I have selected a few studies, which
were presented at the 2EULAR 2020 Meeting, which has been online
because of Covid-19.
The first study has been by B. Kundakci
and colleagues [1]: „THU0461 THE COMPARATIVE
EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS FOR FIBROMYALGIA: A
SYSTEMATIC REVIEW WITH BAYESIAN NETWORK META-ANALYSIS“.The
authors looked at 78 studies (n = 5,639 participants).
Multidisciplinary treatment was the best for improving pain, sleep
and depression, balneotherapy and exercise were the most effective
treatments for FIQ and fatigue. Allow me to intervene, as one doesn't
treat the Fibromyalgia Impact Questionnair, but nevertheless one can
see improvement in the score of this questionnaire. 47 exercise
trials (n = 3,271 participants) were also analysed. Strengthening
showed the greatest benefits for FIQ, pain and depression, whereas
aerobic exercise was the best for fatigue and sleep. As the effect
size tvaries between interventions and outcomes, the authors
conclude, that „the results of this study may be used to guide the
selection of the most effective non-pharmacological interventions
according to the predominant symptom in individual patients.“
Though the approach with comparing effect sizes is a good idea, I
doubt that this will happen in real life.
My
next selection is the study by L. López-Núñez and colleagues [2]:
„THU0462 CHARACTERIZATION
OF PATIENTS WITH FIBROMYALGIA AFFECTS WITH OR WITHOUT JOINT
HYPERLAXITY SYNDROME“.
If you have read more on my blog you know about my long lasting
interests in hyperlaxity or the benign hypermobility syndrome. In
their conclusion the authors point out: „Our work revealed that FM
patients with JHS are different from FM without JHS, by manifesting
differences in certain clinical, anthropometric, and bone metabolism
features.“ The Body Mass Index and Muscle Mass were less in the
FM-JHS group. The FM-JHS group also had less bone mineral density
(BMD) at total hip DXA, which might be due to the lesser weight. So
the study gives interesting data, but implications on treatment are
not emminent.
The
next study is by S. A. A. Tabra and colleagues [3]: „THU0471 VITAMIN
D SUPPLEMENTATION; IS IT EFFECTIVE IN FIBROMYALGIA PATIENTS?“ 100
adult patients of primary FMS (according to the 2010 ACR criteria for
FMS) associated with vitamin D insufficiency (21-29 ng/mL) took
part in this interventional double-blinded study. 21-29 ng/ml is just
below normal and after six months the vitamin D group had a level of
just above the lower limit (36.8 +/- 3.9 ng/ml). May this be as it
is, there have been differences in the results between the vitamin D
group and the placebo group. Gth authors concluded, that „Vitamin D
supplement is effective as an adjuvant therapy in improving
functional status, quality of life and psychological status in
fibromyalgia patients with vitamin D insufficiency.“ Please repeat
the study with a higher level of vitamin D as a goal.
A. Negm and
J. Alsaleh presented [4]:
„THU0484 FIBROMYALGIA AND
MULTIPLE SWITCHING OF BIOLOGICS IN SPONDYLOARTHRITIS“. The
authors looked at 305 patients; but there were only 43 patients with
coexisting fibromyalgia. They concluded: „FM coexistence with SpA
might impact clinical evaluation of disease activity and possibly
negatively affect self-measurement of treatment response. In our
study, SPA patients exposed to more biologics if they have coexisting
FM; Moreover, they are more frequent switchers among biologics
including TNFi and IL17i.“ The study shows that our tools to make
treatment decisions in spondyloarthopathies are too inaccurate if it
comes to concomitant fibromyalgia.
A.
Gomez-Centeno and colleagues presented the folloeing study [5]:
„AB0952 COENZYME Q10,
TRYPTOPHAN AND MAGNESIUM: A NUTRITIONAL SUPPLEMENT IN THE TREATMENT
OF FIBROMYALGIA SYMPTOMS“.
I don't know if I should already start to whince. The authors studied
23 patients, whereof 3 dropped out. They found an improvement, but:
„no statistically significant differences were found among the
studied variables.“ If the statistics do not support your
hypothesis, it is premature to draw conclusions. Conduct a study of a
larger number of patients and do so for at least half a year. My
educated guess is that you won't find statically significant
differences.
A.
Keskin and colleagues asked [6]: „AB0954 IS
CONNECTIVE TISSUE MASSAGE EFFECTIVE IN INDIVIDUALS WITH
FIBROMYALGIA?“ They
concluded: „According to our results, connective tissue massage has
been shown to be effective in reducing the number of painful areas in
addition to the positive effects of clinical pilates exercises in
individuals with FM. In order to increase the effectiveness of
treatment in individuals with FM, we recommend the use of connective
tissue massage as an additional treatment method.“ The authors
compared an interventional group of N=15 to a control group of N=17.
And they found no statistically significant differences in the
Fibromyalgia Impact Questionnare (FIQ), the Health Assessment
Questionnare (HAQ), the Beck Anxiety Inventory (BAI), the Short
Form-36 (SF-36) and the Cognitive Exercise Therapy Approach (BETY)
Scale; there has been a difference in the Pain Location Inventory
(p=0.023). This is cherry picking and not science. The authors should
have formulated a hypothesis and an endpoint.
A.
