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.
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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.
Patient standing at 0 minutes CREDIT University of Leeds
An unusual case of a Long Covid patient’s legs turning blue after 10 minutes of standing highlights the need for greater awareness of this symptom among people with the condition, according to new research published in the Lancet.
The paper, authored by Dr Manoj Sivan at the University of Leeds, focuses on the case of one 33-year man who developed with acrocyanosis – venous pooling of blood in the legs.
A minute after standing, the patient’s legs began to redden and became increasingly blue over time, with veins becoming more prominent. After 10 minutes the colour was much more pronounced, with the patient describing a heavy, itchy sensation in his legs. His original colour returned two minutes after he returned to a non-standing position.
The patient said he had started to experience the discolouration since his COVID-19 infection. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing.
Dr Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine in the University of Leeds’ School of Medicine, said: “This was a striking case of acrocyanosis in a patient who had not experienced it before his COVID-19 infection.
Patient standing at 2 minutes
“Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid.
“We need to ensure that there is more awareness of dysautonomia in Long Covid so that clinicians have the tools they need to manage patients appropriately.”
Long Covid affects multiple systems in the body and has an array of symptoms, affecting patients’ ability to perform daily activities. The condition also affects the autonomic nervous system, which is responsible for regulating blood pressure and heart rate.
Patient standing at 10 minutes
Acrocyanosis has previously been observed in children with dysfunction of the autonomic nervous system (dysautonomia), a common symptom of post-viral syndromes.
Previous research by Dr Sivan’s team has shown that both dysautonomia and POTS frequently develop in people with Long Covid.
Dysautonomia is also seen in a number of other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.
Dr Sivan said: “We need more awareness about dysautonomia in long term conditions; more effective assessment and management approaches, and further research into the syndrome. This will enable both patients and clinicians to better manage these conditions.”
Fibromyalgia is common, affecting around 2% of people in the general population.1,2 The 2017 EULAR recommendations state that tramadol – a weak opioid – may be considered for pain management in fibromyalgia, but advise against use of strong opioids due to lack of evidence of efficacy, and the high risk of side effects and addiction.3 However, with limited therapeutic options available to tackle this condition, opioids are frequently used in clinical practice.
The impact of the opioid epidemic in North America has caused concern around the world. Long-term opioid use is associated with potential harm and adverse outcomes. In their abstract presented at the 2023 annual congress, in a session on Pain in RMDs, Ramirez Medina and colleagues argue that understanding the factors associated with long-term opioid use in such patients is the first step in helping to develop targeted interventions for de-prescribing.
The team conducted a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD) – a UK database of electronic health records from primary care. Overall, 28,554 fibromyalgia patients without prior cancer who were new opioid users between 2006 and 2021 were included. Long-term opioid use was defined as having at least three opioid prescriptions within a 90-day period, or at least one prescription lasting 90 days or more in the first year of follow-up.
Findings show that 26% of new opioid users became long-term users in the first year. Several factors were associated with higher risk of long-term opioid use. These included mean daily morphine milligram equivalents (MME) at initiation, history of suicide and self-harm, substance use disorder, deprivation, and obesity. Modelling showed that, of these, the three most important variables were mean MME/day at initiation, history of suicide and self-harm, and deprivation.
Fibromyalgia is common, affecting around 2% of people in the general population.1,2 The 2017 EULAR recommendations state that tramadol – a weak opioid – may be considered for pain management in fibromyalgia, but advise against use of strong opioids due to lack of evidence of efficacy, and the high risk of side effects and addiction.3 However, with limited therapeutic options available to tackle this condition, opioids are frequently used in clinical practice.
The impact of the opioid epidemic in North America has caused concern around the world. Long-term opioid use is associated with potential harm and adverse outcomes. In their abstract presented at the 2023 annual congress, in a session on Pain in RMDs, Ramirez Medina and colleagues argue that understanding the factors associated with long-term opioid use in such patients is the first step in helping to develop targeted interventions for de-prescribing.
The team conducted a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD) – a UK database of electronic health records from primary care. Overall, 28,554 fibromyalgia patients without prior cancer who were new opioid users between 2006 and 2021 were included. Long-term opioid use was defined as having at least three opioid prescriptions within a 90-day period, or at least one prescription lasting 90 days or more in the first year of follow-up.
Findings show that 26% of new opioid users became long-term users in the first year. Several factors were associated with higher risk of long-term opioid use. These included mean daily morphine milligram equivalents (MME) at initiation, history of suicide and self-harm, substance use disorder, deprivation, and obesity. Modelling showed that, of these, the three most important variables were mean MME/day at initiation, history of suicide and self-harm, and deprivation.