Fibromyalgia and Quack Therapies

Fibromyalgia patients as well as other patients with chronic pain suffer so much, that they are so desperate and would to do anything to relieve these pains. I feel very sad, when I see “colleagues”, pharmaceutical or neutriceutical firms, institutions, or self acclaimed gurus to exploit these people with quack medicines or therapies.


How can they get past scientific scrutiny? Very easily. These quack methods stay well outside the scientific world. The masterminds behind do pseudoscience, which they publish in esoteric corners. They might use some scientific reference or reference from other fields that are irrelevant to medicine. These masterminds become gurus, with followers, who try to cry or sue silent any critic with proclaiming unquestionable truths. For example: “It has been proven without any doubt: fibromyalgia can be cured!” or (my favourite): “Are you afraid you wil lose your desperate patients who believes in your ignorance and stupidity”. Questioning and discussing new methods or hypothesis is essential for scientific research.


Now, we shall build a quack therapy against fibromyalgia. You will see, how easy it is and how easily you might believe someone, who relieves you of your money, but hardly of your pain.


Let’s call our therapy: Shamanistic tattooing of fibromyalgia. That’s still too long, abbreviations look more convincing, so it’s the STF Therapy.


We have a name, now we look into the method. Ötzi, the Tyrolean iceman, had several carbon tattoos. Have a look at the Wikipedia article of Ötzi under tattoo: http://en.wikipedia.org/wiki/%C3%96tzi_the_Iceman . Do you see it? We’ve already hit the mark! Someone asked questions about these tattoos like “5200-year-old acupuncture in central Europe?” or: "A medical report from the stone age?". These questions were articles. published in scientific papers. We can refer to these papers ( http://www.ncbi.nlm.nih.gov/pubmed/9841386 and http://www.ncbi.nlm.nih.gov/pubmed/10501382 ). And now we look for a crude method concerning healing with symbols: esowatch has something (esowatch does in German what quackwatch does in English, both are highly recommended) worth looking up: http://www.esowatch.com/ge/index.php?title=Neue_Hom%C3%B6opathie#ixzz1hRjftsSJ . "New homeopathy is a form of pseudo medical, magic spirit healing, in which certain characters are painted on the skin of sufferers." "This goes back to the Viennese electrician of the Austrian Mail, esoteric, and medical laymen Erich Körbler (1938-1994)..." Esowatch


“According to Körbler’s conviction, symbols ("bar code antennae") are used to "influence cell communication and exchange of energy in living systems". The geometry of the painted symbols at acupuncture points should have "balancing" effects on a supposed meridian system." Esowatch


You can further refer to people practicing painting symbols to heal like http://www.leonie-zander.ch/021_aim_alltag.html in Switzerland (Angewandte Informations Methode - Applied information method).

Now we look for a tattoo artist, who wants to make money. You come across this guy from Siberia, whose grandfather has indeed been a shaman. You copyright and trademark your method. You set up a practice with enough shamanistic paraphernalia and are ready for floods of clients (better call your patients clients). You have a talk with your lawyer not to break a law you have overseen. You send articles that praise your method to self help groups. You start business. You get rich. You escape to the Bahamas.


If someone offers you STF Therapy or any equal quack therapy because you are desperate to get rid of your pain, please keep a critical mind!

Spam

Sorry, folks. I'm stalked by a spammer, who belongs to a sectarian group. I will remove the nonsense as soon as I see it. hm richel [h.richel@gmail.com] is also spamming my email account.

FreitagsGedichte

Im Laub

Der harte Regen hat
Blätter von den Bäumen geschlagen

Nun liegen sie
Auf dem Laub vom letzten Herbst
Das immer noch verendet

VerEinzelte SonnenStrahlen
DurchWühlen das Laub

Einer trifft auch mich


Spalten

Spalten
Scheit um Scheit um Scheit

Spalten
Haar um Haar um Haar

Spalten
Wort um Wort um Wort

Bei allem Spalten
Wo bleibt das Bindende?


Abspringen

Das Rad der Welt
Dieses RiesenRad der Gefühle
Dreht sich unAusWeichlich
Manchmal eiert es
Manchmal läuft es perfekt
Immer läuft es
Zieht uns mit sich
UnAusWeichlichlich
Bis wir abSpringen

.

Increased Prescription of Narcotic Analgesics for Osteoarthritis in the Elderly Is Associated with Increased Falls and Fractures in the Post-Vioxx Era

Is it really coincidence that this study has the number 9-11? Merck’s withdrawal of Vioxx in 2004 had ampact on the COX-2-inhibitor world, which can be compared to the world after 9-11.


Lydia Rolita and colleagues looked into the unintended consequences of narcotic analgesics for osteoarthritis in the elderly. Narcotic analgesics contribute to falls in the elderly. Prescriptions were rising post-rofecoxib from 8% to 40%. The rate of falls has been higher in the group of narcotic analgesics users. The authors concluded that “these findings strongly indicate that recommendations for the treatment of chronic pain be reevaluated.”


[MON] 911
Unintended Consequences; Increased Prescription of Narcotic Analgesics for Osteoarthritis in the Elderly Is Associated with Increased Falls and Fractures in the Post-Vioxx Era.
Lydia Rolita1, Adele Spegman2 and Bruce N. Cronstein3.
1NYU School of Medicine, New York, NY, 2Geisinger Health System, Danville, PA, 3New York Univ Medical Center, New York, NY
Conclusion: After Vioxx was taken off the market there was a marked increase in the prescription of narcotic analgesics. Falls and fractures in this elderly population with OA increased markedly and all of the increase in falls were in patients prescribed narcotic analgesics. These findings strongly indicate that recommendations for the treatment of chronic pain be reevaluated.

Pain Assessment at our Center (1st Visit)

When patients come to our center for the first time, they might not know,  how to talk about their pain. Nearly all patients coming to see a rheumatologist for the first time come beause of pain. Every patient receives a 5 pages questionnaire to assess symptoms, a pain inventory, drugs, allergies, and so on, a HAQ, and a pain manniquin.

Short questionnaire to assess your pain

How much pain did you have?

0  1   2   3   4   5   6   7   8   9   10
no pain                                      great pain

How much fatigue did you have?
0   1   2   3   4   5   6   7   8   9   10
No fatigue                                  great fatigue

Where did the pain start? (open question)
Since when do you have pain? (open question)
I there a certain time of  the day, when pain is especially intense? (open question)
What would you character your pain? pulling, stabbing, burning, boring, cutting, unpleasant, disturbing, annoying (and more, open for addional characteristics)
What relieves the symptoms? (open question)

What enhances the complaints? (open question)



When taking the patient's history we can take this as a starting point for questions to get a deeper knowledge. For instance strongest and weakest pain during the past 24 hour or week to look for fluctuations.

