Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eleven patients with rheumatoid arthritis that had been refractory to conventional drug therapy were treated with total lymphoid irradiation (TLI). Followup continued for 6 months in 9 patients, 12 months in 6 patients, and 24 months in 3 patients. At 6 and 12 months post-TLI, a significant improvement in clinical disease activity was demonstrated. Side effects noted during TLI included fatigue, nausea, diarrhea, and vomiting. One patient died of cardiorespiratory arrest, 2 patients died of kidney failure secondary to generalized amyloidosis, and 1 patient died of septic shock secondary to a multilocular septic arthritis. One patient experienced 2 episodes of septic arthritis; 2 patients manifested delayed wound healing. Immunologic assessments showed consistent lymphopenia in all patients. T lymphocyte subsets decreased after TLI, and showed a transient increase at 6 months post-TLI. The suppressed mitogen responsiveness, which was noted 2 months after irradiation, was found to increase almost to the pre-TLI levels at 12 months. The observed increase in morbidity and mortality after TLI is evidence that discourages the use of this therapeutic technique, at least in its present form.
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PMID:Total lymphoid irradiation in patients with refractory rheumatoid arthritis. 293 45

Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation at a total dose of 20 Gy. Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced a similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and the number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four of the patients have since died, one of renal failure and another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and a reduction in T-helper cells, while the number of T-suppressor cells remained unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored.
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PMID:Total lymphoid irradiation of intractable rheumatoid arthritis. 294 4

Ultraviolet-A (UV-A) light penetrates the epidermis, reaches the macrophages and circulating mononuclear cells within the dermis, and has immunoregulatory effects in humans. We examined the effect of UV-A irradiation on disease activity in 26 patients with rheumatoid arthritis (RA) and on immunologic function in these patients and in 11 normal subjects. Ten joules/cm2/day of total body UV-A irradiation, given 5 days each week for 3 weeks, resulted in significant improvement in the duration of morning stiffness, fatigue, joint tenderness, joint swelling, grip strength, patient assessment of disease activity, and physician assessment of disease activity. Platelet counts decreased significantly in the RA patients. Phytohemagglutinin (PHA)-stimulated lymphocyte production of interleukin-2 (IL-2) increased significantly in the combined RA and normal groups. These results suggest that UV-A light may be effective in the treatment of patients with RA, but elucidation of its precise role will require further study including double-blind trials.
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PMID:Ultraviolet-A light in the treatment of rheumatoid arthritis. 344 Mar 28

Chronic musculoskeletal pain and fatigue of "fibrositis syndrome" are associated with a physiologic arousal disorder within sleep, the alpha (7.5 to 11 Hz) electroencephalographic, non-rapid-eye-movement sleep anomaly. In this nonrestorative sleep disorder, pain and mood symptoms may be mediated by psychologic distress (e.g., following a nonphysically injurious industrial or automobile accident), noxious environmental stimuli (e.g., noise), physiologic disturbance (e.g., sleep-related myoclonus, painful inflamed joints, i.e., rheumatoid arthritis), and altered central nervous system metabolism (e.g., disordered brain serotoninergic functions). Because such heterogeneous agents influence this hitherto poorly understood nonarticular rheumatic syndrome, the descriptive term "rheumatic pain modulation disorder" is suggested.
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PMID:Sleep and musculoskeletal pain. 346 14

The clinical symptoms of 55 patients with primary fibromyalgia (PF) were studied and compared with 30 patients with rheumatoid arthritis (RA). The PF patients expressed a more intense feeling of illness than did the RA patients. Stiffness occurred just as often in PF as in RA. Trigger points occurred less frequently in RA patients. Muscular fatigue appeared to be one of the most disabling symptoms in PF. Neurophysiological studies indicated that the fatigue was at least partly of central origin. Ischemic forearm exercise test gave no evidence of impaired glycogenolysis. Laboratory investigation revealed normal 25-hydroxyvitamin D, cobalamin, folate, estrogen, testosterone, and myoglobin in the PF patients.
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PMID:Primary fibromyalgia. A clinical and laboratory study of 55 patients. 346 25

