Erik Kåss

Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis

&NA; In 30 patients with diagnosed fibromyalgia, the CSF level of immunoreactive substance P (SP) was investigated. Compared to normal values (9.6 ± 3.2 fmol/ml), all the patients had elevated CSF levels of SP (36.1 ± 2.7 fmol/ml, range 16.5–79.1 fmol/ml). Anamnestic information from the patients revealed that 53.3% had Raynaud/Raynaud‐like phenomenon localized in the fingers, the toes or both. Although SP levels did not differ significantly in patients with or without the Raynaud phenomenon, elevated activity may be present in the peripheral branches of SP neurons which could be responsible for the last (rubor) phase of the triphasic Raynauds phenomenon. SP levels were significantly higher in patients who were smokers (40.1 ± 2.7 fmol/ml, range 25.3–64.1 fmol/ml), compared to patients who were non‐smokers (29.2 ± 5.0 fmol/ml, range 16.5–79.1 fmol/ml). We propose elevated CSF levels of SP and the Raynaud phenomenon as characteristic features for fibromyalgia with potential as diagnostic markers of the disease and further that smoking might be an aggravating factor for its pathogenesis or development.

Treatment of fibromyalgia (Fibrositis syndrome): A parallel double blind trial with carisoprodol, paracetamol and caffeïne (Somadril comp®) versus placebo

SummaryForty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo. Twenty-three patients received placebo and twenty active medication. In the placebo group 56.5% of the patients used additional analgesics or nonsteroidal anti-inflammatory drugs compared to only 20% in the active treatment group (p=0.015). Forty-three percent of the patients in the placebo group and none of the patients in the active treatment group used tricyclic antidepressants, anxiolytics or sedatives (p=0.0008). Active treatment gave statistically significant improvement after treatment for pain (p<0.01), for sleep quality (p<0.01) and for the general feeling of sickness (p<0.05). In the active treatment group increased pressure pain threshold after eight weeks was found at 70% of the sites measured, while the pressure pain threshold was increased at only 30% of the sites in the placebo group. In the placebo group improvement was found for the pain and sleep quality (p<0.05). This improvement may in part be due to the large amounts of extra medication in this group. Thus, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia.

Family Studies in Bechterew's Syndrome (Ankylosing Spondylitis): II. Prevalences of Symptoms and Signs in Relatives of HLA 827 Negative Probands

All available adult first-degree relatives of 9 probands with HLAB27 negative ankylosing spondylitis were examined. Completion rate was 90%. Prevalences of symptoms and signs and distributions of chest and spinal mobility are presented. No secondary case of Bechterews syndrome was found among the relatives, compared with 10% among the relatives of HLAB27 positive probands (p = 0.05). We conclude from this study and that of relatives of HLAB27 positive probands, that a HLAB27 negative relative runs a low risk of contracting Bechterews syndrome, irrespective of the HLAB27 status of the proband.

Dermatomyositis Associated With BCG Vaccination

Two young boys developed serious forms of dermatomyositis following BCG vaccination. Possibilities of a causal relationship between the disease and the vaccination are discussed. Extensive immunological tests, however, including in vitro stimulation of lymphocytes with PPD, gave no decisive evidence of abnormalities. It is concluded that in cases of dermatomyositis there is an absolute indication for a full anamnesis with regard to previous vaccination, to obtain clarification of the practical and theoretically important questions of a possible connection in this respect.

The distribution of clinical findings in Bechterew's syndrome (ankylosing spondylitis) suggests distinct genetic subgroups

