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Del-Río-Guerrero V, Martínez-Martínez LA, Arias-Callejas K, Carbonell-Bobadilla N, Mejía-Segura A, Azamar-Morales G, Espinosa-Orantes A, Molina-Sánchez JR, Mora-Ramírez M, Mejía-Ávila MF, Vargas Guerrero A, Silveira LH, Martínez-Lavín M. The value of inquiring patients about local discomfort during blood pressure measurement for fibromyalgia detection. A cross-sectional study. Semin Arthritis Rheum 2023; 61:152218. [PMID: 37229846 DOI: 10.1016/j.semarthrit.2023.152218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Fibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. OBJECTIVE To evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. PATIENTS AND METHODS All adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: "I am going to take your blood pressure; tell me if the cuff's pressure causes pain". Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated "did it hurt much or little". Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. RESULTS Four hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having "much" local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. CONCLUSIONS Inquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.
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Affiliation(s)
| | | | - Karina Arias-Callejas
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Alejandra Mejía-Segura
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Gibran Azamar-Morales
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - José-Raúl Molina-Sánchez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Mauricio Mora-Ramírez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Angélica Vargas Guerrero
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Luis H Silveira
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Manuel Martínez-Lavín
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico.
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Godet R, Bruneau A, Vielle B, Vincent F, Le Tourneau T, Carre F, Hupin D, Hamel JF, Abraham P, Henni S. Post-exercise ankle blood pressure and ankle to brachial index after heavy load bicycle exercise. Scand J Med Sci Sports 2018; 28:2144-2152. [PMID: 29858514 DOI: 10.1111/sms.13234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
The American Heart Association (AHA) recommendations for diagnosing peripheral artery disease (PAD) after exercise are a decrease >20% of ankle brachial index (ABI) or >30 mm Hg of ankle systolic blood pressure (ASBP) from resting values. We evaluated ABI and ASBP values during incremental maximal exercise in physically active and asymptomatic patients. Patients (n = 726) underwent incremental bicycle tests with pre- and post-exercise recording of all four limbs arterial pressures simultaneously. Univariate and multivariate analyses were performed to define the correlation between post-exercise ABI with various clinical factors, including age. Thereafter, the population was divided into groups of age: less than 40 (G < 40), from 40 to 44 (G40/44) from 45 to 49 (G45/49), from 50 to 54 (G50/54), from 55 to 59 (G55/59), from 60 to 64 (G60/64), and 65 and above (G ≥ 65) years. Results are mean ± SD. * is two-tailed P < .05 for ANOVA with Dunnett's post-hoc test from G40. Changes from rest in ASBP were -3 ± 22 (G < 40), -2 ± 20 (G40/44), 4 ± 22* (G45/49), 10 ± 25* (G50/54), 18 ± 21* (G55/59), 23 ± 27* (G60/64), and 16 ± 22* (G ≥ 65) mm Hg. Decreases from rest in ABI were 32 ± 9 (G < 40), 33 ± 9 (G40/44), 29 ± 8 (G45/49), 27 ± 10* (G50/54), 24 ± 7* (G55/59), 22 ± 12* (G60/64), and 21 ± 12* (G ≥ 65) % of resting ABI. Maximal incremental exercise results in ABI and ASBP changes are mostly dependent on age. The AHA limits for post-exercise ABI are inadequate following maximal incremental bicycle testing. Future studies detecting PAD in active patients should account for the effect of age.
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Affiliation(s)
- R Godet
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - A Bruneau
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - B Vielle
- Maison de la recherche, University Hospital, Angers, France
| | - F Vincent
- University Hospital, Limoges, France
| | - T Le Tourneau
- Inserm U1087, Institute of Thorax, University Hospital, Nantes, France
| | - F Carre
- University Hospital, Rennes, France
| | - D Hupin
- Department of Clinical and Exercise Physiology, EA SNA EPIS 4607, University Hospital of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - J F Hamel
- Maison de la recherche, University Hospital, Angers, France
| | - P Abraham
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.,CNRS6015-INSERM1228 University of Angers, Angers, France
| | - S Henni
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.,CNRS6015-INSERM1228 University of Angers, Angers, France
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Gladczak AK, Shires PK, Stevens KA, Clymer JW. Comparison of indirect and direct blood pressure monitoring in normotensive swine. Res Vet Sci 2013; 95:699-702. [PMID: 23790711 DOI: 10.1016/j.rvsc.2013.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/08/2013] [Accepted: 05/26/2013] [Indexed: 11/19/2022]
Abstract
The gold standard for blood pressure measurement in pigs is direct monitoring of arterial pressure, but this is an invasive technique adding complexity to surgical procedures. We sought to compare direct measurements obtained via catheterization to more easily-obtained indirect measurements using a sphygmomanometer with an automated cuff. Simultaneous measurements via an arterial pressure transducer and a child-size cuff were performed in pigs undergoing abdominal surgical procedures under normotensive conditions. Correlation between direct and indirect measurements was good (r=0.881). Systolic blood pressures for the cuff were higher than those for arterial measurements, while diastolic pressures were lower for the cuff than arterial. A Bland-Altman analysis confirmed this bias at the extremes of the normotensive range. For highly accurate readings, especially under stressed conditions, direct arterial catheterization remains the preferred method of measuring blood pressure. When monitoring surgical procedures, the more convenient blood pressure cuff can provide reliable measurements.
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