All in all this small inventory has helped to get started with assessing pain.

What is lacking in fibromyalgia studies on drugs?

I think it’s a discussion on reasons for the observed (small) effects. It may be a bias that comes into effect before people come to enter a study. I see different patients: drug seeker, drug takers, drug avoiders, drug deniers, compensation seekers, non compensation seekers, depressed avoiders, happy sustainers, and patients who fit more categories if you like. I think that motivation for or against a therapy effects outcome. Currents studies do not address this issue. If you have a larger number of drug seekers coming to your drug testing center and a small number of drug avoiders of drug deniers, you might get a wishful thinking effect, a self fulfilling prophecy.


But wait a minute; we’ve got our placebo group! Look at the study of LJ Crofford et al. on Pregabalin in Fibromyalgia (Arthritis Rheum 2005, 52: 1264-1273), an eight week, randomized, double-blind, placebo-controlled, monotherapy dose-finding study. A reduction of pain greater than 50% compared to baseline has been primary endpoint of the study. This has been achieved in 13,2% of the placebo group, 13% in the 150 mg group, 18,9% in the 300 mg group, and 28,9% of the 450 mg group. Now let’s have a closer look at one of all the possible side effects: dizziness. Dizziness was complained in 15% of the placebo group, 30% in the 150 mg group, 42% in the 300 mg group, and 65% of the 450 mg group. So side effects aren’t matched! If patients desperately seek to get rid of their pains, this has an effect on quality of life, they cling to every straw. If you take a drug and notice that it’s doing something to you like dizziness, would you not also expect that it relieves your pain?


Drug studies in fibromyalgia patients should tell more about the motivation of patients to different therapies. A statistical analysis taking different levels of side effects into account should be established in these studies.

Mystic North Korea

Some places in the world own a mysticism that keeps people going there to see it with their own eyes: as Timbuktu, Taj Mahal, Forbidden City, Bagan, Ankor Wat, Fireland, Tahiti, and so on. Most lists won’t mention North Korea, but it is mysterious, shrouded, someone called it the Hermit Kingdom, but it is the last stalinistic state. The many hearsays you come across makes you want to go there, have a look for yourself.


Visa isn’t really the problem, though we had to wait as we were trying to stay longer than the usual tourist, who comes for a short trip of about four days. We stayed 16 days. We flew in from Beijing and took the railway out.


You can’t go anywhere without your driver, your guide, and your interpreter. We had a German speaking interpreter, me friends were talking French, the guide tried a few word of English with my friends, but was quite fluent in Chinese, so he could communicate with me directly. The driver only knew Korean. We learned and used some Korean words on the trip.


The tour is prearranged. You tell, where you want to go, and then you see, where you are to go. Some things may be arranged on the spot, but not much.


The strangest discussion has been on raising snails. You have to appreciate snails. Most places the local guides would tell you a few lines, where the most important part was, when Kim Il Song, the Great Leader, or Kim Jong Il, the Dear Leader, visited place.


Mystic places could also be seen – the ragged mountains. And it was possible to hike, not alone and your guide eager to avoid any accident.

The mysticism will stay as long as there is no easy access. But all mysticism of North Korea is bought by the suffering of the greater part ot its population.

Antiphospholipid Syndrome at the ACR 2011

There have three studies addressing the subject of antiphospholipid syndrome (APS), that are interesting to show. There were some more, that I don’t show as I’m already stretching the criterium interesting.






Antiphospholipid Syndrome Patients and Coenzyme Q Treatment


Chary Lopez-Pedrera and colleagues studied oxidative stress and its role in the pathophysiology of APS by analyzing mitochondrial function, which was measured by mitochondrial membrane potential (MMP) with flow cytometry. Mitochondrial dynamics in monocytes treated with aPL-IgG in the presence or in the absence of CoQ10 was studied. “CoQ10 decreased significantly the percentage of cells with altered MMP as well as the production of ROS and aPL-IgG-induced production of peroxides. CoQ10 treatment also affected significantly the aPL-IgG induced expression of TF, VEGF and Flt1, as well as the intracellular signalling pathways regulating their expression.” Look for the conclusion of the study below. My own conclusion is that CoQ10 might prevent monocyte activation in patients with APS. And – reducing oxidative stress might also be a good idea, e.g. quit smoking.


[SUN] 725
Mitochondrial Dysfunction in Monocytes From Antiphospholipid Syndrome Patients: Implications in the Pathogenesis of the Disease and Effects of Coenzyme Q Treatment.
Chary Lopez-Pedrera1, Carlos Perez-Sanchez1, Patricia Ruiz-Limon1, Ma Angeles Aguirre1, Rosario Ma Carretero1, Nuria Barbarroja1, Antonio Rodriguez-Ariza1, Eduardo Collantes-Estevez1, Jose Antonio Gonzalez-Reyes2, Jose Manuel Villalba2, Francisco Velasco1, Munther A. Khamashta3, Maria Laura Bertolaccini3 and Ma Jose Cuadrado4.
1IMIBIC-Reina Sofia Hospital, Cordoba, Spain, 2University of Cordoba, Cordoba, Spain, 3Lupus Research Unit, The Rayne Institute, Kings College London School of Medicine, London, United Kingdom, 4The Rayne Institute, London, United Kingdom
Conclusion: The binding of aPL-IgG to monocytes membrane elicites a redox-signalling pathway in which mitochondrial activity is compromised, and dynamics is altered towards enhanced rates of mitochondrial fission. The induced mitochondrial dysfunction, which is prevented by CoQ10, seems to be directly involved in the aPL-induced monocyte activation.




Effects of Fluvastatin on Pro-Inflammatory and Pro-Thrombotic Markers in Antiphospholipid Antibody (aPL)-Positive Patients

Vijaya L. Murthy and colleagues studied “the effects of fluvastatin on pro-inflammatory and pro-thrombotic biomarkers in persistently aPL-positive patients.” The following biomarkers showed a statistically significant reduction compared to baseline (p<0.0001): IL-6, IL-1-beta, TNF-alpha, sTF, sICAM-1, sVCAM-1 and E-selectin. Other biomarker didn’t show a statistically significant reduction compared to baseline (p<0.0001): IL-8, VEGF, IP10, sCD40L, INF-alpha2. Fluvastatin showed a signicicant reduction of pro-inflammatory and prothrombotic biomarkers patients with APS.