Moshrif and colleagues presented a study on vertical nail ridging
[7]: „AB0956 VERTICAL
NAIL RIDGING IN PATIENTS WITH FIBROMYALGIA: FREQUENCY, PROPOSED
GRADING AND CORRELATION WITH OTHER DISEASE FEATURES.“ The
authors concluded: „vertical nail ridging is a frequent finding and
can be considered helpful for diagnosis of patients with FM.“ The
authors found 98.6% vertical nail ridging in the fibromyalgia group,
and they found vertical nail ridging in 76.2% of the control group.
If vertical nail ridging is related to stressful conditions, why not
look there in the first place? Of what use is a test, if the control
group shows the same sign in a high proportion of patients? Maybe the
next study shows a correlation between number of freckles in red
haired fibromyalgia patients and the development of the FIQ score in
the next six months. And please look for a study on vertical nail
ridging on PubMed; there is none. The reference in the study [8] is a talk, which
has been held in 2007, concerning vertical nail ridging it says:
„Another stress-related nail habit that Dr. Mayoral discussed is
people who rub their fingers over their thumb nail, which can create
a ridge across the nail. This rubbing causes a distortion of the nail
plate, and when the nail grows, a raised ridge forms in the middle of
the nail.“ I guess looking for vertical nail ridging won't make it
into the ACR Fibromyalgia Criteria.
M.
Giovale and colleagues presented the following study [9]:
„LOW-ENERGY PULSED
ELECTROMAGNETIC FIELD THERAPY REDUCES PAIN IN FIBROMYALGIA: A
RANDOMIZED SINGLE-BLIND CONTROLLED PILOT STUDY.“ 21
women with fibromyalgia were evaluated in TWO groups, one receiving
active treatment under single-blinded condition. Makes me whince
again. „In all endpoints, we observed a general reduction at T4
and T8 compared to T0 also for FIQ, VAS pain, SS, SF-36, regardless
of the treatment arm and the decrease was higher in the active
treatment arm compared to the placebo group, albeit not reaching
statistical significance.“ I haven't found the definition of an
endpoint. The authors concluded: „The results of our pilot study
show that PEMF is more effective than placebo in reducing widespread
pain in fibromyalgia while confirming that a placebo effect is clear
in this complex disease.“ No, that is what the sponsor of the
study likes to hear. The study showed no statistically significant
difference between the two groups.
Hoping
for better studies in future meetings concernig fibromyalgia.
References:
[1]
Kundakci B, Kaur J, Shim SR, et al: THU0461 THE
COMPARATIVE EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS FOR
FIBROMYALGIA: A SYSTEMATIC REVIEW WITH BAYESIAN NETWORK
META-ANALYSIS. Annals of the
Rheumatic Diseases 2020;79:463-464.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.803
[2]
López-Núñez L, Blanch J, Ciria Recasens M, et al:
THU0462 CHARACTERIZATION OF PATIENTS WITH
FIBROMYALGIA AFFECTS WITH OR WITHOUT JOINT HYPERLAXITY SYNDROME.
Annals of the Rheumatic
Diseases 2020;79:464.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.4115
[3]
Tabra SAA, Abu-Zaid MH, Hablas S: THU0471 VITAMIN D
SUPPLEMENTATION; IS IT EFFECTIVE IN FIBROMYALGIA PATIENTS? Annals
of the Rheumatic Diseases 2020;79:468-469.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.487
[4]
Negm A, Alsaleh J: THU0484 FIBROMYALGIA AND MULTIPLE
SWITCHING OF BIOLOGICS IN SPONDYLOARTHRITIS. Annals
of the Rheumatic Diseases 2020;79:475-476.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.6224
[5]
Gomez-Centeno A, Ramentol M, Gonzalez MJ, et al: AB0952 COENZYME
Q10, TRYPTOPHAN AND MAGNESIUM: A NUTRITIONAL SUPPLEMENT IN THE
TREATMENT OF FIBROMYALGIA SYMPTOMS. Annals
of the Rheumatic Diseases 2020;79:1769-1770.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.5531
[6]
Keskin A, Basakci Calik B, Gur Kabul E, et al: AB0954 IS
CONNECTIVE TISSUE MASSAGE EFFECTIVE IN INDIVIDUALS WITH FIBROMYALGIA?
Annals of the Rheumatic
Diseases 2020;79:1770-1771.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.6316
[7]
Moshrif A, Abdelkareem M, Moneer M, et al: AB0956 VERTICAL
NAIL RIDGING IN PATIENTS WITH FIBROMYALGIA: FREQUENCY, PROPOSED
GRADING AND CORRELATION WITH OTHER DISEASE FEATURES. Annals
of the Rheumatic Diseases 2020;79:1771.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.5317
[8]
American Academy of Dermatology. (2007, November 12). Feeling
Stressed? How Your Skin, Hair And Nails Can Show It. Science
Daily. Retrieved December
30, 2019 from www.sciencedaily.com/releases/2007/11/071109194053.htm
[9]
Giovale M, Novelli L, Rampoldi S, et al: AB0958 LOW-ENERGY
PULSED ELECTROMAGNETIC FIELD THERAPY REDUCES PAIN IN FIBROMYALGIA: A
RANDOMIZED SINGLE-BLIND CONTROLLED PILOT STUDY. Annals
of the Rheumatic Diseases 2020;79:1772.
http://dx.doi.org/10.1136/annrheumdis-2020-eular.6409
.
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