Fifteen children (16 years and younger, 10 females, 5 males, mean age 13 years) with juvenile primary fibromyalgia syndrome (JPFS) were seen in a private rheumatology practice over two years. This represented 45 percent of the total number of pediatric rheumatology patients. Symptoms included polymyalgias, polyarthralgias, nonrestorative sleep, difficulty concentrating in school and fatigue. Examination revealed typical tender points, absence of joint swelling, synovitis or nodules and absence of neurological findings. Dolorimetry was abnormal and standard laboratory tests were normal. Most of these patients (67 percent) had seen three or more doctors prior to their rheumatological evaluation and not (60 percent) were told they had juvenile chronic arthritis. Other diagnoses offered were "growing pains" (20 percent), hysteria (7 percent) and psychological problems (7 percent). None of the JPFS patients responded to salicylate or other anti-inflammatory medication. Most (73 percent) responded to cyclobenzaprine, mean dose 12.75 mg. (range 5-25 mg. qhs). JPFS is a very common pediatric rheumatologic problem and is confused with other disorders. Reassurance is very important in the therapy since many parents are fearful that their children may have a potentially crippling disorder. Medication, especially with tricyclics, moderate exercise and proper sleep are also mainstays of therapy.

Adolescent↗

PubMed1990

Normal pressure hydrocephalus in a patient with systemic lupus erythematosus.

We describe a patient who had concomitant systemic lupus erythematosus (SLE) and a normal pressure hydrocephalus. She improved only after appropriate therapy for each. Although 6 patients with arthritis and normal pressure hydrocephalus have been described, this is the first report of it occurring in a patient with SLE. It has been emphasized that normal pressure hydrocephalus can easily be overlooked in elderly patients with arthritic conditions. Since neuropsychiatric symptoms are likelier to occur in patients with SLE than in other rheumatologic conditions, the diagnosis of normal pressure hydrocephalus may be delayed or overlooked. Because normal pressure hydrocephalus is a potentially reversible cause of neurologic dysfunction, it should be considered in appropriate populations.

Aged↗

PubMed1990

This is still the United States of America.

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Humans↗

PubMed1990

Clinical experiences with post-traumatic fibromyalgia syndrome.

Fibromyalgia syndrome (FS) is a musculoskeletal problem that has become more and more widely recognized. There are three types: primary (PFS idiopathic), secondary (associated with another disorder), and post-traumatic (PTFS). The latter condition, PTFS, is especially intriguing since quite often litigation is involved, and doubt is cast as to whether the patient is actually suffering. Accusations of malingering have been made. A retrospective chart review of 14 PTFS patients was made in an effort to ascertain the likelihood of malingering. Over the past two years, 14 patients (three male, 11 female) were treated for PTFS. The mean age was 37 years for both men and women. All had classic PTFS with a chronic musculoskeletal problem that started immediately after a traumatic event, classic myofascial tender points, poor sleep, and normal standard laboratory tests. Twenty-three per cent went to trial; 77 per cent settled out of court. All were given a monetary award. The vast majority (77 per cent) returned to a rheumatologist for continued treatment, suggesting that patients who meet strict FS criteria are not malingering and are indeed in need of medical help.

Adult↗

PubMed1989

Evaluation of the patient with suspected malabsorption.

The term "malabsorption" is generally used to indicate any defect in absorption; strictly speaking, however, it is a defect in the mucosal phase of absorption. Defects in the intraluminal phase are termed "maldigestion." This distinction is essential when considering the pathophysiology to apply diagnostic tests in the evaluation of malabsorption. This article first discusses the signs and symptoms associated with malabsorption, the disorders associated with malabsorption, normal intestinal absorption, and, finally, the diagnostic test used to investigate absorption.

Biopsy↗

PubMed1989

Sjogren's syndrome: implications for the primary care physician.

Sjogren's syndrome (SS) is a common immunologically-mediated disorder that will afflict a great proportion of our population in future years. The primary care physician undoubtedly will be confronted with such patients, many of whom will have complaints and findings not generally believed to be due to SS. In this communication, case reports of four patients with SS as well as a literature review are presented. Two patients had presentations that were classic for SS; however, the other two were diagnostic challenges. Emphasis is placed on the atypical and unusual way SS can present so that the primary care physician can more easily make the diagnosis and initiate therapy.

Female↗

PubMed1988

The fibromyalgia syndrome. It's the real thing.

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Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1988

Bleeding colonic ulcers secondary to atheromatous microemboli after left heart catheterization.

Atheromicroembolism after aortic or cardiac catheterization is frequently found at autopsy but rarely recognized in life, perhaps because many cases are asymptomatic. We report two patients who, after left heart catheterization, developed gastrointestinal hemorrhage from a solitary colonic ulcer caused by occlusive atheromicroemboli in submucosal vessels. We briefly review the spectrum and pathogenesis of atheromicroembolic injury to the gastrointestinal tract. Atheromicroemboli, which occlude vessels too small to be visualized by angiography, should be considered in the differential diagnosis of gastrointestinal bleeding in patients who have undergone aortic instrumentation.

Aged↗

PubMed1988

Fibrositis in men.

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Adult↗