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All Rheumatologic and Myofascial Pain Articles

with Joel M. Kremer, MD, Don L. Goldenberg, MD, and Liana Fraenkel, MD
As rheumatoid arthritis (RA) treatment continues to improve, more patients are experiencing disease remission, but even with new biologic agents, about 30% of patients do not respond well to them.
Metformin is a commonly used as a first-line agent for the treatment of type 2 diabetes mellitus. The agent acts through various mechanisms to accomplish blood glucose lowering. These mechanisms are broadly linked to effects on the cell cycle as well as signaling pathways, including m-TOR and AMPK.
Osteoarthritis and Chronic Knee Pain: A Patient Case A 62-year-old woman presents with a history of knee pain. She is overweight and has experienced progressive pain in the knees for the last several months. She describes her pain as a deep ache inside the knees and a grinding/sandpaper-like sensation with certain movements. Pain is localized, non-radiating and is intermittent.
Gout is a life-long, recurrent metabolic disorder considered to be type of arthritis, with both acute exacerbations and chronic joint damage and pain. Usually, the acute exacerbation of gout is associated with a rapid onset of severe pain and swelling in the joints.
with Melissa Laitner PhD, MPH, SWHR’s Director of Public Policy and Government Affairs
with Kevin Byram, MD Depression and anxiety are common comorbidities in people living with rheumatoid arthritis (RA), with perhaps as many as 16.8% of people with RA experiencing major depressive disorder (MDD) and 25 to 46% living with anxiety.1,2 In addition, depression in this population is associated with poorer outcomes.1
Osteoarthritis affects more than 300 million people worldwide, making it the most common form of arthritis. It is one of the leading causes of disability, specifically among older adults.
Introduction Infracalcaneal heel pain is a common podiatric condition presenting as plantar fasciitis, an acute inflammation of the plantar fascial band. Plantar fasciitis is caused by mechanical overload and excessive strain on the plantar fascia secondary to pronation, a high arched foot, and equinus.
As a practicing orthopaedic surgeon, I often see patients with knee osteoarthritis (OA) referred to me by their primary care physicians. Many patients think that seeing an orthopaedic surgeon is the end of the road and that they will immediately need to undergo surgery, which I understand can be scary for them.
The American College of Rheumatology (ACR) and Arthritis Foundation have issued a joint updated guideline emphasizing the importance of provider-patient collaboration and multimodal, integrative approaches for the management of osteoarthritis (OA) and OA-related joint pain.
Fibromyalgia syndrome is a common chronic pain disorder affecting 3% to 8% of the general population.
Hydroxychloroquine is considered to be an effective treatment option for systemic lupus erythematosus (SLE) to sustain disease remission and reduce the risk of irreversible renal damage.
Background Any person with a chronic medical condition may be considered at increased risk for developing complications from the novel coronavirus, SARS-CoV-2, or subsequentCOVID-19 illness.
The American College of Rheumatology (ACR) released its first-ever guideline on managing reproductive health in patients with rheumatic diseases, titled, 2020 Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases.1
New insights into psychiatric problems associated with rheumatoid arthritis provide new thought into a potential link.
In this September/October 2019 Ask the Expert, we examine the analgesic properties of the extract capsaicin for OA.
Current treatment options as well as emerging therapies for osteoarthritis, including NGF, TNF, and disease-modifying drugs.
A hormone produced during pregnancy might be an effective treatment for frozen shoulder and arthrofibrosis of other joints as well.
Beyond age and BMI, researchers obtained several key risk factors.
A preliminary study explores the potential link between fibromyalgia and impaired glucose metabolism.
The JAK1-selective inhibitor was found to have a solid safety profile.
A higher dose may be efficient to treat patients in this population
The nerve growth factor (NGF) inhibitor has been developed for osteoarthritis, chronic low back, and cancer pain.
A growing uncertainty continues to be made among pharmacological interventions for this chronic joint condition.