One hundred and twenty‐two consecutive patients hospitalized for ankylosing spondylitis (AS) were reexamined. The frequency of clinical signs and results of tests for associations are presented. Psoriasis was associated with a distal pattern of peripheral arthropathy. Spinal rigidity was predominantly seen in males. Males with phalangeal arthropathy exhibited preserved spinal mobility. This was the case also when HLA B27 positives and patients who did not have psoriasis were considered separately. HLA B27 positive patients in this group had frequently experienced acute anterior uveitis. It seems possible that the disease in such males is the result of combined predisposition to ankylosing spondylitis and psoriatic arthropathy. Hip arthropathy was frequently present in males with spinal rigidity. The associations observed confirm that AS is a heterogenous group of diseases. The term “syndrome” may be suitable for such a heterogenous group, and we prefer the term “Bechterews syndrome” as the name of this group. When these new findings are added to the previous observations that acute anterior uveitis probably is a clinical, sex‐influenced characteristic of HLA B27 positive Bechterews syndrome, that HLA B27 negative patients with Bechterews syndrome frequently had psoriasis and were HLA B13 and B17 negative, and that psoriasis was frequent in HLA B27 positive patients as well, we tentatively conclude that different and interacting genetic mechanisms may be involved in the etiology of Bechterews syndrome.

How Does Bechterew's Syndrome (Ankylosing Spondylitis) Start?: Interrelations between Onset of Symptoms

Detailed medical histories were obtained from 122 consecutive patients with Bechterews syndrome (ankylosing spondylitis) who had been hospitalized at Oslo Sanitetsforening Rheumatism Hospital. Frequencies of symptoms, age at onset of symptoms and their interrelationships are presented. Low back pain affected more patients than any other symptom and, generally speaking, it started earlier than any other individual symptom. However, any symptom could antedate low back pain. Symptoms preceding low back pain were most frequently reported at a young age, and most often affected the extremities. The presence of psoriasis was associated with an increased frequency of symptoms in the peripheral joints. Acute anterior uveitis and chest stiffness were more common in males than in females. The influence of the selection of patients on the results is discussed.

Bechterew's Syndrome (Ankylosing Spondylitis): A Syndrome with Distinct Subgroups

The results of tests for associations among radiographic findings of the dorsolumbar spine, peripheral joints, tendon insertions and the pubic symphysis are presented. Ankylosis of sacro-iliac joints, ankylosis of apophyseal joints, bridging syndesmophytes, ossified interspinous ligament, block vertebrae, arthritis of the pubic symphysis and new bone formation of the ischium were strongly mutually associated. They probably belong to the same subgroup of disease. Such findings were negatively associated with distal peripheral joint arthritis. Mixed osteophytes, parasyndesmophytes or shining corners (anterior spondylitis) showed associations suggesting that the etiology may be mixed. A late stage of sacro-iliitis, regressive changes, characterized by narrow joint spaces without extensive ankylosis and with minimal sclerosis (grade IV sacro-iliitis) was associated with distal peripheral joints arthritis, but negatively associated with signs of ankylosing processes of the dorsolumbar spine. On the basis of the radiographic findings, distinct subgroups of AS could be identified. These results confirm our previous results of an association pattern between clinical findings. We would also recommend that the grading system of sacro-iliitis put forward by Dale be adopted, since it turned out that this grading system often distinguished between distinct subgroups of this heterogeneous condition(s).

Laboratory Findings in Chronic Prostatitis—With Special Reference to Immunological and Microbiological Aspects

Twenty-nine consecutive patients hospitalized for chronic prostatitis were examined. The HLA and radiographic findings are presented in detail elsewhere. Serum immunoglobulin levels were normal. The concentrations of IgG, IgA and IgM in prostatic fluid were significantly lower than in serum, both absolutely and as percentages of total protein concentration. Distinct bands were seen in the gamma region of agarose gel electrophoresis from prostatic fluids both in patients and in controls, and other tests also indicated that they did not reflect oligoclonal Ig responses. Growth of Chlamydia or Mycoplasma species was not detected in any of the biopsy specimens. We conclude that, with the test panel used, we have not been able to confirm that immunological factors or the presence of Chlamydia or Mycoplasma species is important in chronic prostatitis.

Collaboration between Rheumatologist and Orthopedic Surgeon—a Necessity

The importance of orthopedic surgery as an auxiliary to any treatment of rheumatoid arthritis is underlined in the present article. No treatment programme for rheumatoid arthritis is satisfactory, if it does not recognize this fact. It must form part of all future planning for hospital care of rheumatological patients.