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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two elderly patients presented with generalized aches and pains (particularly in the shoulders and the pelvic girdle), stiffness, fatigue, anemia, and an elevated erythrocyte sedimentation rate, but there were no signs or symptoms directly referable to the joints. Two and five months later respectively, pain, swelling, and signs of synovitis appeared in several joints in a symmetrical pattern, and a diagnosis of rheumatoid arthritis was made. Rheumatoid arthritis in the elderly may resemble polymyalgia rheumatica. On the other hand, synovitis in many patients with polymyalgia rheumatica may resemble rheumatoid arthritis. In the elderly, the differentiation of these two entities may be difficult. Moreover, patients initially presenting with the signs and symptoms of polymyalgia may eventually manifest typical rheumatoid arthritis.
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PMID:Rheumatoid arthritis in the elderly, presenting as polymyalgia rheumatica. 42 38

Continuity of care is claimed to be an important and integral part of general practice. A main result of continuity is the doctor's accumulated knowledge about his or her patients. The objective of the present study was to evaluate the modifying effects of this knowledge on the decision-making process that takes place in consultations, as experienced by practitioners. A representative sample of 133 Norwegian general practitioners evaluated a total of 3,918 of their own consultations. The main independent variable was the doctor's own subjectively evaluated knowledge about the patient's medical history, while the major outcome measures included the perceived influence of accumulated knowledge on the consultation process in general, and on the diagnostic and management decisions in particular. In two-thirds of all consultations, or in three out of four in which the doctor had previous knowledge about the patient, this knowledge was considered to be clinically useful. In more than one-third of all consultations with previously unknown patients, this lack of information was felt to be a hindrance. Among patients with new medical problems and when the doctor had prior knowledge about the patient, this knowledge was felt to have significantly more therapeutic than diagnostic impact. Accumulated knowledge was generally felt to be of most help in consultations due to psycho-social problems, and was of special diagnostic value in patients presenting new, unspecific problems such as fatigue, fever, and generalized pain. This study indicates that accumulated knowledge about the patient is felt by the general practitioners to play an important and integral part in their clinical decision-making process.
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PMID:The influence of general practitioners' knowledge about their patients on the clinical decision-making process. 148 Aug 69

Fibromyalgia is a syndrome characterized by generalized aches, pains and tender points. Fatigue and unrefreshed sleep are typical features often seen. In addition, patients complain of vasospastic extremities, irritable bowel syndrome, irritable bladder syndrome, tension headaches and sexual problems. Despite the many complaints, investigations are invariably normal. Other chronic pain and fatigue syndrome may be differentiated from Fibromyalgia. The pathophysiology is unknown but mechanical factors and a sleep disorder are implicated. Non-pharmacological methods of treatment are more important than drugs. This includes explanation regarding the disease, reassurance, physiotherapy, stress elimination etc. Tricyclic anti-depressants may be useful. More research is needed to better understand this condition.
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PMID:The fibromyalgia syndrome. 163 92

Muscle fatigue is the most disabling symptom in primary fibromyalgia (PF), which in addition is characterized by generalised pain and muscle stiffness. In order to assess whether the fatigue is of central and/or peripheral origin, skeletal muscle function was studied by measuring maximum voluntary hand grip strength, and by measuring various contraction characteristics in the adductor pollicis muscle after electrical stimulation of the ulnar nerve. The PF-patients were also studied after a regional sympathetic blockade of the forearm with guanethidine. A lower hand grip strength was found in the PF-patients compared to the controls, before as well as during the sympathetic blockade. The developed force, measured during electrical stimulation, did not differ between patients and controls. A lower muscle relaxation rate was found in the PF-patients. The relaxation rate increased in the PF-patients during the sympathetic blockade. The results indicate both a central and a peripheral cause of muscle dysfunction. Activity in the muscle sympathetic system may be one link in the chain of events that leads to muscular symptoms in PF.
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PMID:Skeletal muscle function in primary fibromyalgia. Effect of regional sympathetic blockade with guanethidine. 337 44

Amitriptyline and cyclobenzaprine have shown some efficacy in treatment of the generalised pain syndrome, fibromyalgia. The aim of this study was to examine the efficacy of antidepressant dosages of the serotonin re-uptake inhibitor citalopram in fibromyalgia. In a double-blind, placebo-controlled study 22 patients with fibromyalgia were randomized to treatment with citalopram for 4 weeks at a dosage of 20 mg a day while 21 received placebo. After 4 weeks the dosage was increased to 40 mg for a further 4 weeks if the subjects did not report a marked improvement. After the end of treatment (8 weeks) no changes were observed in self-assessment of symptoms, physician's global assessment, tender points, Beck depression score or voluntary muscle strength and no differences were observed between the groups. Citalopram showed no demonstrable effect on this group of pain patients. The strength of the study was sufficient to exclude an effect of citalopram of more than 1 steps of 10 on the categoric scales for pain, fatigue and general condition (95% confidence limit), which indicates that the sample size was sufficiently large.
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PMID:A randomized controlled trial of citalopram in the treatment of fibromyalgia. 747 88