A combination of manual therapy and home-based exercise may be beneficial for patients with knee OA.
Results from the trial are expected in 2020.
Galectins could be biomarkers for future OA treatment approaches.
The potential use of pes anserine corticosteroid injections to treat chronic knee pain in overweight women with and without osteoarthritis.
Photobiomodulation, or low-level light therapy can be used to treat fibromyalgia syndrome. This case study reviews an at-home approach of using light therapy.
A common painkiller for arthritis and joint pain has been tied to increased risk of heart problems.
The BCG vaccine could become a huge part of future treatments for fibromyalgia and diabetes.
There is a notable lack of detailed knowledge on pain areas in axial spondyloarthritis, and their clinical relevance is largely unknown.
Researchers identified domains used to define acute events in other conditions to synthesize a definition of knee OA flares.
Results from a survey show a need for better collaboration and greater access to information for CRD patients considering pregnancy.
This CINGAL clinical trial is one of many to demonstrate the efficiency of the knee osteoarthritis treatment.
With Angus B. Worthing, MD, Don L. Goldenberg, MD, and Bharat Kumar, MD, FACP
A look at patient outcomes and chronic pain relief after using orthobiologic therapy.
How to effectively assess patients with rheumatoid arthritis or osteoarthritis, using case study examples.
Study on arthritis trends in the US turns up some unexpected results.
Zilretta is shown to reduce pain in patients with moderate to severe knee osteoarthritis.
Results show significant impact on signs, symptoms and radiographic progression compared to placebo.
LDN has shown great benefits to those with chronic pain conditions.
A new blood test can detect fibromyalgia with 94% accuracy.
A look at the mechanisms responsible for psoriatic arthritis as well as standards of care including new and emerging treatments.
Primary care providers need to work closely with the rheumatologist to identify and manage comorbid conditions with special attention to cardiovascular risk, depression, and osteoporosis.
Myofascial pain is a common yet underdiagnosed pain syndrome that may present with symptoms such as low back pain, and will respond best to an integrated, multifaceted approach to treatment.
Patients with rheumatoid arthritis should be evaluated for signs of central sensitization to better define a treatment plan.
In this PPM commentary, a new study is assessed that offers the first evidence linking a certain type of gum bacteria to rheumatoid arthritis (RA).
Clinicians can improve their ability to distinguish between overlapping symptoms of pathologic fatigue, mood/depression, and pain in 3 syndromes: fibromyalgia, chronic fatigue, and chronic fatigue syndrome.
Genetic factors play a role in the development of fibromyalgia and chronic widespread pain. Learn what genes may influence a person's perception and sensitivity to pain.
Learn how the American Academy of Orthopaedic Surgeons (AAOS) and the Department of Veterans Affairs (VA/DoD) recommendations for nonsurgical treatments for osteoarthritis stack up.
Learn how rapid developments in the field of pain neurobiology is shedding light on the causes of osteoarthritis pain.
Dr. Ajay Wasan speaks with Practical Pain Management to discuss the increased risk for depression, anxiety, pain catastrophizing, and sleep problems among patients with osteoarthritis.
Patients often rank their osteoarthritis as more severe than physicians' assessment. Find out why.
Patients with osteoarthritis are affected by both peripheral structural and joint changes, but also be central pain sensitization.
Philip J. Mease, MD, and Elaine Husni, MD, MPH, explore the incidence, diagnosis, and established and emerging treatments of psoriatic arthritis, a painful autoimmune arthritis.
Learn more about polymyalgia rheumatica, the second most common form of autoimmune rheumatic disease.
Practical Pain Management's Editorial Board lend their Tips for the Management of Osteoarthritis. Learn what the expert do to manage this common condition.
Practical guide to osteoarthritis (OA) of the spine, hand, hip, knee, and ankle, written by experts in the field. Learn more about the symptoms and diagnosis of OA.
