How to deal with autoimmune disease flares- A Rheumatologist POV

Flares happen. We do everything we can to prevent them and understand why they occur, but sometimes, they just happen. This is true regardless of the inflammatory or autoimmune disease: lupus, arthritis, fibromyalgia, vasculitis, and all the others. As frustrating as they can be, there are things you can do to manage them with care and grace.

A blood test will diagnose fibromyalgia more reliably

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CREDIT Mart Production (Pexels).

A research team from the Universitat Rovira i Virgili, the University of Ohio and the University of Texas has developed an innovative method for reliably diagnosing fibromyalgia from a blood sample. Identifying this disease nowadays is highly complex, especially because the symptoms are similar to those of other rheumatic pathologies and persistent COVID-19. This new study represents an important step forward in the accurate diagnosis and personalisation of treatment for affected individuals, and at the same time, opens new avenues for research into this pathology and clinical care. The results of the study have been published in the journal Biomedicines.

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Fibromyalgia is a chronic disease that affects 6% of the population worldwide and is characterized by widespread muscle pain and fatigue. The variety of symptoms can easily be confused with other disorders, such as rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis or chronic low back pain. This means that reaching a diagnosis is not easy or quick and, therefore, ends up having an impact on the quality of life and mental health of the people who suffer from it.

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To carry out the study, the research team collected blood samples from three different groups: people diagnosed with fibromyalgia, people with similar rheumatic diseases and people without any of these pathologies, who served as a control group. A combination of techniques was used to isolate and analyse specific chemical signals in the blood that could help differentiate fibromyalgia from other diseases with similar effects on health to open a more accurate and faster diagnostic pathway.

The blood samples underwent filtration, which allows the focus to be put on a very specific part of the blood that contains small molecules, known as the low molecular weight fraction. These molecules can include a variety of substances, for example, amino acids, which act as the building blocks of proteins.

To analyse these tiny molecules, the researchers used the technique of Raman spectroscopy, which consists of “illuminating” the samples with a special laser light and studying how they react. This technique makes it possible to observe which molecules are present and in what quantities based on how light interacts with them. Gold nanoparticles were used to refine this process further, increasing the signal they receive from the small molecules and making the results clearer and easier to interpret.

A statistical method classified the samples based on their chemical characteristics so that the differences between groups could be determined. The results highlighted that some patterns in small molecules, such as amino acids, could serve as “chemical signatures” to distinguish fibromyalgia from other diseases.

“This tool is fast, accurate and non-invasive, and can easily be integrated into the clinical environment to improve the quality of life of patients with fibromyalgia”, says Sílvia de Lamo, a researcher from the URV’s Chemical Engineering Department, who played a part in the research during a stay at Ohio University, where she collaborates with two research groups specialising in vibrational spectroscopy as a method for diagnosing diseases. The tool, which is still in the validation phase, could be available in health centres in about two years, according to the research team.

Two types of CBT are equally effective in the treatment of fibromyalgia.

Maria Hedman-Lagerlöf

Maria Hedman-Lagerlöf CREDIT Andreas Beronius

There does not appear to be any profound differences between so-called exposure-based CBT and traditional CBT in treating fibromyalgia, according to a study led by researchers at Karolinska Institutet. Both forms of treatment produced a significant reduction in symptoms in people affected by the disease. The study is one of the largest to date to compare different treatment options for fibromyalgia and is published in the journal PAIN.



About 200,000 people in Sweden currently live with fibromyalgia, a long-term pain syndrome that causes great suffering for patients through widespread pain, fatigue, and stiffness in the body. There is no cure for fibromyalgia. Existing drugs often have insufficient effect, raising the need for more effective treatment methods. Cognitive behavioural therapy (CBT) has shown some effect, but there is a lack of trained CBT practitioners. There is also a lack of knowledge about which
CBT is most effective. 


The study compared two different forms of internet-delivered cognitive behavioural therapy in terms of how well they reduce the symptoms and functional impact of fibromyalgia. 

In brief, exposure-based CBT involves the participant systematically and repeatedly approaching situations, activities, and stimuli that the patient has previously avoided because the experiences are associated with pain, psychological discomfort, or symptoms such as fatigue and cognitive problems. 

In traditional CBT, the participant is presented with several strategies to work on during treatment, such as relaxation, activity planning, physical exercise, or strategies for managing negative thoughts and improving sleep. 

The study showed that traditional CBT was, by and large, equivalent to the newer treatment form of exposure-based CBT. 

“This result was surprising because our hypothesis, based on previous research, was that the new exposure-based form would be more effective. Our study shows that the traditional form can provide an equally good result and thus contributes to the discussion in the field,” says Maria Hedman-Lagerlöf, licensed psychologist and researcher at the Center for Psychiatry Research at the Department of Clinical Neuroscience, Karolinska Institutet.

The randomized study involved 274 people with fibromyalgia, who were randomly assigned to be treated with traditional or exposure-based CBT. The treatments were delivered entirely online, and all participants had regular contact with their therapist. 

Participants answered questions about their mood and symptoms before, during, and after treatment. After the 10-week treatment, 60 per cent of those who received exposure-based CBT and 59 per cent of those who received traditional CBT reported that their treatment had helped them.

“The fact that both treatments were associated with a significant reduction in the participants’ symptoms and functional impairment and that the effects were sustained for 12 months after completion of the treatment, indicates that the internet as a treatment format can be of great clinical benefit for people with fibromyalgia,” says Maria Hedman-Lagerlöf. “This is good news because it enables more people to access treatment.” 

The study is the second largest to compare different psychological treatment options for fibromyalgia, according to the researchers.

“Our study is also one of the first to compare with another active, established psychological treatment,” says Maria Hedman-Lagerlöf.