[SUN] 726
Effects of Fluvastatin on Pro-Inflammatory and Pro-Thrombotic Markers in Antiphospholipid Antibody (aPL)-Positive Patients: Preliminary Results from an Open-Label Prospective Pilot Study.
Vijaya L. Murthy1, Doruk Erkan2, Praveen Jajoria1, Rohan Willis1, JoAnn Vega2, Giuseppe Barilaro1, Gurjot Basra1, Elizabeth Hsu1, Laura Aline Martinez-Martinez1, Shraddha Jatwani1, Elizabeth Papalardo1, Emilio B. Gonzalez1, Prashanth R. Sunkureddi3 and Silvia S. Pierangeli1.
1University of Texas Medical Branch, Galveston, TX, 2Barbara Volcker Center for Women and Rheumatic Diseases,
Hospital for Special Surgery, New York, NY, 3The University of Texas Medical Branch, Nassau Bay, TX
samples, fluvastatin significantly reduced IL6, IL1_, TNF_, sTF, sICAM-1, sVCAM, and sE-sel levels within 30–90 days of treatment (Table). There was no significant change in aCL or a_2GPI titers.
Conclusion: Based on the preliminary analysis of our ongoing pilotstudy, fluvastatin 40 mg daily for 3 months significantly reduced the or without SLE. These findings: a) underscore the importance of identifying aPL-related disease biomarkers; and b) provide further support for the potential beneficial effects of statins in aPL-positive patients justifying future controlled clinical studies.



Rituximab in Antiphospholipid Syndrome (RITAPS)

Doruk Erkan and colleagues studied rituximab in antiphospholipid syndrome. “The primary objective of this pilot, open-label, Phase II study was to evaluate the safety of rituximab in 20 aPL-positive patients, as assessed by serious and non-serious adverse events (AE) (up to 12 months [m]).” Two patients out of 19 developed infusion reactions, which I think is a high number; the study does not reflect about the issue of a special risk. They counted 59 AEs (12 serious with hospitalizations, but interpreted these as “unlikely” to be related to rituximab, 7 non-serious within 48h of infusion were interpreted as “likely”. Even if unrelated to rituximab is correct, I’ve never seen as many AEs, especially with hospitalization is my own patients (rheumatoid arthritis), so I think that this is another hint to look into special risks for aPL-positive patients treated with rituximab. There were some effects on aPL-tests, but not convincing as the largest effects are in the smallest groups (down to n=2). In the aCL IgM group (n=5) we may look at the results: 20/20/60 (4 weeks), 20/20/60 (16 weeks), 25/25/50 (24 weeks, 1 drop-out), 33/33/33 (52 weeks, 2 drop-outs) [all: complete respense/partial response/no response in %]. I think with 40% drop-out in a year and the small size of groups it’s hardly convincing to draw conclusions. The largest group of patients has been the lupus anticoagulant group with n=17 and they showed 100% no response. The authors concluded that “safety appears to be consistent with rituximab’s known safety profile” “B cell depletion appears to be effective in controlling some aPL manifestations during 6m of follow-up”.


I have been pondering quite a while if we really need this study as the effects aren’t convincing and I think that there are safety issues. The study leaves open the question, why aPL-positive patients should be treated with a biologic at all. Out of ethic concerns think it’s better to stop this ongoing study.



[SUN] 727
Rituximab in Antiphospholipid Syndrome (RITAPS)—A Pilot Open-Label Phase II Prospective Trial for Non-Criteria Manifestations of Antiphospholipid Antibodies (aPL).
Doruk Erkan1, JoAnn Vega2, Glendalee Ramon2, Elizabeth Kozora3 and Michael D. Lockshin2.
1Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York, NY, 2Barbara Volcker Center for Women and Rheumatic Diseases: Hospital for Special Surgery, New York, NY, 3National Jewish Health, Denver, CO
Conclusion: Based on the preliminary analysis of our ongoing pilot study of rituximab-receiving aPL-positive patients with non-criteria aPL manifestations: a) safety appears to be consistent with rituximab’s known safety profile although 11% of our patients could not complete the treatment protocol due to reactions; b) B cell depletion appears to be effective in controlling some aPL manifestations during 6m of follow-up; and c) no substantial change in aPL profiles was observed in patients who completed 12m of follow-up.



Effects of Maximal Acute Physical Exercise on Prothrombin Time in Patients with Primary Antiphospholipid Syndrome


Carolina B. Garcia and olleagues were interested to evaluate “the effect of acute physical exercise on prothrombin time (PT) in patients with primary antiphospholipid syndrome under oral anticoagulation therapy with warfarin.” But they fail to tell us, why they are interested in this question or if any effect of physical exercise on anticoaluation would have been to be expected. But now we know that physical exercise doesn’t change prothrombin time in patients with primary antiphospholipid syndrome.


OT: The authors abbreviate primary antiphospholipid syndrome as PAPS, which is already elsewhere in use.


[MON] 1572
Effects of Maximal Acute Physical Exercise on Prothrombin Time in Patients with Primary Antiphospholipid Syndrome (PAPS) Under Oral Anticoagulation with Warfarin and Exercise Capacity.
Carolina B. Garcia1, Luciana N. J. Matos2, Carlos E. Negrao2, Hamilton Roschel3, Ana Lucia S. Pinto4, Jozelio F. Carvalho5, Eloisa Bonfa6 and Fernanda R. Lima1.
1Rheumatology Department, Sao Paulo, Brazil, 2University of Sao Paulo, InCor, Sao Paulo, Brazil, 3University of Sao Paulo, School of Physical Education and Sport, Sao Paulo, Brazil, 4University of Sao Paulo, School of Medicine, Rheumatology Division, LACRE, Sao Paulo, Brazil, 5Faculdade de Medicina da Universidade de Sa˜o Paulo, Sa˜o Paulo, Brazil, 6Faculdade de Medicina da Universidade de Sa˜o Paulo (FMUSP), Sao Paulo, Brazil
Conclusion: This is the first study to demonstrate that an acute exercise bout of maximal intensity is safe and did not affect PT in patients with primary antiphospholipid syndrome under oral coagulation therapy with warfarin.

A stagnant society

The tourist will be shown all the achievements; the state likes you to see not realizing that all the repetitions only show stagnation. The revolutionary opera isn’t playing any more, because everybody has seen the plays of Kim Il Song ad nauseam. Lots of free seats at the Arirang performance, maybe even more performers than spectators; seats filled with military personel. You see the buildings in movie town and imagine how movie after movie of the same topic is produced. You see the war museum (Victorious War Museum!) and while being dragged along every rifle and tank you wonder why people still live mentally in post-war Korea, especially if they think of themselves as the victorious side. Work on the fields is manual work.


Where could be a motivation to change, when developments out of the strict line of the party are ostracized?


You can’t just pay a visit to the next city. You need a special permit. And don’t forget there is hardly any public transport. You don’t see relatives. You don’t meet secretely with people, who’d want to overturn this state like yourself.


