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 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A multidisciplinary referral center was established at a university hospital for prospectively assessing patients with possible Lyme disease. Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public. Sixty-five patients were referred for suspected Lyme borreliosis. Detailed histories were obtained and physical examinations were performed; patients were investigated aggressively in accordance with their symptom complexes. Strict diagnostic criteria consistent with published standards were applied. Only two of the 65 patients were judged to have probable Lyme disease. Definite major alternate diagnoses were made for 50 patients (77%); firm medical diagnoses (11 dermatologic, 9 rheumatologic, 9 infectious disease, 6 gastrointestinal, 4 neurological, and 2 miscellaneous) were made for 41 patients (63%); and major psychiatric diagnoses were made for 9 patients (14%). Probable diagnoses of chronic fatigue syndrome and fibromyalgia were made for 11 patients (17%). The conditions of four patients (6%) were undiagnosed. A referral center for patients with suspected Lyme disease can be useful even in an area of nonendemicity, and careful clinical assessment will reveal treatable alternate diagnoses for many patients with suspected Lyme disease.
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PMID:Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. 851 65

Historically, arthritis was the main symptom which led to the description of the disease called Lyme borreliosis. However, a relatively high awareness of doctors and patients of tick-borne diseases seems to cause a trend to frequently diagnose this antibiotic-sensitive disease. A case can be defined as borreliosis only if either the typical erythema migrans is reliably identified by a physician or if a characteristic late manifestation of Lyme disease is accompanied by unequivocal serological and/or bacteriological evidence of Borrelia infection. Within the musculoskeletal system, the only reliably characteristic symptom is true synovitis, as defined by the palpable swelling of a joint. Mere joint pain or the subjective pain syndrome of fibromyalgia do not constitute a defining symptom for borreliosis. An evaluation of the frequency of Borrelia-associated arthritis in our Viennese rheumatology outpatient clinic revealed only six well-defined cases among 1,673 subsequent referrals. Based on "serological" suspicion, the question had been asked about possible borreliosis in 87 of these patients. In order to avoid unnecessary anxiety about possible long-term complications of Lyme disease among (actually misdiagnosed) patients, the diagnosis of Lyme arthritis should only be made according to the stringent criteria mentioned above. The antibiotic treatment, which is given to many questionable cases of borreliosis ex iuvantibus, although possibly of benefit to a few cases of otherwise undiagnosed reactive arthritis due to infections with microbes other than Borrelia burgdorferi, has to be termed irrational.
Infection
PMID:A "minority" opinion about the diagnosis and treatment of Lyme arthritis. 885 81

In the second part of their article on the emerging field of neuroimmunology, the authors present an overview of the role of neuroimmune mechanisms in defence against infectious diseases and in immune disorders. During acute febrile illness, immune-derived cytokines initiate an acute phase response, which is characterized by fever, inactivity, fatigue, anorexia and catabolism. Profound neuroendocrine and metabolic changes take place: acute phase proteins are produced in the liver, bone marrow function and the metabolic activity of leukocytes are greatly increased, and specific immune reactivity is suppressed. Defects in regulatory processes, which are fundamental to immune disorders and inflammatory diseases, may lie in the immune system, the neuro endocrine system or both. Defects in the hypothalamus-pituitary-adrenal axis have been observed in autoimmune and rheumatic diseases, chronic inflammatory disease, chronic fatigue syndrome and fibromyalgia. Prolactin levels are often elevated in patients with systemic lupus erythematosus and other autoimmune diseases, whereas the bioactivity of prolactin is decreased in patients with rheumatoid arthritis. Levels of sex hormones and thyroid hormone are decreased during severe inflammatory disease. Defective neural regulation of inflammation likely plays a pathogenic role in allergy and asthma, in the symmetrical form of rheumatoid arthritis and in gastrointestinal inflammatory disease. A better understanding of neuroimmunoregulation holds the promise of new approaches to the treatment of immune and inflammatory diseases with the use of hormones, neurotransmitters, neuropeptides and drugs that modulate these newly recognized immune regulators.
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PMID:Neuroimmune mechanisms in health and disease: 2. Disease. 887 36

