Terry H. Oh

Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project.

To estimate and compare the prevalence of fibromyalgia by 2 different methods in Olmsted County, Minnesota.

Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients.

OBJECTIVE To assess the clinical characteristics, treatment, and outcome of patients with inflammatory myopathy-associated dysphagia. PATIENTS AND METHODS We retrospectively reviewed the medical records of all patients with inflammatory myopathy-associated dysphagia seen at the Mayo Clinic in Rochester, Minn, between January 1, 1997, and December 31, 2001. RESULTS A total of 783 patients were diagnosed as having inflammatory myopathy during the 5-year study period. Of these, 62 patients (41 women and 21 men; mean age, 68.6 years) had inflammatory myopathy-associated dysphagia: 26 with inclusion body myositis (IBM), 18 with dermatomyositis, 9 with polymyositis, and 9 with overlap syndrome. Dysphagia was a presenting symptom in 13 patients (21%), with the highest incidence in the IBM group. Videofluoroscopic examinations revealed pharyngeal pooling and impaired oropharyngeal and cricopharyngeal function. The benefits of swallowing compensation techniques and exercises were difficult to establish. Interventional procedures were performed in 24 patients (39%) and most frequently (62%) in patients with IBM, with cricopharyngeal myotomy being most beneficial. Patients with IBM had the least symptomatic improvement. Overall, 11 patients died during the median follow-up of 38 months, with respiratory failure due to aspiration pneumonia as the most common cause. Mortality was high in patients who required percutaneous endoscopic gastrostomy (7/11, 64%), and 1- year mortality was highest (31%) in those with dermatomyositis. CONCLUSION Dysphagia is a serious and at times presenting problem in patients with inflammatory myopathy. It occurs most frequently and appears to be most refractory in patients with IBM. The mortality rate was high in patients who required percutaneous endoscopic gastrostomy, and the 1-year mortality rate was the highest in patients with dermatomyositis.

Use of Complementary and Alternative Medical Therapies by Patients Referred to a Fibromyalgia Treatment Program at a Tertiary Care Center

OBJECTIVE To evaluate the frequency and pattern of complementary and alternative medicine (CAM) use in patients referred to a fibromyalgia treatment program at a tertiary care center. PATIENTS AND METHODS Patients referred to the Mayo Fibromyalgia Treatment Program between February 2003 and July 2003 were invited on their initial visit to participate in a survey regarding CAM use during the previous 6 months. An 85-question survey that addressed different CAM domains was used. RESULTS Of the 304 patients invited to participate, 289 (95%) completed the survey (263 women and 26 men). Ninety-eight percent of the patients had used some type of CAM therapy during the previous 6 months. The 10 most frequently used CAM treatments were exercise for a specific medical problem (48%), spiritual healing (prayers) (45%), massage therapy (44%), chiropractic treatments (37%), vitamin C (35%), vitamin E (31%), magnesium (29%), vitamin B complex (25%), green tea (24%), and weight-loss programs (20%). CONCLUSION CAM use is common in patients referred to a fibromyalgia treatment program.

Association of body mass index with symptom severity and quality of life in patients with fibromyalgia

To examine the association between body mass index (BMI) and symptom severity and quality of life (QOL) in patients with fibromyalgia.

Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia.

Objectives This study examined the relationship between the severity of fibromyalgia symptoms and current tobacco use in patients evaluated at a specialized fibromyalgia treatment program. Methods Demographic and clinical data from 984 consecutive patients evaluated at the Mayo Clinic Fibromyalgia Treatment Program including the Fibromyalgia Impact Questionnaire (FIQ) were prospectively collected and stored in an electronic medical record and an electronic database. Univariate analyses were performed comparing tobacco users and nonusers. A post-hoc analysis of covariance was conducted for tobacco use, using group differences of confounding clinical and demographic variables. A P value ≤ 0.05 was accepted as the level of significance. Results One hundred and forty-five patients were identified as tobacco users (14.7%). Tobacco use was associated with greater pain intensity as measured by pain scales and the pain component of the FIQ. Tobacco users had a greater FIQ composite score 70.0(15.1) versus 61.8(16.8), P<0.001. By univariate analysis, tobacco users had higher scores on all the FIQ components and fewer good days and more days of work missed per week. Tobacco use was associated with several confounding clinical and demographic variables including lower education, higher unemployment, not being married or widowed, and history of abuse. After adjusting for these confounding variables, tobacco users continued to have greater pain intensity, a higher total and component FIQ scores except for fatigue. Smoking was not associated with a higher number of tender points. Discussion Current tobacco use was associated with more severe fibromyalgia symptoms in patients presenting to a specialized fibromyalgia treatment program.