And then you see some fragile plants growing: people use cell phones, small endeavours like selling cigarettes. The cell phone net is only for priveledged people, but even they like to have South Korean or Chinese SIM cards to be able to communicate with the outside world. But I think the small vendours are the indicator for changes that are about to come to a stagnant society. It takes only a snow ball to start an avalanche.

Fibromyalgia and Andullation Therapy

A couple of weeks ago I’ve found a paper in my mailbox: "your health newspaper - scientific, medical, human for €2,10". It hailed the so-called andullation. The article "Fibromyalgia - chronic disease and mystery" doesn’t reflect current scientific knowledge about the disease.


Andullation doesn’t have a Wikipedia article: http://de.wikipedia.org/wiki/Wikipedia:Fragen_von_Neulingen/Archiv/2007/November (s.o. wants to put it on Wikipedia, but hasn’t done so, yet.) Some information is available from the German homepage esowatch: http://www.esowatch.com/ge/index.php?title=Andullationstherapie#ixzz1aYWXjJNX. Scientific studies are not available. In German speaking patients’ fora, for example, http://schmerzliga-forum.de/patienten/showthread.php?940-Andullation-kennt-das-wer-und-hilft-das or http://www.gutefrage.net/frage/wer-kennt-die-andullationstherapie-und-hat-erfahrung-damit, all available information comes down to: andullation therapy is a special bench for an expensive price. One retired person couldn’t resist the advertisement and spent his savings (€ 3500) on the bench.


Andullation therapy comes to the UK: http://www.homehealthproducts.co.uk/andullation-therapy-system.html. It has been my motivation translate and rewrite me own blog entry.


I advise not to invest in such a costly therapy, that comes without scientific prove of its claims.

A Glimpse at North Korea: My home is my castle

My home is my castle

In the larger cities you see high buildings and that’s all you see. You can’t see the interiors. But you can imagine that you live in a castle, high up, stairs, stairs, and stair and no working elevator because of energy shortage. You might see nice buildings or unfinished concrete.


In rural areas the families have own houses with a small garden. Even in the well doing communities you don’t see much furniture. You might see a TV set, one picture shows a Chinese calligraphy (永和万事成) saying eternally all things succeed. Heating comes from under the house (ondol heating). In the kitchen all is prepared at ground level. Slim people don’t have problems crouching, but obese people would have problems preparing their meals so. You might recognize the small windmills to produce electricity. We’ve seen only some of the household utensils using electricity; some were obviously hidden as you don’t show off in North Korea. There are even refrigerators, but how to keep these working with power cuts.

(I had written this blog entry before the death of Kim Jong Il)

The King is dead! Long live the King!

With Kim Jong Il dead question and speculation rises who will follow him. Most promising candidate is Kim Jong Un, in the West perhaps known as Brilliant Comrade, but then called by the honorific title of the Young Dear General and is now the Great Successor. His elder halfbrother Kim Jong Nam had fallen out of favour.




Wikipedia on Kim Jong Il: http://en.wikipedia.org/wiki/Kim_Jong-il


Wikipedia on Kim Jong Un: http://en.wikipedia.org/wiki/Kim_Jong-un  


Wikipedia on Kim Jong Nam:  http://en.wikipedia.org/wiki/Kim_Jong-nam


The Guardian on the death of Kim Jong Il: http://www.guardian.co.uk/world/2011/dec/19/kim-jong-il-north-korean-leader-dies?newsfeed=true  


Other/older entries on North Korea on my blog: http://rheumatologe.blogspot.com/search?q=north+korea+  


Since I've published this entry, I already have to edit it:
Reuters Reuters Top News: Deceased North Korea leader Kim's son Jong-un is called "Great Successor" by state news agency.

FreitagsGedichte

Im Grab

Die aufGeschüttete Erde
Kränze und die Blumen
Noch wärmen sie den Toten

Wenn alles zusammenGefallen ist
Spürt er die Kälte nicht
Dann fühlt er nur noch
Unsere Liebe


Einsame Welt

Einsam ist die Welt
Sie wartet gebannt
Vor TV-Geräten

Hier SalzStangen
Dort Chips

Hier Bier
Dort Brause

Und geht das Licht
Aus, bleibt einsam
Zurück die Welt

Is Calcium Pyrophosphate Deposition Associated with Vitamin D Deficiency?

There are some know risk factors for calcium pyrophosphate deposition like gout, hyperparathyroidism, loop diuretics. osteoarthritis, rheumatoid arthritis, and more. Calcium pyrophosphate deposition is causing the second most common form of crystal-associated arthropathy. Sophia Li and colleagues researched the question, if calcium pyrophosphate deposition is associated with vitamin d deficiency. The study leads to the conclusion that vitamin D deficiency may be another metabolic abnormality associated with CPPD.


[SUN] 218
Is Calcium Pyrophosphate Deposition Associated with Vitamin D Deficiency?
Sophia Li1, Joshua Baker1, Janet E. Dinnella1, Gilda M. Clayburne2, Joseph R. Perno2, H. Ralph Schumacher2 and Sally W. Pullman-Mooar2. 1
University of Pennsylvania, Philadelphia, PA, 2VA Medical Center, Philadelphia, PA
Conclusion: Our study suggests that vitamin D deficiency may be another metabolic abnormality associated with CPPD. Strengths of this study include the crystal proven diagnosis and blinded assessment of synovial fluid. Limitations of this study include the small numbers which limits controlling for all potential confounders. Further study is warranted to better understand the implications of vitamin D deficiency in CPPD.

Women’s Dress Code

Lots of women in everyday life wear trousers or skirts in dark colours with a white blouse. And then you see lots of women in gary colours, in tradional dresses – chima (skirt) and jogori (blouse). These women are quite a contrast to the drab colours of the cities. You will have local guides at every place you visit and mostly they’re dressed like this. They show a uniform hairdo, somehow resembling old movies. And you wil see the ladies at the street corners, not what you think, they control the youths that they don’t violate the dress code (no blue jeans!) or listen to Western or South Korean music. They even tell people to dye their hair.
And you will see women in khaki uniforms wearing high heels.
I've just written a second part with less text and more pictures:

http://rheumatologe.blogspot.de/2013/03/north-korea-womens-dress-code-no-2.html

Fibromyalgia Research – quo vadis?

Fibromyalgia research – quo vadis? And where should research be heading to? The problem with research in fibromyalgia is the change of paradigm which has taken place during the past 10 years or so. While there has been more basic research before, the focus has shifted to drug research, which is funded by the pharma industry, and other research, which is neceassary, but won’t get us forward to know better the basic facts of the changes that start or maintain the disease. We were so excited when we learned that changes in the HPA-axis are important in fibromyalgia.
Let’s have a look at the studies and filter out, what might belong to better understanding fibromyalgia or to drug research. And be patient as there have been a lot of studies at the 2011 ACR meeting.

