State-of-the-art on fibromyalgia mechanism

Fibromyalgia syndrome (FMS) is a very prevalent disorder defined by the presence of hyperalgesia and allodynia that leads to musculoskeletal chronic pain very frequently associated with fatigue and a diversity of other symptoms. The cause of FMS is unknown and its pathogenesis is complex and not well understood. This paper will rather discuss central pain mechanisms and the role of stressors and other factors as triggering events for onset of clinical manifestations.publishersversionpublishe

Rank/Rankl/opg: literature review

The discovery of the receptor activator of nuclear factor-kB (RANK)/RANK Ligand (RANKL)/osteoprotegerin (OPG) pathway contributed to the understanding of how bone formation and resorption were processed and regulated. RANKL and OPG are members of the tumor necrosis factor (TNF) and TNF receptor (TNFr) superfamilies, respectively, and binding to receptor activator of NF-kB (RANK) not only regulate osteoclast formation, activation and survival in normal bone modeling and remodeling, but also in several other pathologic conditions characterized by increased bone turnover. There is accumulating evidence of the potential role of OPG and RANKL in other tissues. Looking beyond the RANK/RANKL/OPG axis, Wingless (Wnt) pathway emerged as the osteoblast differentiation way, and also as a bone mass regulator. Researchers have been discovering new molecules and cytokines interactions. Altogether, data suggest that RANK/RANKL/OPG system could be targeted as a new treatment strategy in bone conditions. FREEDOM is the more recently published clinical trial about a RANKL-specific recombinant fully human monoclonal antibody (denosumab). OPG is also a potential innovative therapeutic option to be investigated.publishersversionpublishe

Poncet's disease: a symmetric seronegative polyarthritis with enthesopathy refractory to therapy

Poncet's disease is a reactive polyarthritis associated to active tuberculosis (TB), with excluded presence of mycobacterium in the joints and bones affected, and no other cause for the clinical arthritis. It is a frequently forgotten entity, especially in countries with low tuberculosis prevalence. It is described a case report of a man of Guinea-Bissau that presented symmetrical generalized polyarthralgias and hands swelling, clinical sacroiliitis and multiple enthesopathies. Serum and urinary biochemical testing were normal. Immunologic studies were negative and serum levels of angiotensin-converting enzyme and calcium were normal. Sexual transmitted diseases were excluded. The initial diagnose was undifferentiated polyarthritis or reactive arthritis. A persistent and refractory monoarthritis of the right wrist demanded a direct and cultural exam of the synovial fluid, synovial biopsy and protein chain reaction for TB that were negative. After he developed right wrist arthritis with purulent synovial fluid positive to TB in the direct exam and the detection of M. tuberculosis in the cultural exam. Granula was found in his chest radiograph. He was diagnosed a Poncet's disease reactive to a pulmonary TB infection.publishersversionpublishe

EPIREUMAPT PROTOCOL - PORTUGUESE EPIDEMIOLOGIC STUDY OF THE RHEUMATIC DISEASES

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Life History of Women with Fibromyalgia: Beyond the Illness

Fibromyalgia is a chronic pain syndrome, which mostly affects middle age women and whose etiological factors remain unclear. Psychosocial aspects may have a relevant role as predisposing, triggering, and/or perpetuating factors for this syndrome, raising the interest about life history of patients with fibromyalgia. In this study, we interviewed 10 women with a diagnosis of fibromyalgia, who had identified a critical or very stressful life event before the onset of the syndrome. The interview about the life history comprises the whole life, before and after the onset of the syndrome, and the narratives were analyzed with interpretative phenomenological analysis. Nine themes emerged: struggle, focus on adversities, positive overlaps the negative, scars of unhappy childhood, help others, perfectionism and desire to achieve, unsatisfactory present, perception of injustice, and keep feelings inside. A difficult life history is prevalent in these women and the themes identified are discussed in their relation with other qualitative studies and their possible role as predisposing and perpetuating factors for fibromyalgia. The ability to value the positive side of things, despite the adversities these women emphasized, is highlighted as an aspect to explore in psychological intervention, to enable a better management of this syndrome

Klebsiella pneumoniae Spinal Epidural Abscess treated conservatively

Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.publishersversionpublishe