Thomas J. Romano

Magnesium Deficiency in Fibromyalgia Syndrome

Since patients with either fibromyalgia syndrome (FS) or low magnesium (Mg) levels can have fatigue, sleep disturbance and anxiety, it was necessary to determine if some patients with FS also have low Mg levels. Both red blood cell (RBC) and plasma Mg levels were measured in 100 consecutive FS patients and 12 osteoarthritis (OA) control patients. Compared to reference laboratory and OA controls, FS patients had significantly lower RBC Mg levels. The plasma Mg levels of FS patients were no different than the reference laboratory or OA controls. Some FS patients have low Mg levels, a problem that is potentially correctable.

Magnesium Deficiency in Systemic Lupus Erythematosus

Reduced erythrocyte magnesium (Mg) levels have been reported in fibromyalgia syndrome (FS), chronic fatigue syndrome (CFS), myofascial pain syndrome (MPS) and eosinophilia myalgia syndrome (EMS). These disorders have chronic pain as a common symptom. Chronic pain also affects some patients with systemic lupus erythematosus (SLE). To determine if SLE patients are also prone to hypomagnesemia, red blood cell (RBC) and plasma Mg levels were measured in all SLE patients seen in a general rheumatology practice in a 3-year period. There were 25 such patients with a mean age of 47 years. Thirteen SLE patients had FS and 12 did not have either FS or MPS. The mean RBC Mg level for the SLE patients was 4.60 mg dl - 1, statistically significantly lower than that of the reference controls and 12 osteoarthritis controls. It did not matter whether the SLE patients had FS or MPS. This finding has implications for diagnosis and treatment.

Other Soft Tissue Pain Conditions

SUMMARY This study purported to identify the results of using ultrasound [US]-guided injections of corticosteroid for biceps brachii tendinitis. This is a randomized prospective study of 98 patients with biceps brachii tendinitis. In Group A, 45 patients were treated by free-hand injection without US guidance and in Group B, 53 patients were treated by US-guided injection. Mean age was 47 years [range 28 to 72 years]. The average follow-up was 33 weeks [range 24 to 56 weeks]. No significant differences between the two groups were noted for age, gender or weight. Thirty-six patients from Group A and 12 patients from Group B underwent repeated injections [p50.5]. Visual analog scale [VAS] score and the Constant-Murley score were used to evaluate outcomes. The VAS score decreased from 7.1 � 2.3 before injection to 4.2 � 3.1 at follow-up in Group A and from 6.9 � 2.6 to 2.1 � 1.9 in Group B [p50.05]. The Constant-Murley scale improved from 31.4 � 11.6 before injection to 73.5 � 19.2 at followup in Group A and from 32.5 � 14.7 to 85.5 � 10.3 in Group B [p50.01]. The authors concluded that the US-guided injection group fared better than the group of patients that got free-hand injections. It was important to note that injection therapy was not satisfactory for patients who demonstrated severely frayed tendons at arthroscopy. No complications were noted from the injections in either group. The authors further concluded that the corticosteroid injection under US guidance is a safe and welltolerated procedure. COMMENTS

Coexistence of systemic lupus erythematosus and parotid hypertrophy. A case report and literature review

A patient with systemic lupus erythematosus and marked diffuse bilateral parotid swelling is described. Special staining techniques were required to demonstrate a lymphoplasmacytic infiltrate in the otherwise normal appearing acinar tissue. This finding suggests that a humoral, rather than a cellular, mediated immune process is responsible for the parotid hypertrophy in this patient.