[SUN] 735
Long-Term Outcomes In Fibromyalgia Patients Treated with Cortical Electrostimulation.
Jeffrey B. Hargrove1, Robert M. Bennett2 and Daniel J. Clauw3.
1Kettering University, Flint, MI, 2Oregon Health & Science Univ, Portland, OR, 3University of Michigan, Ann Arbor, MI

[SUN] 737
Cortical Oscillatory Changes During Mechanical Brushing in Fibromyalgia Syndrome Patients.
Nick Fallon, Yee Ho Chiu, Xiaoyun Li, Turo Nurmikko and Andrej Stancak.
University of Liverpool, Liverpool, United Kingdom
Gives some insights to somatosensory cortex activation, disinhibition , potentially stronger recruitment of thalamic neurons …

[SUN] 739
Nocebo in Fibromyalgia: Meta-Analysis of Placebo-Controlled Clinical Trials and Implications for Practice.
DD Mitsikostas1, NG Chalarakis1, LI Mantonakis1, E. Delicha2 and PP Sfikakis2.
1Naval Hospital, Athens, Greece, Athens, Greece, 2First Department of Propaedeutic and Internal Medicine, Laiko, Athens University Medical School, Greece, Athens, Greece

[SUN] 740
The Performance of American College of Rheumatology 2010 Diagnostic Criteria for Fibromyalgia Among Fibromyalgia Patients Seen in a Rheumatology Clinic and Diagnosed by 1990 Classification Criteria.
Muhammad B. Yunus and Jean C. Aldag.
University of Illinois College of Medicine at Peoria, Peoria, IL

[MON] 902
Economic Burden of Fibromyalgia: A Systematic Review and Meta-
Analysis.
John B. Wong, Marcia P. Griffith and Chenchen Wang.
Tufts Medical Center, Boston, MA

[MON] 925
Milnacipran Improves Health Outcomes in Fibromyalgia Patients Who Have Had An Inadequate Response to Duloxetine Treatment As Measured by PROMIS Computer Adaptive Testing.
Steven I. Blum, Stavros Tourkodimitris and Allan Spera.
Forest Research Institute, Jersey City, NJ
Drug research!

[MON] 926
The Frequency of Fibromyalgia Syndrome and the Quality of Life in Patients with Periton Dialysis.
Muyesser Okumus, Hulya Parpucu, Seher Kocaoglu, Esma Ceceli, Pinar Borman and Murat Duranay.
Ministry of Health Ankara Education and Training Hospital, Ankara, Turkey

[MON] 927
Correlates of Word Finding Deficits in Fibromyalgia.
Robert S. Katz and Frank Leavitt.
Rush University Medical Center, Chicago, IL
”Slow naming speed likely reflects time delays in accessing the mental lexicon.”

[MON] 928
Carpal Tunnel Syndrome in Fibromyalgia: Evidence of a Subclinical Neuropathy?
Robert S. Katz1 and Bhagwan Shahani2. 1Rush University
Medical Center, Chicago, IL, 2University of Chicago Hospital, Chicago
“Almost one third of the fibromyalgia patients tested were found to have carpal tunnel syndrome.”
Is there enough force in this study to shift from central pain processing back to pheripheral nerve alterations? Or are these findings an epiphenomenon?

[MON] 929
Designing a Fibromyalgia Screening Questionnaire for Primary Care Settings.
Robert S. Katz1, Alexandra Small2, Lauren Kwan3, Patricia Kuenzi1 and Jessica L. Polyak3.
1Rush University Medical Center, Chicago, IL, 2University of Illinois Medical School, 3Rheumatology Associates, Chicago, IL

[MON] 930
The Effectiveness of Long-Term and Short-Term Interdisciplinary Treatment Approaches in Female Patients with Fibromyalgia.
Ilknur Saral1, Dilsad Sindel1, Ozlem S. Berk2 and Sina Esmaeilzadeh1.
1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey, 2Istanbul University, Faculty of Letters, Istanbul, Turkey

[MON] 931
Continuing Efficacy of Milnacipran Demonstrated After Long-Term Treatment of Fibromyalgia.
Daniel J. Clauw1, Philip J. Mease2, Yimin Ma3, Arlene Baldecchi3, Robert H. Palmer3 and Joel M. Trugman3. 1University of Michigan, Ann Arbor, MI, 2Seattle Rheumatology Associates and Swedish Medical Center, Seattle, WA, 3Forest Research Institute, Jersey City, NJ
Drug research!

[MON] 932
The Care Gap in Management of Fibromyalgia: A Needs Assessment Prompting the Development of Clinically Relevant Guidelines for the Diagnosis, Management and Follow-up of Patients.
Peter A. Ste-Marie1, Mary-Ann Fitzcharles2, Pantelis Panopalis2, John Pereira3 and Yoram Shir2.
1University of Montreal, Montreal, QC, 2McGill University, Montreal, QC, 3University of Calgary, Calgary, AB

[MON] 933
Supporting Evidence for the Clinical Utility of the Pain Subscale of the American College of Rheumatology 2010 Preliminary Diagnostic Criteria for Fibromyalgia.
Peter A. Ste-Marie1, Marc-Olivier Martel2,Mary-Ann Fitzcharles2 and Yoram Shir2.
1University of Montreal, Montreal, QC, 2McGill University, Montreal, QC

[MON] 934
Fibromyalgia Syndrome in the General Population of Israel: A Prevalence Study.
Jacob N. Ablin1, Anat Oren2, Sarit Cohen3, Valerie Aloush1, Ori Elkayam4, Yonatan Wolman1 and Mark Berman1.
1Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, 2Tel Aviv University, Tel Aviv, Israel, 3Carmel Medical Center, Haifa, Israel, 4Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

[MON] 935
Concordance Between Subjective Dry Eye Symptoms and Objective Findings in Fibromyalgia Patients.
Marco Antivalle, Michele Battellino, Alberto Batticciotto, Maria Chiara Ditto, Alessandra Mutti. Gabriella Santalena,
Valentina Varisco and Piercarlo Sarzi-Puttini, L. Sacco University Hospital, Milano, Italy

[MON] 936
High Prevalence of Fibromyalgia Symptoms Among Healthy Full Term Pregnant.
Sharon Saad, Ariel Many, Giris Jacob and Jacob N. Ablin. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

