Luiz Severiano Ribeiro

Fibromialgia e estresse infeccioso: possíveis associações entre a síndrome de fibromialgia e infecções viróticas crônicas

Chronic viruses are implicated in the etiopathogenesis of fibromyalgia syndrome. The increasing interest in research is derived from the clinical manifestations shared by both conditions, mainly the musculoskeletal pain and fatigue. However, in spite of intense research no viruses have unequivocally been identified as directly causing fibromyalgia. Exception may be the probable association between fibromyalgia and hepatitis C virus chronic infection. The authors present a literature review in order to approach the presumed associations or lack of associations between fibromyalgia and viral chronic infections. This compilation was done using Medline and Lilacs databases.

EpiFibro - um banco de dados nacional sobre a síndrome da fibromialgia: análise inicial de 500 mulheres

INTRODUCAO: A fibromialgia (FM) e uma condicao dolorosa do sistema musculoesqueletico, geralmente acompanhada de varios sintomas em outros sistemas, com uma prevalencia no Brasil estimada em 2,5%. Apresentamos os dados iniciais do EpiFibro, um banco de dados nacional de pacientes com FM atendidos em servicos publicos e privados. OBJETIVO: Avaliar como e feito o diagnostico da doenca, identificar um conjunto de dominios clinicos considerados relevantes por medicos e por pacientes com FM, analisar o impacto da doenca na qualidade de vida dos pacientes e comparar os achados entre pacientes de servicos publico e privado. METODOS: Foram analisadas as respostas das primeiras 500 mulheres nesse banco de dados. Esse banco de dados foi baseado em um questionario contendo dados demograficos e clinicos. O Fibromyalgia Impact Questionnaire (FIQ), traduzido e validado para o Brasil, foi preenchido pelos medicos e/ou pacientes. RESULTADOS: Uma analise preliminar do banco de dados EpiFibro revelou que as pacientes com FM no Brasil tem um alto impacto da doenca avaliada pelo FIQ, uma alta prevalencia de sintomas associados, um baixo grau de educacao (um achado que pode ser explicado pelo fato de a saude publica no Brasil ser usada principalmente por aqueles desfavorecidos socialmente) e a maioria percebe a sua dor como sendo difusa a partir do inicio da doenca. CONCLUSAO: Depressao e ansiedade sao percebidas como as principais causas dos sintomas da FM, mas uma quantidade significativa considera o esforco no trabalho como o primeiro gatilho. Ha um atraso de poucos anos em busca de ajuda medica e para chegar ao reumatologista.

EpiFibro – a nationwide databank for fibromyalgia syndrome – the initial analysis of 500 women

INTRODUCTION Fibromyalgia syndrome (FS) is a common painful condition of the musculoskeletal system that is typically accompanied by several symptoms in other systems. In Brazil, the prevalence of FS is estimated at 2.5%. Here, we present the initial data from Epi-Fibro, a nationwide databank of FS patients seen in public and private settings. OBJECTIVE The aims of this study were to assess how the diagnosis of FS was made, identify a set of clinical domains considered relevant by both clinicians and patients in cases of FS, analyse the impact of disease on patient quality of life, and compare the findings among patients of public and private services. METHODS Based on the results of questionnaires, we analysed data corresponding to the first 500 women in the database. Questionnaires pertaining to demographic and clinical data and the Fibromyalgia Impact Questionnaire (FIQ), which was translated and validated for Brazilian patients, were completed by the clinicians and/or patients. RESULTS Preliminary analysis of the EpiFibro databank revealed that female FS patients in Brazil reported a high impact of disease, as measured by the FIQ, a high prevalence of associated symptoms, and a low degree of education (consistent with the public health care in Brazil used mainly by the underserved). In addition, most patients perceived their pain as diffuse from the onset of disease. CONCLUSION Depression and anxiety were seen as the main triggers of FM symptoms, but a significant proportion of the subjects perceived work strain as the initial trigger.We also observed a delay of a few years in seeking medical help and examination by a rheumatologist.

Fibromialgia e infecção crônica pelo vírus da hepatite C: ausência de associação em duas amostras

OBJECTIVE: to evaluate a possible association between fibromyalgia and hepatitis C virus (HCV) chronic infection. METHODS: cross-sectional study comprising 186 fibromyalgic women, 55 non-fibromyalgic controls with a diagnosis of diffuse connective tissue diseases (DCTD), 33 HCV chronically infected women and 34 selected from the gastroenterology outpatient clinic with no liver related infection disease, all aged 18 or older. Fibromyalgia was diagnosed according to the American College of Rheumatology (ACR) classification criteria. Chronic HCV infection was defined by detection of HCV-RNA using the polymerase chain reaction (PCR). Other extra-hepatic manifestations comprised: fatigue, paresthesia, Raynaud´s phenomenon, sicca symptoms, depression and detectable thyroid autoantibodies. RESULTS: HCV-RNA was detected in 3 of the 185 fibromyalgic women (1.6%) and in none of the 55 DCTD group (p = 0.39). Chronic widespread musculoskeletal pain was more prevalent in the infected group (45.5%) than in the non-infected (26.5%), but no association was found between fibromyalgia and HCV chronic infection (OR = 1.39; 95% CI = 0.43-4.57). With the regard to other variables, only sicca symptoms were found to be associated with chronic infection (OR = 6.40; 95% CI = 1.94-21.87). CONCLUSION: we found no association between fibromyalgia and chronic HCV infection.

New guidelines for the diagnosis of fibromyalgia

OBJECTIVE To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. MATERIAL AND METHODS Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.