Other Soft Tissue Pain

This is a study involving 33 patients suspected of having poststreptococcal reactive arthritis [PSRA]. Seven of the 33 patients suspected of having PSRA were excluded because alternative diagnoses were more likely and one patient had a normal antistreptolysin titer. Twenty-six patients were left in the study, 14 females, 12 males, with ages ranging from 11 to 41 years [mean = 25.4 years]. Eighteen were of Arab origin and eight were Asian. Fifteen patients [57.6 percent] had a history of sore throat and another had a history of recurrent tonsillitis prior to the onset of arthritis. The onset of joint pain was two weeks after the sore throat in six patients, 10 days in one patient, six days in two patients, three weeks in one patient, four weeks in one patient, and six weeks in one patient. There was insufficient information to determine the interval in the remaining four patients. The knees were involved most frequently followed by the ankles, elbows, wrists, shoulders, hips, metacarpophalangeals, metatarsophalangeals, and low back. The average sedimentation rate was 44 mm [range = 4–110 mm] and the average C-reactive protein 57.1 mmol/L [range = 0–322 nmol/ L]. Treatment with nonsteroidal anti-inflammatory drugs was generally sufficient with only four patients needing to be treated with corticosteroids. Long-term penicillin injections were given to 15 patients. No patient had carditis on presentation or follow-up. Five patients had tendonitis, bursitis, and tenosynovitis, one had bilateral Achilles tendonitis, and one had bilateral polyenthesitis of both elbows [lateral epicondylitis], bilateral wrists [extensor carpi ulnaris tendon], left ankle [tibialis posterior], and right Achilles tendon. One patient had bilateral knee tendonitis and plantar fasciitis. One had bilateral medial ankle tenosynovitis. One had myalgias and bilateral plantar fasciitis. Nine patients had tendonitis, enthesitis, and tenosynovitis alone, or with arthritis/ arthralgias. The authors conclude PSRA often presents itself with polytendonitis, tenosynovitis, and enthesitis, as well as arthritis, and that the soft tissue inflammation could be the only manifestation of a poststreptococcal infection.

Retracted: Other Soft Tissue Pain Syndromes

RETRACTED

Other Soft Tissue Pain Disorders

This is a case report of a 46-year-old man with calcific tendinitis of the left shoulder who eventually developed a left shoulder rotator cuff tear. The patient presented with a one year history of episodic and repeated left shoulder pain diagnosed as calcifying tendinitis prior to the authors examining him. On the initial visit the authors noted a calcium deposit localized in the left supraspinatus tendon without any tear of the tendonor rotatorcuff apparatus.Thiswas determined based on physical examination, radiographs, and magnetic resonance imaging. Three months after the initial visit magnetic resonance imaging revealed a partial thickness rotator cuff tear at the site of the calcium deposit. The patient underwent surgery. The histologic study of the surgical specimen suggested that the calcium deposit was the cause of the rotator cuff rupture. The authors contend that this is the first case report in the English literature in which a progression from calcifying tendinitis to rotator cuff tear had been observed and documented.

Miscellaneous Soft Tissue Pain Syndromes

This case involves a 54 year old African American male who presented to the emergency department with a three day history of acute onset of calf pain. The pain started in his right calf, but he developed left calf pain about 24 hours later. Within 48 hours the pain became debilitating. The pain was minimally responsive to opioids. He denied other symptoms. His past medical history revealed a right total knee replacement following a gunshot wound, a left hip fracture following a motor vehicle accident, and a 15 year history of diabetes mellitus. He also had a history of alcohol abuse but denied any consumption of alcohol in the eight years preceding this particular problem. He also had a 35 packday-year history of smoking. He denied illicit drug use or high risk sexual behavior. His sister had been diagnosed as having systemic lupus erythematosus and another sister died from a stroke at the age of 51. Salient features on physical examination revealed a flexion deformity of the right knee of approximately 20 degrees. He had scars from his previous arthroplasty but no other cutaneous lesions. Calf muscles were exquisitely tender to palpation. He also had an antalgic gait because of calf pain. There was no evidence of warmth, swelling, or color change. Peripheral pulses were normal. Sensation to light touch was intact bilaterally. Reflexes were normal as was the remainder of the physical examination. Laboratory investigation revealed a hemoglobin of 16.8