[MON] 937
Fibromyalgia: Can Online Cognitive Behavioral Therapy Help?
Gwendoline Menga1, Bobby J. Dupre2, Carl Gauthier3, William E. Davis4, Tamika A. Webb-Detiege5, Eve Scopelitis3, Jerald M. Zakem4 and Robert Quinet6.
1Ochsner Clinic Center, New Orleans, LA, 2Ochsner Health System, Baton Rouge, LA, 3Ochsner Clinic Foundation, New Orleans, LA, 4Ochsner Clinic, New Orleans, LA, 5Ochsner Medical Ctr, New Orleans, LA, 6Ochsner Medical Center - New Orleans, New Orleans, LA

[MON] 938
The 2010 American College of Rheumatology Fibromyalgia Survey Diagnostic Criteria and Symptom Severity Scale Is Valid and Reliable in a French Speaking Fibromyalgia Cohort.
Peter A. Ste-Marie1, Pantelis Panopalis2, Mary-Ann Fitzcharles2, Henri A. Menard3, Yoram Shir2 and Frederick Wolfe4.
1University of Montreal, Montreal, QC, 2McGill University, Montreal, QC, 3Montreal General Hospital, Montreal, QC, 4National Data Bank for Rheumatic Diseases, Wichita, KS

[MON] 939
The Michigan Body Map and Its Use in Assessing the American College of Rheumatology Survey Criteria for Fibromyalgia.
Chad M. Brummett1, Afton L. Hassett2, Katherine A. Brummett1, Daniel J. Clauw3 and David A. Williams4.
1University of Michigan Health System, Ann Arbor, MI, 2University, of Michigan Medical School, Ann Arbor, MI, 3University of Michigan, Ann Arbor, MI, 4Univ of MI Hlth System-Lobby M, Ann Arbor, MI

[MON] 940
Longitudinal Assessment of Fibromyalgia in Young Adults Previously Diagnosed with Juvenile Fibromyalgia.
Tracy V. Ting1, Daniel Strotman1, Emily Verkamp1, Anjali Desai1, Anne Lynch-Jordan1, Lesley M. Arnold2 and Susmita Kashikar-Zuck1.
1Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 2University of Cincinnati College of Medicine, Cincinnati, OH

[MON] 941
Prevalence of Physician-Diagnosed Fibromyalgia and Fibromyalgia-Related Fatigue in Olmsted County.
Ann Vincent1, Debra L. Barton2, Daniel J. Clauw3, Mary Whipple1, Brian Lahr4, Eric Hawkins1, Terry H. Oh2, Connie Luedtke1 and Jennifer St.Sauver4.
1Mayo Clinic, Rochester, MN, Rochester, MN, 2Mayo Clinic, Rochester, MN, 3University of Michigan, Ann Arbor, MI, 4Mayo Clinic, Rochester

[MON] 942
What Does Affect the Sexual Behaviour in Fibromyalgic Patients?
Laura Bazzichi1, Alessandra Rossi2, Ciro Conversano2, Camillo Giacomelli2, Claudia Ferrari1, Francesca De Feo2, Francesca Sernissi2, Marica Doveri2, Linda Carli2 and Stefano Bombardieri1. 1Rheumatology Unit, Pisa, Italy, 2University of Pisa, Pisa, Italy

[MON] 943
Functional MRI (fMRI) in Patients with Cognitive Dysfunction Related to Fibromyalgia (Fibrofog).
Robert S. Katz1, Vy T. Dinh1, Glen Stebbins2 and Frank Leavitt1.
1Rush University Medical Center, Chicago, IL, 2Rush University Medical Center, Chicago
Pilot study with 2 patients only.

[MON] 970
Reduced Insular Gamma-Aminobutyric Acid in Fibromyalgia.
Bradley Foerster1, Myria Petrou1, Richard Edden2, Pia Sundgren1, Tobias Schmidt-Wilcke1, Suzan E. Lowe1, Steven Harte1, Daniel J. Clauw1 and Richard E. Harris1.
1University of Michigan, Ann Arbor, MI, 2Johns Hopkins, Baltimore, MD
Well, see #971 and know, what I mean.

[MON] 971
Pregabalin Reduces Posterior Insula Combined Glutamate and Glutamine in Fibromyalgia.
Richard E. Harris1, John P. Huggins2, Lynne Pauer2, Pia Sundgren1, Craig Urwin1, Kathy Scott1 and Daniel J. Clauw1.
1University of Michigan, Ann Arbor, MI, 2Pfizer Inc., Sandwich, United Kingdom
Drug research!

[MON] 1566
Dysautonomia and Chronotropic Incompetence in Fibromyalgia.
Roberta P. C. Ribeiro1, Thalita Dassouki2, Luiz A. Perandini2, Guilherme G. Artioli1, Ana L. G. Calich3, Ana Lucia S. Pinto4, Hamilton Roschel5, Fernanda R. Lima6, Eloisa Bonfa7 and Bruno Gualano8.
1University of Sao Paulo,, Sao Paulo, Brazil, 2University of Sao Paulo, Rheumatology Division, LACRE, Sao Paulo, Brazil, 3University of Sao Paulo, Sao Paulo, Brazil, 4University of Sao Paulo, School of Medicine, Rheumatology Division, LACRE, Sao Paulo, Brazil, 5University of Sao Paulo, School of Physical Education and Sport, Sao Paulo, Brazil, 6University of Sao Paulo, School of Medicine, Rheumatology Division, Sao Paulo, Brazil, 7Faculdade de Medicina da Universidade de Sa˜o Paulo (FMUSP), Sao Paulo, Brazil, 8University of Sao Paulo,School of Physical Education and Sport, Sao Paulo, Brazil
Quite a bit of names and places.

[MON] 1577
Conception, Family Size and Miscarriages in Fibromyalgia Patients.
Robert S. Katz1, Sharon M. Ferbert2, Patricia Kuenzi1, Jessica L. Polyak3 and Susan Shott1.
1Rush University Medical Center, Chicago, IL, 2Advocates for Funding Fibromyalgia Treatment, Education and Research(AFFTER), Libertyville, IL, 3Rheumatology Associates, Chicago, IL

[MON] 1605
Continued Opioid Use in Fibromyalgia Is Associated with Negative Health Related Outcomes.
Peter A. Ste-Marie1, Mary-Ann Fitzcharles2, Marc-Olivier Martel2, Ann Gamsa2, Pantelis Panopalis2 and Yoram Shir2.
1University of Montreal, Montreal, QC, 2McGill University, Montreal, QC
I like this study, because it might help arguing to getting patients off unnecessary but harmful drugs.

[MON] 1606
5-HT2C Receptor Agonists Attenuate Muscle Pain in a Rat Model of Fibromyalgia.
Shinichi Ogino, Mina Tsukamoto, Yukinori Nagakura, Tomonari Watabiki, Yasuaki Shimizu and Hiroyuki Ito. Astellas Pharma Inc., Tsukuba, Japan
Pre drug research!