Dysphagia in inclusion body myositis: clinical features, management, and clinical outcome.

Oh TH, Brumfield KA, Hoskin TL, Kasperbauer JL, Basford JR: Dysphagia in inclusion body myositis. Am J Phys Med Rehabil 2008;87:883–889. Objective:To evaluate the clinical features, treatment strategies, and outcome of dysphagia in patients with inclusion body myositis. Design:Retrospective review of all 26 patients (20 women, 6 men, mean age of 72.2 yrs) with inclusion body myositis-associated dysphagia seen in 1997–2001 at our institution. Results:Twenty-four patients (92%) had a dysphagia evaluation. Cricopharyngeal muscle dysfunction was noted in all nine patients who had barium swallow studies. Eighteen patients (69%) underwent one or more interventional procedures: cricopharyngeal myotomy (10), pharyngoesophageal dilation (6), percutaneous endoscopic gastrostomy (6), and botulinum injection of the upper esophageal sphincter (2). Dysphagia tended to worsen with time. Symptomatic improvement was noted with cricopharyngeal myotomy (63%) and pharyngoesophageal dilation (33%). The Mendelsohn maneuver seemed helpful in maintaining oral intake in the three patients in whom it was recommended. Thirteen patients died during follow-up at a mean age of 81 yrs. The cause of death was identified in eight and in all cases was because of the respiratory complications of aspiration. Conclusions:Dysphagia is a progressive condition in patients with inclusion body myositis and often leads to death from aspiration pneumonia. Treatment targeting cricopharyngeal muscle dysfunction, such as the Mendelsohn maneuver, will benefit from further investigation.

Brief Interdisciplinary Treatment Program for Fibromyalgia: Six to Twelve Months Outcome

Oh TH, Stueve MH, Hoskin TL, Luedtke CA, Vincent A, Moder KG, Thompson JM: Brief interdisciplinary treatment program for fibromyalgia to twelve months outcome. Objective:To evaluate the impact and long-term benefit of a brief 1½-day fibromyalgia treatment program. Design:We assessed 6–12-mo outcome of 521 participants who underwent a 1½-day interdisciplinary fibromyalgia treatment program in a tertiary medical center. We administered three self-reported instruments: the Fibromyalgia Impact Questionnaire, the Short Form-36 Health Status Questionnaire, and a satisfaction survey, at baseline, and 6–12 mos after completing the fibromyalgia treatment program. The difference in the Fibromyalgia Impact Questionnaire and Short Form-36 scores before and after the fibromyalgia treatment program was the main outcome measure. Results:Compared with baseline, the Fibromyalgia Impact Questionnaire total score was decreased by a mean (SD) of 7.2 (17.7) points at follow-up (P < 0.001). All Fibromyalgia Impact Questionnaire subscales improved significantly at follow-up (all P < 0.001), except depression score (P = 0.67). The Short Form-36 scores improved significantly in all areas at follow-up (all P < 0.001), except general health perception (P = 0.58) and role emotional (P = 0.13). Conclusions:A brief 1½-day fibromyalgia treatment program improves symptoms and quality of life in patients with fibromyalgia for 6–12 mos. Further clinical investigations are needed to compare this fibromyalgia treatment program with other programs and interventions.

Direct medical costs in patients with fibromyalgia: Cost of illness and impact of a brief multidisciplinary treatment program.

Objective: To compare the direct medical costs of clinically diagnosed patients with fibromyalgia with the medical costs of matched controls during a 4-yr period and to assess the impact of a fibromyalgia treatment program on healthcare utilization and associated medical costs. Design: A retrospective comparison of economic outcomes in 87 patients who participated in a fibromyalgia treatment program between 2001 and 2004 and who were local residents for the entire 4-yr period spanning their participation in the program, with age and sex-matched controls. Costs for the 2 yrs before and 2 yrs after program participation were also compared. Results: Four-year medical costs for controls were

Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia

7774 compared with

Relation of Age With Symptom Severity and Quality of Life in Patients With Fibromyalgia

15,759 for those with fibromyalgia. There was no significant change in direct costs after participation in a brief fibromyalgia treatment program. Those with increased symptom severity averaged