Inflammation, wear and tear, aging—all these are common causes of osteoarthritis, one of the most common chronic pain conditions seen today. Forest Tennant, MD, DrPH, introduces our Practical Guide to Osteoarthrtis.
Learn more about the differential diagnosis of fibromyalgia and myofascial pain.
Question: A 55 year-old woman with lupus was taking pregabalin (Lyrica) for 2-years, then developed suicidal ideation. Could this be related to the pregabalin, a drug-drug interaction, or her disease?   
Although patients with psoriasis have a relatively high risk of psoriatic arthritis, they often go undiagnosed, leaving them at risk for progressive joint damage and disability.
Although juvenile fibromyalgia (JFM) is one of the most understudied pain syndromes in children, in recent years more has come to light about the clinical characteristics, long-term outcomes, and effective treatments for managing the many symptoms of JFM.
Fibromyalgia (FM) is a syndrome manifested by widespread pain, stiffness, fatigue, cognitive difficulties (“fibrofog”), and non-refreshing sleep.
Recently, the Centers for Disease Control and Prevention (CDC) dramatically increased the estimate of the annual number of new cases of Lyme Disease (LD) in the United States from 30,000 to 300,000, with 14 states accounting for over 96% of cases reported.1 In the United States, Lyme disease is most common in northeastern states, from Virginia to Maine; Upper Midwest states, mostly W
Juvenile idiopathic arthritis is one of the most common rheumatologic conditions seen in children. Thankfully, there are treatments that can help minimize symptoms and aid in diminishing the potential long-term sequelae of the disease. This article reviews the pharmacological options to control pain and inflammation.
Read about new research on the effectiveness of massage for knee osteoarthritis.
Review of current treatments for hip osteoarthritis.
Pain research updates from the December 2012 issue of Practical Pain Management.
This article reviews pain management methods to determine which method is most efficacious in reducing postoperative pain in patients undergoing elective lower extremity arthroplasty.
The high prevalence of painful diseases that occur below the knee clearly calls on all of us to invite the podiatrists in our communities to be members of our teams.
Physicians should consider platelet rich plasma prolotherapy for patients with tendinopathies or rotator cuff tears before any surgical interventions.
Gary W. Jay, MD, FAAPM knew Janet Travell, MD, the physician who treated John F. Kennedy's pain. He comments on her pain management plan.
John F. Kennedy’s medical history highlights how a genetic autoimmune disorder became centralized intractable pain.
Three cases illustrate the difficulties that may be seen when diagnosing, treating, and caring for patients with RA.
Myofascial pain is now estimated to affect approximately 44 million Americans. Article explores the many root causes of the condition.
From oral and topical medications to lifestyle intervention, this article provides tips for the treatment of knee osteoarthritis.
In-depth fibromyalgia article. It reviews the literature and examines the etiology, comorbid symptoms and disorders, and non-pharmacological treatment options for fibromyalgia.
Patients who present with general ankle pain need to be closely worked up for accurate diagnosis because “ankle” as a term is a relatively unspecific anatomical term. Details on diagnosis and treatments of this type of degenerative arthritis.
Recognizing an increasing focus on fibromyalgia and a developing need for information, the authors conducted a survey of providers, primarily from Vermont, with the goal of evaluating their awareness and treatment of fibromyalgia.
Does having gout increase the risk of heart failure? A team of researchers investigates this question.
Research has shown that some rare forms of gout are genetic, but is this true for all gout cases? In a new twin study, researchers investigated whether gout is mostly genetic or if environmental factors play a role, too.
Myofascial pain syndrome is a common musculoskeletal disorder caused by myofascial trigger points. Article covers diagnosis and management of myofascial pain syndrome.
Article provides practical information on treating the pain of lupus. Covers medications, exercise, sleep, and more.
It has long been recognized that the optimal management of fibromyalgia (FM) syndrome is multimodal and multispecialty—multimodal in all patients and invoking multispecialty consultation when indicated. Article review fibromyalgia diagnosis and treatments.