Silicone implants have been associated with the development of multiple organ system abnormalities, including rheumatic disorders, nervous system, pulmonary dysfunction associated with autoantibodies and abnormalities of cellular immunity. In this regards a number of case reports and series of articles have been described. We hypothesized that an immune reaction to silicone breast implants would include the host reactivity against silicone and the macromolecules within the microenvironment of the implant, and these autoantibodies may react with other tissue antigens far from the site of the implant. To test this hypothesis 520 Symptomatic women with Silicone Implants which have developed Silicone related Immunological disorders and have typically complained of breast pain, Myalgia-Arthralgia, fatigue, or generalized pain, were examined by their physician. Blood samples were obtained and examined for the presence of Silicone antibodies, Myelin Basic Protein and human serum albumin antibodies. These samples were then compared to 520 matched controls without implants. At least at the level of two standard deviation silicone specific antibodies, IgG, IgA IgM, IgE and IgG+IgA+IgM antibodies were detected above the mean of normal controls. When these antibodies were classified based on the specialty of the examining physician, the % of patients with Silicone Antibodies were varied; general practice 51.6, Rheumatology 58.7, and Plastic Surgery 83.3, which may relate to the severeness of the disease. Being that a large % of patients demonstrated very high levels of Myelin Basic Protein Antibodies, possible cross reactive antibodies were sought. However, absorption of highly positive sera for Silicone Antibodies with MBP did not change the levels of Silicone Antibodies. On the other hand, Silicone-HSA was able to reduce the antibody values significantly. This reduction in antibody levels by Silicone is the best indication for the specificity of these antibodies. Moreover when data for silicone antibodies and MBP antibodies was analyzed in patients some with high and others with medium or low levels of silicone antibodies, MBP antibodies did not correspond to the silicone antibody levels. Similarly human serum albumin antibodies which was significantly higher in patients with silicone implants did not correlate with levels of silicone antibodies. These results indicate that immune reaction to silicone and different tissue antigens do occur and they are initiated through different mechanisms. And since predominant antibody class against silicone, MBP and HSA was IgM, clonal activation of IgM is possible which certainly warrants further investigation.
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PMID:Antibody to silicone and native macromolecules in women with silicone breast implants. 753 75

Fibromyalgia (FM) is a very frequent syndrome of unknown cause, characterized by generalized pain, fatigue and a number of tender points to palpation. Among the several etiopathogenic hypotheses discussed, the association of FM with some viral infections has been the object of multiple studies due to its relation and similarity with the chronic fatigue syndrome, acknowledges as being related, although not exclusively, with the chronic infection by the Epstein-Barr virus. Many individual descriptions of association between infection with the human parvovirus B19 and FM led us to carry out this study, comparing the serology for that virus in 52 patients with FM and 39 healthy controls. The titers of specific IgG anti-parvovirus B19 antibodies, indicating previous infection with that virus, were determined in all 91 individuals through ELISA method and at the same laboratory. Results revealed, though not significantly, a greater prevalence of positive titers, of which the mean was also higher, in patients than in controls. When comparing the women from both groups, this tendency was even less perceptible. These data imply that there is no etiologic association between infection with the human parvovirus B19 and FM.
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PMID:[Viral infection and fibromyalgia]. 794 34

The syndrome of fibromyalgia includes an unusually large and heterogeneous number of symptoms apart from the core features of generalized pain and widespread tenderness. Widespread tenderness is the only objective criterion. There is no evidence that fibromyalgia is a disease of the muscles or a rheumatic syndrome. The experience from an Australian epidemic of fibromyalgia indicates that there is an important psychosomatic component in the pathogenesis. Probably, fibromyalgia is not a disease entity; rather, the symptoms reflect difficulties in coping with various types of environmental stress. Secondary to this, sleep disturbances, fatigue, a low level of physical activity and poor physical fitness may develop, rendering the patients susceptible to muscle pain and tenderness elicited by sleep disturbances. A vicious circle may be responsible for the chronicity of the syndrome. Identification of environmental factors and early intervention should be given a high priority.
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PMID:Fibromyalgia: a clinical challenge. 812 May 14

Fibromyalgia syndrome (FMS) is characterised by generalised aches, pains, tender points, stiffness and fatigue, yet, despite increasing recognition of this syndrome as a clinical entity, its aetiology remains obscure. There is now increasing evidence that FMS represents a distinct rheumatic disorder and should not be regarded as a somatic illness secondary to psychiatric disorder.
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PMID:Fibromyalgia syndrome and psychiatric disorder. 852 24

Fever in elderly persons is only one clinical presentation that can be used to assist the clinician at suspecting a serious disease, such as an infection. Infections, like all other illnesses in the geriatric patient, may occur with a variety of nonspecific, atypical, nonclassic, and unusual manifestations. The clinician caring for elderly patients should be aware of these nonclassical presentations of infections in this age group. Unexplained change in functional capacity, worsening of mental status, weight loss or failure to thrive, weakness and fatigue, falls, and generalized pain are only some of the clues that may aid the clinician in considering infection in elderly persons. Key concepts of fever in older adults are: Fever generally indicates presence of serious infection, most often caused by bacteria. Fever may be absent in 20%-30% of elderly patients harboring a serious infection. Criteria for fever in elderly patients should also include an elevation of body temperature of at least 2 degrees F from baseline values. FUO in elderly persons is caused by infections (30%-35%), CTD (25%-30%), and malignancies (15%-20%) in the majority of cases.
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PMID:Fever in the elderly. 869 97


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