This paper presents the design and evaluation of an occupational therapy program developed at the National Institutes of Health for teaching energy conservation and joint protection to adults with rheumatoid arthritis. An existing model for educational diagnosis in health education was used to identify program, behavioral, and educational objectives for the new program. The use of this model resulted in measurable objectives, which were used as outcome measures in the randomized research evaluation of the new program. The dependent variables measured were activity-of-daily-living status, psychosocial adjustment to illness, knowledge, disease activity, pain, and fatigue. None were significantly different after the intervention. The independent variables measured included components of balancing rest and physical activity. After 3 months, a greater percentage of the subjects receiving the workbook-based occupational therapy program than those receiving traditional occupational therapy demonstrated an application of the behaviors the intervention was designed to change.
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PMID:A program for improving energy conservation behaviors in adults with rheumatoid arthritis. 356 25

We investigated the weight of various factors involved in the activity of rheumatoid arthritis (RA) and joint deformity in an attempt to establish a more objective method of evaluation of the impairment in RA using these factors as parameters. The subjects were 100 patients with RA. Multiple regression analysis was undertaken using Lansbury parameters and Stage as predictor variables and the classification of functional capacity (Class) as a criterion variable. The results of analysis showed that the weight was greatest, 32% for the time of appearance of fatigue, followed by 29% for the Stage, 16% for joint index, 10% for grasping power, 7% for ESR, 5% for morning stiffness and 0% for the dose of aspirin used. On the basis of these results, an original method of evaluation of impairment in RA was proposed. There was a close correlation (R = 0.82) between the Class and the total score obtained by this method.
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PMID:Approach to evaluation of impairment in rheumatoid arthritis--a study by multiple regression analysis. 357 38

A new system for measuring strength of the hand using a torsion dynamometer linked to a microprocessor is described. The system permits analysis of timed squeezes of both grip and pinch and is adjustable to all sizes of hand and degrees of hand deformity. Results obtained with the system were found to be reproducible, and the rigid device was acceptable to a group of patients with arthritic hands. In rheumatoid arthritis there is a marked reduction in maximum grip and pinch strength, together with a prolongation of the time taken to reach this maximum, and increased fatigue. The limitations of grip strength as a measure of function of the hand are discussed.
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PMID:Functional assessment of the hand: reproducibility, acceptability, and utility of a new system for measuring strength. 357 83

Women with rheumatoid arthritis performed 1 of 3 low intensity aerobic exercise protocols (15, 25, and 35 minutes) 3 times per week for 12 weeks. A nontraining group served as controls. All exercise groups improved their aerobic capacity, exercise time, and joint counts. Subjects described improvement in activities of daily living and reduced joint pain and fatigue. Exercise duration up to 35 minutes can be therapeutic, and as little as 15 minutes of exercise 3 times/week is sufficient to improve aerobic capacity in rheumatoid arthritis patients with severe limitations.
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PMID:Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. 396 39

Fibrositis is a misnomer for a very common form of nonarticular rheumatism. The name implies an inflammatory process in fibroconnective tissue which has never been verified. The symptoms of fibrositis are ill-defined musculoskeletal pain made worse by stress, cold, noise and unaccustomed exercise; there is usually a significant element of depression, nonrestorative sleep, chronic fatigue and early morning stiffness. Results of physical examination are strikingly normal, apart from painful tender spots which are remarkably consistent in location from patient to patient. It is important to realize that fibrositis can complicate diseases such as rheumatoid arthritis and systemic lupus erythematosus, where its prompt recognition is essential in averting inappropriate medication. Drug therapy alone is seldom effective in alleviating symptoms; a carefully planned education program is necessary to readjust both psyche and soma.
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PMID:Fibrositis: misnomer for a common rheumatic disorder. 616 73


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