[MON] 1607
Mechanisms of Improvement in Fibromyalgia Symptoms in a Clinical Trial of Exercise: Increased Fitness or Hawthorne Effect?
Steven A. Mazzuca1, Anthony Kaleth2, Chandan Saha3, James Slaven3 and Dennis C. Ang4.
1Indiana Univ Schl of Medicine, Indianapolis, IN, 2Indiana University Purdue University Indianapolis, 3Indiana University, 4Indiana University, Indianapolis, IN

[MON] 1608
Study of the Measurement Properties of the Arnold Fibromyalgia Diagnostic Screen: Results From a Cross-Sectional Study.
Susan Martin1, Cheryl Coon2, Lori McLeod2, Arthi Chandran3 and Lesley M. Arnold4.
1RTI-Health Solutions, Ann Arbor, MI, 2RTI-Health Solutions, Research Triangle Park, 3Pfizer, New York, 4University of Cincinnati College of Medicine, Cincinnati, OH

[MON] 1609
A Multicenter, Randomized, Double-Blind, Placebo-Controlled Switch Study to Evaluate the Safety, Tolerability, and Efficacy of Milnacipran in Patients with An Inadequate Response to Duloxetine for the Treatment of Fibromyalgia.
Lucinda Bateman1, Allan Spera2, Robert H. Palmer2, Joel M. Trugman2 and Jennifer Lin2.
1The Fatigue Consultation Clinic, Salt Lake City, UT, 2Forest Research Institute, Jersey City, NJ
Drug research!

[MON] 1610
An 11-Year Longitudinal Study of Pharmacologic Therapy in Fibromyalgia.
Frederick Wolfe1, Brian T. Walitt2, Robert S. Katz3, Yvonne C. Lee4, Kaleb D. Michaud5 and Winfried Häuser6.
1National Data Bank for Rheumatic Diseases, Wichita, KS, 2Washington Hospital Center, Washington, DC, 3Rush University Medical Center, Chicago, IL, 4Brigham and Women’s Hospital, Boston, MA, 5Univ of Nebraska Med Ctr & National Data Bank for Rheumatic Diseases, Omaha, NE, 6Technische Universität München, Munich, Germany
My favourite study, because it might help arguing getting patients off unnecessary but harmful drugs. Wonderful presentation.

[TUE] 1899
Stress Is a Key Modulator of Mood, Coping, Type of Control and Characteristic Symptoms in Females with Fibromyalgia.
Katrina Malin1 and Geoffrey O. Littlejohn2.
1Monash Medical Centre, Clayton, Australia, 2Monash Medical Center, Melbourne, Australia
(OT: miss not having met Geoff in Chicago)

[TUE] 1900
Fibromyalgia and Parental Medical Histories of Depression and Alcoholism.
Robert S. Katz1, Ben J. Small2, Sharon M. Ferbert3, Patricia Kuenzi1 and Susan Shott1.
1Rush University Medical Center, Chicago, IL, 2Rush University Medical School, Chicago, IL, 3Advocates for Funding Fibromyalgia Treatment, Education and Research(AFFTER), Libertyville, IL

[TUE] 1901
The Survey Diagnostic Criteria of Fibromyalgia Syndrome—Results From the German Fibromyalgia Syndrome Consumer Reports.
Winfried Häuser1, Eva Jung1 and Frederick Wolfe2.
1Technische Universität München, Munich, Germany, 2National Data Bank for Rheumatic Diseases, Wichita, KS

[TUE] 1902
Prevalence of Fibromyalgia at the Medical Out Patient Clinic Kenyatta National Hospital.
Sophia Dokwe and Omondi.G Oyoo.
University of Nairobi, Nairobi, Kenya

[TUE] 1903
Fibromyalgia in Systemic Lupus Erythematosus and Association with Fatigue and Disease Activity: Comparison of 2010 Versus 1990 Criteria.
Vinicius Domingues, Hong Fang and Michelle Petri.
Johns Hopkins University School of Medicine, Baltimore, MD

[TUE] 1904
Return of Pain and Functional Impairment After Discontinuation of Milnacipran in Patients with Fibromyalgia. Philip J. Mease1, Daniel J. Clauw2, Yimin Ma3, Arlene Baldecchi3, Joel M. Trugman3 and Robert H. Palmer3.
1Seattle Rheumatology Associates and Swedish Medical Center, Seattle, WA, 2University of Michigan, Ann Arbor, MI, 3Forest Research Institute, Jersey City, NJ
Drug research!

[TUE] 1905
Safety and Tolerability of Milnacipran in a 3-Year, Open-Label, Flexible-Dosing Study of Patients with Fibromyalgia.
Lesley M. Arnold1, Yimin Ma2, Robert H. Palmer2, Allan Spera2 and Arlene Baldecchi2.
1University of Cincinnati College of Medicine, Cincinnati, OH, 2Forest Research Institute, Jersey City, NJ
Drug research!

[TUE] 1906
Cannabinoid Use in Fibromyalgia Is Associated with Male Gender, Opioid Use and Drug Seeking Behaviour.
Peter A. Ste-Marie1, Mary-Ann Fitzcharles2, Ann Gamsa2, Pantelis Panopalis2 and Yoram Shir2.
1University of Montreal, Montreal, QC, 2McGill University, Montreal, QC

[TUE] 1907
3-Year Efficacy of Milnacipran in Patients with Fibromyalgia: An Open-Label, Flexible-Dosing Study.
Lesley M. Arnold1, Yimin Ma2, Robert H. Palmer2, Allan Spera2 and Arlene Baldecchi2.
1University of Cincinnati College of Medicine, Cincinnati, OH, 2Forest Research Institute, Jersey City, NJ
Drug research!

[TUE] 1908
Improvements in Fatigue Are Incompletely Explained by Improvements in Pain in Fibromyalgia Patients Treated with Milnacipran.
Philip J. Mease1, Robert H. Palmer2, Yong Wang2 and R. Michael Gendreau3.
1Seattle Rheumatology Associate and Swedish Medical Center, Seattle, WA, 2Forest Research Institute, Jersey City, NJ, 3Cypress Bioscience, Inc., San Diego, CA
Drug research!