Can cognitive-behavioral therapy lessen fibromyalgia pain?

Pain - what works best?
Pain – what works best?

In a recent randomized clinical trial of patients with fibromyalgia, cognitive-behavioral therapy (CBT)—which uses structured techniques to alter distorted thoughts and negative moods—was superior to a matched education treatment in reducing the interfering effects of pain and other aspects of fibromyalgia on daily living.

Within the group that received CBT in the trial, which is published in Arthritis & Rheumatology, improvements were at least partly attributable to reductions in what’s known as catastrophizing, a state comprised of cognitive and emotional processes such as helplessness, rumination, and magnification of pain complaints.

Neuroimaging tests indicated that CBT exerts these effects by altering the connectivity of specific regions of the brain. Therefore, changes in the brain circuitry underlying pain catastrophizing may underpin CBT’s benefits for patients with fibromyalgia, a condition characterized by function-impairing symptoms such as widespread pain, fatigue, cognitive difficulties, and psychosocial distress.

“These findings contribute to a growing literature highlighting the benefits of non-pharmacologic treatments—including CBT—for chronic pain conditions such as fibromyalgia,” said corresponding author Jeungchan Lee, PhD, of Spaulding Rehabilitation Hospital and Harvard Medical School. “Identifying the multiple biopsychosocial mechanisms by which these treatments help to alleviate pain may help to facilitate the practice of precision pain medicine and improve treatment outcomes for the many patients suffering from chronic pain.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/art.42672

Cognitive behavioral therapy eases how fibromyalgia pain is experienced by the brain

A randomized, controlled trial led by Mass General Brigham researchers demonstrates that cognitive behavioral therapy can significantly reduce the impact of fibromyalgia pain
A randomized, controlled trial led by Mass General Brigham researchers demonstrates that cognitive behavioral therapy can significantly reduce the impact of fibromyalgia pain

Patients living with fibromyalgia (FM) – a disease that predominantly affects women and is characterized by chronic pain, fatigue and brain fog – often find limited treatment options and a scarcity of explanations for their symptoms. Research led by Mass General Brigham investigators has found that cognitive behavioral therapy (CBT) can significantly reduce the burden of FM by, in part, reducing pain-catastrophizing, a negative cognitive and emotional response that can intensify pain through feelings of helplessness, rumination and intrusive thoughts. This finding is backed by neuroimaging data, evidencing reduced connectivity between regions of the brain associated with self-awareness, pain and emotional processing. Results are published on September 20 in Arthritis & Rheumatology.

“In this study, we looked at the interplay between psychological processes and the brain’s connectivity patterns in response to pain,” said co-senior author Robert Edwards, PhD, a clinical psychologist in the Department of Anesthesiology, Perioperative & Pain Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “We wanted to explore how CBT, a talk therapy aimed at combatting maladaptive thoughts, can enhance individuals’ daily functioning and alter the brain’s processing of pain-related information.”

Edwards explains that CBT can reduce negative cognitive and emotional responses to pain. He says that while these responses are normal, they can amplify the disabling effects of chronic pain, and make conditions like FM more burdensome.

The research team for the study included researchers from three Mass General Brigham members: Spaulding Rehabilitation Hospital, Brigham and Women’s Hospital and Massachusetts General Hospital. Mass General Brigham brings together 16 member institutions, including academic medical centers, top-tier specialty hospitals, community hospitals and more. Research that spans more than one of these entities is more than the sum of its parts, helping to provide insights and unique perspectives from multiple settings and areas of expertise.

Researchers recruited 98 women, randomly assigning 64 to a treatment group receiving CBT and 34 to a control group that received education about FM and chronic pain but was not taught specific CBT techniques. All participants were between 18 and 75 years old and had a confirmed FM diagnosis for at least six months. To collect baseline data, all participants completed several validated pain and quality of life questionnaires.

Each group participated in eight intervention sessions, consisting of 60–75-minute visits with a licensed mental health provider. Participants were primarily assessed for their levels of pain interference, or a measure of how much their pain disrupted their daily activities, pain catastrophizing, pain severity and the overall impact FM had on patients’ quality of life.

Results demonstrated that those who underwent CBT experienced significantly greater reductions in pain interference. CBT participants also exhibited significantly less pain catastrophizing and reported that their FM symptoms had significantly less impact on their daily lives.

The team saw evidence that after undergoing CBT, patients experienced changes in the activities of all three networks that suggested a diminished focus on pain.

“Prior to participants undergoing CBT, we saw that certain parts of the brain linked to self-awareness and sensation were very connected, suggesting patients were pertinently aware of the pain sensation they were experiencing and internalized these symptoms,” said co-first author Jeungchan Lee, PhD, an instructor in the Department of Physical Medicine and Rehabilitation based at Spaulding Rehabilitation Hospital and the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital. “After CBT, these connections were significantly less strong, suggesting that patients were better at separating themselves from their pain after therapy.”

This study was limited to women, partly because of its high prevalence, and partly to eliminate confounding gender differences in brain activity. In the future, the researchers hope to collect data from men and non-binary patients with FM. Additionally, CBT includes several therapeutic components, and these results cannot be generalized to assess the impact across all forms of CBT on reducing FM chronic pain.

Both Lee and Edwards agree that these findings ultimately suggest that complex chronic pain conditions like fibromyalgia should be addressed with a multitude of pharmacological and cognitive therapies.

“I hope that these findings motivate healthcare providers to consider CBT as an effective treatment option to reduce the impact of pain patients experience,” explained Edwards. “Chronic pain conditions like fibromyalgia involve long-standing patterns of changes in the central nervous system, and CBT is one among many treatment options, such as medication and physical therapy, that we know can be beneficial for those living with FM.”