Brazilian consensus on the treatment of fibromyalgia

UNIFESP Ambulatório de FibromialgiaUFPR HC ambulatório de fibromialgiaUNIFESPUNIFESP Setor de reumatismos de partes molesPUC-SP Departamento de MedicinaPUC-Campinas Hospital Universitário Serviço de ReumatologiaSociedade Brasileira de ReumatologiaSanta Casa de Belo Horizonte Ambulatório de Fibromialgia Programa de Residência Médica em ReumatologiaFMUSP HC Serviço de ReumatologiaSanta Casa de Campo Grande Setor de Reumatologia programa de Residência em Clínica MédicaUniversidade Federal de Ciências da Saúde de Porto AlegreUNiSULUniversidade Federal do Espírito Santo Hospital Universitário serviço de ReumatologiaSociedade Brasileira de Clínica MédicaSociedade Brasileira para o Estudo da DorAssociação Brasileira de Medicina Física e ReabilitaçãoUniversidade de São Paulo Faculdade de MedicinaUniversidade Federal FluminenseAcademia Brasileira de Neurologia Departamento de DorEuropean Neurological Society Subcomitê de DorPeripheral Nerve SocietyFMUSP Grupo de MãoSociedade Brasileira de ortopedia e TraumatologiaAxia.Bio farmacoeconomia e pesquisa em saúdeUNIFESP Núcleo de Gestão de PesquisasUNIFESP, Ambulatório de FibromialgiaUNIFESP, Setor de reumatismos de partes molesUNIFESP, Núcleo de Gestão de PesquisasSciEL

Enhanced pain syndromes

Enhanced pain syndromes have their prevalence increased withold age. Fibromyalgia, among them deserves special attention. Itscauses are still unknown. Fibromyalgia syndrome affects mainlyfemales and is characterized by generalized musculoskeletal pain,fatigue, sleep disturbances, diffuse stiffness and other psychic signsand symptoms. Diagnosis is essentially based on the 1990 AmericanCollege of Rheumatology Classifi cative Criteria. In this chapteraspects related to its treatment and prognosis are also discussed

Evaluate the eficacy of acupunture as a treatment for fibromyalgia: prospective study, randomized and controlled

Introdução: A fibromialgia e uma sindrome dolorosa cronica, caracterizada por dor difusa pelo corpo e pela presenca de pontos dolorosos a palpacao. De etioptogenia desconhecida, o seu tratamento ainda e sintomatico e de resultados pouco satisfatorios. A acupuntura e uma tecnica de tratamento bastante difundida para o controle de diversas situacoes dolorosas. Em fibromialgia, a sua utilizacao requer ainda estudos randomizados, placebo controlados. OBJETIVOS: 1) Avaliar a eficacia da acupuntura no tratamento coadjuvante da fibromialgia. 2) Verificar o tempo necessario para o inicio da acao terapeutica da acupuntura. MATERIAL, E METODOS: Foram randomizados 60 pacientes, que preenchiam os criterios de classificacao para fibromialgia do A. C. R., em tres grupos: acupuntura+amitriptiliria, 20 pacientes (grupo A), placebo-acupuntura+amitriptifna, 20 pacientes (grupo B), amitripltilina, 20 pacientes (grupo C). Todos os pacientes, independemente do grupo, recebiam amitriptilina na dose unica de 25 mg/dia ao deitar. Os pacientes que pertenciam aos grupos A ou B realizaram placebo-acupuntura ou acupuntura. uma vez por semana por 16 semanas consecutivas. A avaliacao dos pacientes foi realizada no inicio e mensalmente por uma examinador cego quanto ao grupo terapeutico por meio dos seguintes instrumentos: escala visual analogica d(- dor (EVA), questionario SF-36 de qualidade de vida e inventario de depressao de Bech. A analise estatistica foi realizada por AMOVA . RESULTADOS: Os pacientes dos tres grupos leram homogeneos antes do inicio do tratamento. Comparando os valores basais do EVA, o grupo tratado com acupuntura obteve...(au)BV UNIFESP: Teses e dissertaçõe

A retrospective 5-year analysis of the infliximab use pattern in a tertiary hospital in São Paulo, Brazil

Objective: To analyze the use and results of infliximab therapy atHospital Israelita Albert Einstein (HIAE) from 2001 to 2006. Methods:Questionnaire filled by physicians who prescribed infliximab. Clinicaldata for each individual patient was provided by the attendingrheumatologist according to individual standards. The main reasonfor prescribing infliximab was failure to respond to other diseasemodifying anti-rheumatic drugs. Treatment escalation was definedas increase and/or a decrease in the interval between infusions ofinfliximab (inter-infusional interval). Results: The mean duration ofinfliximab therapy was 78 ± 54 weeks. Patients were more likely todiscontinue treatment during the first two years mainly due to noefficacy. Thirty percent of patients required dose adjustments while8% tolerated longer inter-infusional intervals. Conclusions: Thedata confirms the efficacy of infliximab in the treatment ofinflammatory arthritis. Approximately 50% of patients discontinuedthe medication and one third required dose adjustments. A smallnumber of patients tolerated inter-infusional periods wider thanthe recommended 8 weeks

Prevalence of musculoskeletal pain syndromes in primary healthcare unit workers

Objective: To assess the prevalence of pain syndromes and theirrelation with stress in healthcare workers at primary healthcareunits. Methods: A total of 540 workers of 10 primary healthcareunits were assessed in partnership with the Hospital Israelita AlbertEinstein (HIAE), in São Paulo, in 2005, through the Prevalence of PainSyndromes in the General Population Survey and the Lipp’s StressSymptom Inventory for Adults. Statistical analysis was carriedthrough univariate and multivariate analyses using accurate binarylogistic regression models adjusted for the following variables: stress,sex, dyslipidemia and hypertension. Ratios were compared usingFisher-Freeman-Halton test. Results: 86.93% were women, 54.63%of females were married, the majority worked at daytime and hadattended high school. General prevalence of pain was 54.26% (56.57%of women and 38.24% of men). Schooling was inversely proportionalto onset of pain. Health agents were twice more likely to presentpain than other professionals. Pain likelihood increased by 1.98%each year, and by 20.7% within 10 years. The groups with chronicpain presented statistical significance with stress (p < 0.001).There was no statistical difference in use of medications, number ofphysiotherapy sessions and lost work days in the groups with chronicpain when compared with the group with acute pain. Both chronicand acute pain groups were statistically significant in all variableswhen compared with the group with no pain. Stress, dyslipidemiaand arterial hypertension were positively associated with pain.Employees with stress presented a 4.19-fold higher likelihood ofpresenting pain as compared to those with no stress. Conclusion:The prevalence of pain syndromes among primary healthcare unitsworkers was 54.63%, and it was influenced by schooling and stresslevels. Most workers affected were female. Preventive measuresmust be established for healthcare workers