[TUE] 1909
Alcohol Consumption and Symptom Severity in Patients with Fibromyalgia.
Terry H. Oh, Chul H. Kim, Connie Luedtke, Jeffery Thompson and Ann Vincent.
Mayo Clinic, Rochester, MN

[TUE] 1910
Six-Month Treatment Patterns and Outcomes for Patients with Fibromyalgia.
Rebecca Robinson1, Kurt Kroenke2, David A. Williams3, Yi Chen4, Madelaine M. Wohlreich5, Bill McCarberg6 and Philip J. Mease7.
1Eli Lilly and Company, Indianapolis, IN, 2Indiana University Regenstrief Institute, Indianapolis, IN, 3Univ of MI Hlth System-Lobby M, Ann Arbor, MI, 4i3, Ann Arbor, MI, 5Lilly USA, Indianapolis, IN, 6Kaiser Permanente, Escondido, CA, 7Seattle Rheumatology Associate, Seattle, WA

[TUE] 1911
Subgrouping Chronic Pain Patients At a Tertiary Care Center Based on the Presence of Fibromyalgia Symptoms.
Afton L. Hassett1, Chad M. Brummett2, Jenna Goesling2, Kevin Rakovitis2, Daniel J. Clauw3 and David A. Williams4. 1University of Michigan Medical School, Ann Arbor, MI, 2University of Michigan Health System, Ann Arbor, MI, 3University of Michigan, Ann Arbor, MI, 4Univ of MI Hlth System-Lobby M, Ann Arbor, MI

[TUE] 1912
Smoking and Fibromyalgia: The Need for a Multidisciplinary Approach to Treatment.
Jenna Goesling1, Chad M. Brummett1, Kevin Rakovitis1, Daniel J. Clauw2 and Afton L. Hassett3.
1University of Michigan Health System, Ann Arbor, MI, 2University of Michigan, Ann Arbor, MI, 3University of Michigan Medical School, Ann Arbor, MI
Interesting and useful research, as one can counsel fibromyalgia patients to quit smoking.

[TUE] 1913
Perspectives on Fibromyalgia From Trainees At An Academic Health Center.
Jennifer Lobert1, Xolti Morgan1 and Lesley M. Arnold2.
1University of Cincinnati, Cincinnati, OH, 2University of Cincinnati College of Medicine, Cincinnati, OH

[TUE] 1914
EpiFibro—A Brazilian Nationwide Databank in Fibromyalgia— Analysis of 500 Women. Roberto E. Heymann1, Eduardo S. Paiva2, Marcelo C. Rezende3, Daniel Feldman4, Milton Helfenstein Jr.1, Jose E. Martinez5, Jose R. Provenza6, Aline Ranzolin7, Luiz S. Ribeiro8 and Eduardo J.R. Souza9.
1Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil, 2Universidade Federal do Parana, Curitiba, Brazil, 3Santa Casa de Campo Grande, Campo Grande, Brazil, 4Universidade Federal de Sa˜o Paulo, Sao Paulo, Brazil, 5Pontifı´cia Universidade Cato´lica de Sa˜o Paulo, Sorocaba, Brazil, 6Pontifı´cia Universidade Cato´lica de Campinas, Campinas, Brazil, 7Hospital das Clı´nicas - Universidade Federal de Pernambuco, Recife, Brazil, 8Instituto de Prevideˆncia dos Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil, 9Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
Quite a bit of names and places.

[TUE] 1915
EpiFibro—A Brazilian Nationwide Databank in Fibromyalgia—2010 Fibromyalgia Criteria, “Fibromyalgianess” Score and FIQ Performances.
Eduardo S. Paiva1, Roberto E. Heymann2, Marcelo C. Rezende3, Daniel Feldman4, Milton Helfenstein Jr.5, Jose E. Martinez6, Jose R. Provenza7, Aline Ranzolin8, Luiz S. Ribeiro9 and Eduardo J.R. Souza10.
1Universidade Federal do Parana, Curitiba Parana, Brazil, 2UNIFESP - Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil, 3Santa Casa de Campo Grande, Campo Grande, Brazil, 4Universidade Federal de de Sa˜o Paulo, Sao Paulo, Brazil, 5Universidade Federal de de Sa˜o Paulo, Sa˜o Paulo, Brazil, 6Pontifı´cia Universidade Cato´lica de Sa˜o Paulo, Sorocaba, Brazil, 7Pontifı´cia Universidade Cato´lica de Campinas, Campinas, Brazil, 8Hospital das Clı´nicas - Universidade Federal de Pernambuco, Recife, Brazil, 9Instituto de Previde ˆncia dos Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil, 10Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
Quite a bit of names and places.

[TUE] 1916
A Randomized, Double-Blind Comparison of Duloxetine 30 Mg Once Daily (QD) and Placebo in Adult Patients with Fibromyalgia.
Lesley M. Arnold1, Shuyu Zhang2 and Beth Pangallo3.
1University of Cincinnati College of Medicine, Cincinnati, OH, 2Eli Lilly and Company, Indianapolis, IN, 3ELi Lilly and Company, Indianapolis, IN
Drug research!

[TUE] 1917
Therapeutic Massage on Pain Relief for Fibromyalgia: A Systematic Review and Meta-Analysis.
Lingjun Kong1, Raveendhara R. Bannuru2, Weian Yuan1, Ying-wu Cheng1, Min Fang1, Timothy McAlindon2 and Chenchen Wang2.
1Shanghai University of Traditional Chinese Medicine of Yueyang Hospital, Shanghai, China, 2Tufts Medical Center, Boston, MA

[TUE] 2408
Family Stress in Childhood of Patients with Fibromyalgia.
Robert S. Katz1, Sharon M. Ferbert2, Ben J. Small3 and Susan Shott1.
1Rush University Medical Center, Chicago, IL, 2Advocates for Funding Fibromyalgia Treatment, Education and Research(AFFTER), Libertyville, IL, 3Rush University Medical School, Chicago, IL

[TUE] 2409
Childhood Social Ostracism in Fibromyalgia.
Afton L. Hassett1, Sharon M. Ferbert2, Susan Shott3 and Robert S. Katz3.
1University of Michigan Medical School, Ann Arbor, MI, 2Advocates for Funding Fibromyalgia Treatment, Education and Research(AFFTER), Libertyville, IL, 3Rush University Medical Center, Chicago, IL

[WED] 2564
Psychiatric Disorders in Fibromyalgia Patients, Results Patient Survey.
Robert S. Katz1, Sharon M. Ferbert2, Alexandra Small3, Susan Shott1 and Patricia Kuenzi1.
1Rush University Medical Center, Chicago, IL, 2Advocates for Funding Fibromyalgia Treatment, Education and Research(AFFTER), Libertyville, IL, 3University of Illinois Medical School


Why isn’t there more interest in other hypothalamus-pituary axes? What about the sympathetic nervous system? Somatotropin?
Read the “Medscape Rheumatology” controversy: “Is Fibromyalgia Real?” by Jonathan Kay, MD, and Charles E. Argoff, MD [courtesy of @carvicab: End of year´s lists. According to Medscape this are the Top Ten Rheumatology Articles 2011 http://t.co/NpJIrQIZ #rheumatol ...], and you will agree that basic research in fibromyalgie is still needed.