, 76 widespread pain controls, and 135 general controls in a random community survey of 3395 noninstitutionalized adults living in London, Ontario. FM cases were distinguished from pain controls using the 1990 American College of Rheumatology (ACR) classification criteria for FM. RESULTS: The mean age of FM cases was 47.8 years (range 19 to 86), the same as for pain controls; 86% of FM cases were female versus 67.1% of pain controls (p < 0.01). FM cases were less educated than general controls (p = 0.03). Male and female FM cases were similar, except females were older and reported more major symptoms (both p = 0.02). FM cases reported more severe pain and fatigue, more symptoms, more major symptoms, and worse overall health than pain controls or general controls. The most commonly reported major symptoms among FM cases were musculoskeletal pain (77.3%), fatigue (77.3%), severe fatigue lasting 24 h after minimal activity (77.0%), nonrestorative sleep (65.7%), and insomnia (56.0%). Subjects with 11-14 tender points were more similar to those with 15-18 tender points than to those with 7-10 points in 11 of 14 clinical variables. On multivariate analysis, 4 symptoms distinguished FM cases from pain controls: pain severity (p = 0.004), severe fatigue lasting 24 h after minimal activity (p = 0.006), weakness (p = 0.008), and self-reported swelling of neck glands (p = 0.01). CONCLUSION: In the general population, adults who meet the ACR definition of FM appear to have distinct features compared to those with chronic widespread pain who do not meet criteria.

White KP, Speechley M, Harth M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #10405947 No free full text.

Abstract: OBJECTIVE: To estimate the point prevalence of fibromyalgia syndrome (FM) among noninstitutionalized Canadian adults; and to assess the effect of demographic variables on the odds of having FM. METHODS: A screening questionnaire was administered via telephone to a random community sample of 3395 noninstitutionalized adults residing in London, Ontario. Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria. RESULTS: One hundred confirmed cases of FM were identified, of whom 86 were women. Mean age among FM cases was 49.2 years among women, 39.3 years among men (p < 0.02). FM affects an estimated 4.9% (95% CI 4.7%, 5.1%) of adult women and 1.6% (1.3%, 1.9%) of adult men in London, for a female to male ratio of roughly 3 to one. In women, prevalence rises steadily with age from < 1% in women aged 18-30 to almost 8% in women 55-64. Thereafter, it declines. The peak prevalence in men also appears to be in middle age (2.5%; 1.1%, 5.7%). FM affects 3.3% (3.2%, 3.4%) of noninstitutionalized adults in London. Female sex, middle age, less education, lower household income, being divorced, and being disabled are associated with increased odds of having FM. CONCLUSION: FM is a common musculoskeletal disorder among Canadian adults, especially among women and persons of lower socioeconomic status.

White KP, Speechley M, Harth M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #10229411 No free full text.

Abstract: OBJECTIVE: To estimate direct health care costs associated with fibromyalgia (FM) within a representative community sample. METHODS: A random sample of 3395 noninstitutionalized adults was screened for widespread pain. Individuals screening positive were examined for FM. Direct health care costs were compared among those with confirmed FM (FM cases, FC), those with widespread pain not having FM (pain controls, PC), controls without widespread pain (general controls, GC), and a random sample of age, sex and geographically matched controls from the Ontario Health Insurance Plan database (OHIP controls, OC). RESULTS: One hundred FC (86 women) were compared to 76 PC subjects, 135 GC, and 380 OC. FC used more medications and outpatient health services than PC subjects, and about twice the health services at twice the cost compared to GC and OC. The mean difference in direct costs for health services between FC and OC was $493 Cdn annually (p<0.001). CONCLUSION: FM has a major effect on direct health care costs.

White KP, Harth M, Speechley M, Ostbye T. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #10229410 No free full text.

Abstract: OBJECTIVE: To develop and test an instrument to screen for fibromyalgia syndrome (FM) in general population surveys. METHODS: We designed a questionnaire with 4 pain and 2 fatigue items. A positive screen was defined 2 ways: (1) positive responses to all 4 items on pain, and (2) positive responses to all pain and fatigue items. Sensitivity was tested in the clinic on 31 outpatients with FM, specificity on 30 outpatients with rheumatoid arthritis (RA) and 30 healthy controls. Test-retest reliability (TRR) was estimated in a community survey of 672 noninstitutionalized adults. Positive predictive value (PPV) was estimated as part of a community survey of 3395 noninstitutionalized adults, in which 100 cases of FM were confirmed by examination. RESULTS: For pain criteria alone sensitivity was 100% (95% confidence intervals 90.3%, 100%); in patients with RA specificity was 53.3% (35.4%, 71.2%). For the pain plus fatigue criteria, sensitivity was 93.5% (83.8%, 100%), and specificity in patients with RA 80% (65.7%, 94.3%). In nonpatient controls, specificity was 100% (89.3%, 100%) using either definition of a positive screen. For those initially screening negative, TRR was 100% (93.2%, 100%) using either definition. For positive screens, TRR was 95.0% (88.8%, 100%) for the pain criteria alone, and 81.0% (69.1%, 92.8%) for the combined criteria. PPV was 56.8% (53.0%, 60.6%) using the pain criteria alone, and 70.6% (CI 55.3%, 85.9%) using the combined criteria. CONCLUSION: The instrument appears to be useful in screening for FM in general population surveys of noninstitutionalized adults. Confirmation of FM among those who screen positive requires a personal interview to reestablish pain duration and distribution, and an examination for tender points.

White KP, Speechley M, Harth M, Ostbye T. · University of Western Ontario, London, Canada. · Arthritis Rheum. · Pubmed #9920017 links to  free full text

Abstract: OBJECTIVE: To compare function and disability in fibromyalgia syndrome (FMS) cases in the community versus controls, and to identify variables predicting poor function and disability. METHODS: We identified 100 FMS cases, 76 pain controls, and 135 general controls in a random survey of 3,395 noninstitutionalized adults. RESULTS: FMS cases reported worse function (P < 0.00001), more days in bed (P < 0.001), and more healthy years of life lost (P < 0.0001). More FMS cases were disabled (P < 0.00001) and receiving pensions (P < 0.00001). Risk factors for disability included middle age and previous heavy manual labor. Pain, fatigue, and weakness were most often claimed to affect the ability to work Variables predicting work disability were the Fibromyalgia Impact Questionnaire (FIQ) score, a prior diagnosis of FMS, nonrestorative sleep, and past heavy physical labor. Variables influencing the FIQ score were the number of major symptoms, self-reported health satisfaction, tender point count, and education level. CONCLUSION: FMS commonly results in loss of function and work disability.

Harth M, Nielson W. · No affiliation provided · Rheumatology (Oxford). · Pubmed #14739483 links to  free full text

This publication has no abstract.

White KP, Harth M. · No affiliation provided · J Rheumatol. · Pubmed #11669182 links to  free full text

This publication has no abstract.