Juvenile fibromyalgia (JFM) is a chronic condition of widespread musculoskeletal pain, fatigue, and nonrestorative sleep. The prevalence of JFM among school-aged children is approximately 1% to 6%. Learn more about JFM in this pain management-focused article
Fibromyalgia (FM) syndrome is a common clinical disorder that is characterized by chronic widespread pain. Although pain is the most prominent symptom, there are many other manifestations that mix and match as they contribute importantly to the morbidity of FM. Article reviews practical tips for diagnosis and treatment.
Although some of the pathophysiology of lupus is known, it is clear that there remains much that is unknown. This entity, also known as the great imitator, can be difficult to diagnose because it shares symptoms with many other disorders.
Plantar fasciitis is one of the most common causes of foot pain presenting to the family practitioner, podiatrist, and orthopedist. Learn how to effectively treat this condition.
Intriguing case of a 54-year-old woman with fibromyalgia and sleep apnea.
Article address the overlap of sleep apnea and fibromyalgia. How do you effectively treat both?
Osteoarthritis (OA) is the most significant cause of musculoskeletal morbidity in the elderly, and the hand is the most frequently affected area of the body. Article covers hand osteoarthritis diagnosis and management, including medications.
Fibromyalgia (FM) is a complex disorder that is difficult to diagnose and treat. Article addresses fibromyalgia diagnosis and treatments.
Cranial electrotherapy stimulation (CES) can be used to treat fibromyalgia. Includes cases to review.
A pilot study of chronic pain patients with fibromyalgia demonstrated a positive response to topical herbal agents. Which herbs did they respond best to?
Article highlights pain management options for alleviating pain and increasing mobility for patients with knee osteoarthritis.
While few therapies have proven effective in the past, recent pharmacologic advances provide new hope for this difficult-to-treat disorder.
A survey of current fibromyalgia treatment approaches together with an overview and case studies of a new "old" treatment approach (cannabis).
This article explains how new therapies, combining complementary/alternative medicine (CAM) approaches, and pharmacotherapy, provide options in treating chronic musculoskeletal pain.
A practical approach to the differential diagnosis and treatment of fibromyalgia and myofascial pain syndromes.
Basics of pelvic floor tension myalgia is discussed. Includes discussion of multidisciplinary treatments for optimal outcomes for pelvic floor tension myalgia.
Presenting as toothache, earache, headache, difficulty opening the jaw, or simply jaw pain, osteoarthiritis of the temporomandibular joint presents challenges in diagnosis and management.
This article is part one of a series of articles on the neural plasticity model of fibromyalgia theory, assessment, and treatment. It presents the basis for understanding fibromyalgia theories.
This article discusses the neural plasticity model of fibromyalgia theory, assessment, and treatment. Article also reviews EEG neurotherapy as a direct treatment technique and also discusses outcomes measurements for fibromyalgia.
This article is the third installment of a series of articles that discusses the neural plasticity model of fibromyalgia theory, assessment, and treatment. Also included is a discussion of sEMG and other treatment options for fibromyalgia.
When it comes to treating myofascial pain syndrome patients, multidisciplinary approaches should be used. Article addresses the various treatment options for myofascial pain syndrome patients.
This article is part two of a series of articles on the neural plasticity model of fibromyalgia theory, assessment, and treatment. Article also discusses sEMG and EEG as assessment techniques for fibromyalgia.
Part four of a series reviews fibromyalgia and somatoform pain disorder tests and treatment options.
Dynamic functional capacity and movement assessment via sEMG is a viable tool in treating patients with FMS.
The controversies, misunderstandings, and lack of knowledge surrounding fibromyalgia and chronic widespread pain and the absolute mess the diagnostic label of “fibromyalgia” has created have been well reviewed.
To prevent further joint destruction and improve current joint and muscle capabilities in patients with inflammatory arthritis, physicians can refer patients for physical and occupational therapy.
