Assessing our approach to diagnosing Fibromyalgia

Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2-5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria. Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature. Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.

Improving maintenance of physical activity in older, knee osteoarthritis patients trial-pilot (IMPACT-P): design and methods

Promoting increased physical activity participation is now consistently advocated in the medical management of knee osteoarthritis (OA). Unfortunately, physical activity interventions targeting older knee OA patients are plagued by high attrition rates and poor long-term adherence. Consequently, identifying effective approaches for promoting maintenance of physical activity participation is integral for the successful behavioral management of knee OA. The present study, the Improving Maintenance of Physical Activity in Knee Osteoarthritis Pilot Trial (IMPACT-P), was a single-blind two-arm, randomized controlled pilot study designed to contrast the effects of a group-mediated cognitive behavioral (GMCB) exercise intervention with those of traditional center-based exercise therapy approach (TRAD) in older, knee OA patients. A total of 80 older adults with symptomatic knee OA were randomly assigned to GMCB or TRAD interventions. The primary outcome of the IMPACT-P study was changed in self-reported (CHAMPS questionnaire) and objectively assessed (LIFECORDER EX Plus) physical activity participation of moderate intensity or greater. Secondary outcomes include physical function, quality of life, and social cognitive variables. Outcomes were obtained at baseline, 3 month, and 12 month assessments by trial personnel blinded to participants' randomization assignment. Discussion. Determining the comparable efficacy of the GMCB and TRAD exercise interventions in producing meaningful improvements in physical activity and OA outcomes could enhance the efficacy of implementing physical activity participation in the behavioral management of symptomatic knee OA.

Expression of the mouse FGF-1 and FGF-1.A mRNAs during embryonic development and in the aging heart

The mouse Fgf-1 gene contains at least four upstream promoters that are alternatively spliced to the first protein coding exon, giving rise to different Fgf-1 mRNA variants (1.A, 1.B, 1.C, and 1.G), each expressed in a tissue specific manner. Only the Fgf-1.A promoter contains TATA and CAAT consensus sequences, and its corresponding mRNA is mainly expressed in the mouse heart. In situ hybridization with an Fgf-1.A-specific cRNA probe showed the 1.A message to be very low in embryonic heart, tongue, spinal cord and smooth muscle of the small intestine. Moderate 1.A mRNA levels were revealed in head mesenchyme, paraxial mesoderm, in the embryonic inferior cunniculus, hyppocampus, and thymus. These results suggest a limited role of the Fgf-1.A mRNA variant during development.