Sunday, 29 May 2016

Most Common Disease of 50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Fibromyalgia - The Diagnosis

Kyle J. Norton (Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


Fibromyalgia, according to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

                                               The  Diagnosis

The American College of Rheumatology (ACR), evidence-based interdisciplinary German guidelines on the diagnosis and management of FMS by Klinikum Saarbrücken Internal Medicine 1 Winterberg 1 D-66119 Saarbrücken,  recommended  a step wise diagnostic work-up of patients with chronic widespread pain (CWP), including Fibromyalgia
1.  Complete medical history including medication, complete medical examination, as wide spread pain with no medical condition may constitute the disease development.
2. Basic laboratory tests to screen for inflammatory or endocrinology diseases to rule out other condition with similar symptoms.
3. Referring to specialists only in case of suspected somatic diseases. As psychological problems are found to associate to patients with Fibromyalgia(38)(39).
Dr. Tavel ME said, " Depending upon the type of physician/specialist consulted, those individuals may receive disease labels that range from an implied psychological origin such as somatoform or psychosomatic disease, or to a presumed physical disease such as fibromyalgia"(64)
4.  Referring to mental health specialists in case of mental disorder(63). Psycological treatment of patients with continual and widespread musculoskeletal pain, including multimodal therapy, hypnosis, cognitive-behavioral therapy for insomnia, behavioral therapies, mind-body-based techniques, and biofeedback component showed to reduce symptoms of FM(65).

[Here we quote the text and copy from the study of The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity by FREDERICK WOLFE,1 DANIEL J. CLAUW,2 MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4
Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3–6 AND SS >9).
Conclusion. This simple clinical case definition of fibromyalgia correctly classifies88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Please note:
This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors as Provisional.This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validationbased on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.As disclosed in the manuscript, these criteria were developed with support from the study sponsor, Lilly Research Laboratories.The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participatein the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to thesubmission of the paper. The recipient of the grant was Arthritis Research Center Foundation, Inc. The authors receivedno compensation. The ACR found the criteria to be methodologically rigorous and clinically meaningful.ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse anycommercial product or service. The ACR received no compensation for its approval of these criteria](66).

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(63) Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines by Fitzcharles MA1, Shir Y2, Ablin JN3, Buskila D4, Amital H5, Henningsen P6, Häuser W7.(PubMed)
(64) Somatic symptom disorders without known physical causes: one disease with many names? by Tavel ME1.(PubMed)
(65) Systematic review of psychological treatment in fibromyalgia by Lami MJ1, Martínez MP, Sánchez AI.(PubMed)
(66) The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity by the Arthritis Care & Research

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