Chronic heel pain can be extremely complex and debilitating. Very subtle, and some not so subtle, lower extremity biomechanical compensations frequently occur resulting in symptom complexes that can be extensive and difficult to treat and not isolated to the heel. These multi-factorial pain syndromes can be confusing to the practitioner in the initial diagnosis and work up of the patient.
The ankle joint consists of many bones, ligaments and tendons that all play an integral part in maintaining its stability. All these function to allow a multitude of movements within the ankle joint. Consequently, ankle instability can result if any of the related bones, tendons, or ligaments are compromised. The tibia and fibula are intimately joined by the interosseous membranes.
Article provides a case report of chronic unilateral pain from a sports-related groin injury and suggests that more effective screening tools are needed for this condition.
Learn about traditional Chinese medicine, which has a number of modalities that may help treat primary and secondary symptoms in patients who have fibromyalgia.
Article discusses the criteria for diagnosing fibromyalgia. The American College of Rheumatology updated its fibromyalgia diagnostic criteria in May 2010.
The osteopathic approach to the patient with fibromyalgia is characterized by a comprehensive, functional, health-oriented, patient-centered management plan that restores the patient’s adaptive potential.
Applying laser therapy to the arthritis patient by using a combination of application techniques can provide considerable relief in many cases.
Shingles pain and lesions resolved in 48 hours after treatment with frequency-specific microcurrent. Learn about this non-pharmacologic treatment of shingles.
Inguinodynia as a hernia post-operative chronic pain syndrome may occur due to an assortment of causes including mesh shrinkage, inflammation, scarification, as well as surgical technique.
The Fibromatome Map bridges the gap between recent pharmaceutical discoveries of widespread pain due to hyperactive nerves and interventional spine medicine by effectively identifying and treating specific nerve roots that cause widespread pain.
The biopsychosocial approach offers a method for accurate assessment of patients at risk for poor post-surgical outcomes.
Therapeutic low-level laser has good pain relieving and anti-inflammatory effects and has been shown to increase the quality of life in Fibromyalgia patients.
Acupuncture may be a useful intervention to manage chronic pain of fibromyalgia. Learn about the efficacy and effectiveness of this complementary treatment for firbromyalgia.
Article highlights the basics of milnacipran, a treatment option for fibromyalgia. Learn how milnacipran works to relieve fibromyalgia-related pain and other fibromyalgia symptoms.
In this retrospective pilot study at an Outpatient Charity Clinic in Rural Illinois, Hackett-Hemwall dextrose prolotherapy helped reduce pain and stiffness and clinically improved the quality of life in people with unresolved elbow pain.
Growth hormone deficiency was found in many fibromyalgia patients in a community rheumatology practice. How does that potentially affect fibromyalgia treatment and general understanding of fibromyalgia?
A proposed framework for sub-types within the greater "fibromyalgia construct"addresses the heterogeneous fibromyalgia population and moves toward a rational, mechanistic approach to therapy.
Article discusses the unraveling of the mysteries of myofascial pain syndromes. The results of recent studies tend to suggest that magnetic resonance elastrography technology can detect and quantify deep taut bands of soft tissue and accurately distinguish a symptomatic or pathologic taut band vs a more normal region of tightness.
Read about using duloxetine in the treatment of fibromyalgia. In got FDA approval in 2008 to be used as a fibromyalgia medication.
In late October 2005, the National Fibromyalgia Association (NFA), a non-profit patient advocacy organization, posted an internet survey developed by a distinguished task force of experts who were
A review of the evidence that fibromyalgia is associated with a disruption of dopaminergic neurotransmission together with a discussion of its therapeutic implications.
The National Fibromyalgia Association offers two new healthcare professional programs.
In this article, learn more about prolotherapy, a method of injection treatment designed to stimulate healing.
Guidelines for Beneficial Group Exercise for Fibromyalgia
Sleep Disturbances in Fibromyalgia
Fibromyalgia in Older Adults
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