HCV-infection is an important infectious disease in rheumatology. It is the cause of mixed cryoglobulinemia and other rheumatic manifestations develop frequently during HCV-infection. These comprise: Sicca-syndrome, thromboembolic events associated with anti-cardiolipin antibodies and fibromyalgia. Also associated with HCV-infection is a non-erosive polyarthritis. This synovitis often fulfills the ACR-criteria for rheumatoid arthritis, but the disease course is different with frequent remissions and non-erosive joint involvement. The following autoantibodies are associated with HCV-infection: Cryoglobulins, rheumatoid factor, antinuclear antibodies (ANA), antismooth muscle antibodies (SMA), anti-phospholipid-antibodies and anti-thyroid-antibodies. In HCV-associated sicca-syndrom, antibodies against Ro (SSA) and La (SSB) are not detected. The course of HCV-infection is often occult, without elevation of liver enzymes. We summarize the clinical and serological signs and symptoms when HCV-infection should be suspected and when HCV-testing should be performed in a rheumatological setting. The identification of HCV-infection in rheumatic patients is important to minimize the risk of aggravating hepatitis by prescription of hepatotoxic drugs and because of the availability of alpha-interferon as a potential virus eradicating agent.
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PMID:[Hepatitis C virus in rheumatic diseases]. 946 81

The aims of this study were: (1) to compare two groups of patients with chronic pain conditions (work-related muscular pain, mainly low back pain, and fibromyalgia) in general coping and pain-specific coping; (2) to examine the relationship between general and pain-specific coping and, (3) to examine the influence of state-trait anxiety on general and pain-specific coping. The sample included 80 individuals (range=19-70 years; mean=47; SD=9.9), who were patients at two pain management clinics for examination of their physical and psychosocial health conditions and consideration on disability pension. The patients were asked to respond to theStrategies to Handle Stress Questionnaire, theCoping Strategies Questionnaireand theState-Trait Anxiety Inventory. Patients with fibromyalgia scored significantly higher on T-anxiety and adopted <<problem-solving>> (p<0.01) and <<catharsis>> (p<0.05) less often and <<religion>> more often (p<0.01) than patients with work-related muscular pain in coping with stressful situations in general. No differences were revealed in pain-related coping between the groups. T-anxiety was positively correlated to pain-related <<catastrophizing>> (p<0.001) and negatively to abilities to control and reduce pain (p<0.05 andp<0.01, respectively). The correlation between general and pain-specific coping was weak to moderate. In conclusion, patients with fibromyalgia scored significantly higher on trait-anxiety and seem to interpret stressful situations as more threatening than patients with work-related muscular pain. Anxiety seems to be of central importance for coping with chronic pain. Anxiety-prone patients with fibromyalgia might benefit from psychological support in the process of coping with pain. Copyright 1998 The British Infection Society. All rights reserved.
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PMID:Anxiety and coping in patients with chronic work-related muscular pain and patients with fibromyalgia. 1070 Mar 26

The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans.
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PMID:Neuroimmunologic aspects of sleep and sleep loss. 1160 24

Infection with B. burgdorferi can cause a large joint inflammatory arthritis in patients who have not been treated for early Lyme disease; the knee is the most common joint affected. The diagnosis depends on a history of known exposure to the spirochete, characteristic clinical features, and serologic studies (ELISA and Western blot) confirming exposure to the spirochete. In most patients, antibiotic therapy is curative, but in a smaller percentage of patients, the presence of the HLA-DR beta 1*0401 haplotype can trigger treatment-resistant arthritis, in which antibiotic therapy is ineffective; in these instances, remittive agents, such as hydroxychloroquine and methotrexate, are indicated. Arthroscopic synovectomy may be considered when antibiotic therapy is not curative. Fibromyalgia can follow infection with B. burgdorferi but is unresponsive to antibiotic therapy; it is treated with tricyclic antidepressants and an exercise program. Lyme arthritis is the only chronic inflammatory arthritis in which the specific cause is known and can be cured. As such, it serves as an excellent model with which to study the pathogenesis of more common inflammatory arthritides, such as rheumatoid arthritis.
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PMID:Lyme arthritis. 1198 3

Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain and tender points, which have been present for more than 3 months. Many patients with systemic illnesses can have diffuse pain similar to that found in fibromyalgia, including rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and joint hypermobility. Osteomalacia and thyroid disease are also in the differential diagnosis of diffuse pain and are imminently treatable. In addition, there has been interest throughout the past 10 years in infectious diseases including hepatitis C, Lyme disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger fibromyalgia. This paper provides a framework to use when identifying these diseases as part of the evaluation of a patient with chronic widespread musculoskeletal pain.
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PMID:Rheumatic mimics and selected triggers of fibromyalgia. 1209 63

Lyme disease is a relatively well-described infectious disease with multisystem manifestations. Because of confusion over conflicting reports, anxiety related to vulnerability to disease, and sensationalized and inaccurate lay media coverage, a new syndrome, "chronic Lyme disease," has become established. Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings. We describe factors involved in the psychopathogenesis of chronic Lyme disease and focus on the confusion and insecurity these patients feel, which gives rise to an inability to adequately formulate and articulate their health concerns and to deal adequately with their medical needs, a state of disorganization termed aporia.
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PMID:Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome. 1257 18

Whether one is male or female is one of the most important determinants of human health. While males are more susceptible to cardiovascular and infectious disease, they are outnumbered by women for many autoimmune disorders, fibromyalgia and chronic pain. Recently, individual differences in the physiological response to stress have emerged as a potentially important risk factor for these disorders. This raises the possibility that sex differences in prevalence of disease could at least in part be explained by sex differences in the nature of the physiological response to stress. In a psychophysiological laboratory, the autonomic nervous system response can be provoked by many different stressors including physical, mental and psychosocial tasks, while the hypothalamic-pituitary-adrenal axis (HPAA) response seems to be more specific to a psychosocial challenge incorporating ego involvement. The responses of both systems to different psychosocial challenges have been subject to extensive research, although in respect of sex differences the HPAA response has probably been more systematically studied. In this review, we focus on sex differences in HPAA and autonomic nervous system responses to acute psychosocial stress. Although some differences are dependent on the stressor used, the responses of both systems show marked and consistent differences according to sex, with the phase of the menstrual cycle, menopausal status and pregnancy having marked effects. Between puberty and menopause, adult women usually show lower HPAA and autonomic responses than men of same age. However, the HPAA response is higher in the luteal phase, when for example post stress free cortisol levels approach those of men. After menopause, there is an increase in sympathoadrenal responsiveness, which is attenuated during oral hormone replacement therapy, with most evidence suggesting that HPAA activity shows the same trends. Interestingly, pregnancy is associated with an attenuated response of the sympathoadrenal and HPAA systems at least as assessed by biochemical stimulation. It is likely that these sex differences in autonomic function are a result of estrogen exposure which attenuates sympathoadrenal responsiveness. The HPAA is however somewhat more complex and evidence now suggests the influence of other modifiers such as arginine vasopressin (AVP) and the regulation of circulating cortisol bioavailability by corticosteroid-binding globulin (CBG). The pronounced and multi-faceted sex differences in stress responsiveness suggest that they are a product of a strong evolutionary pressure. We hypothesise that this has to a great deal been driven by the need to protect the fetus from the adverse effects of maternal stress responses, in particular excess glucocorticoid exposure. Studying this hypothesis may have a fundamental impact on our understanding about how adult health is set during early life and how adult disease could be prevented in men and women.
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PMID:The effects of sex and hormonal status on the physiological response to acute psychosocial stress. 1613 59


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