216 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0656 Rheumatology
A Proposed Simple 3-Variable Index for Identifi cation of Fibromyalgia, Analogous to Classifi cation Criteria for RA and SLE
Sang-Ah BAEK1, Sung-Hoon PARK1, Hwajeong LEE1, Seong-Kyu KIM1, Jung-Yoon CHOE1
Daegu Catholic University Medical Center, Korea1
Background: A cumulative index that includes various quantitative data has been useful in developing classifi cation criteria for various rheumatic diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). To analyze a simple 3-variable cumulative scale to identify patients with fi bromyalgia (FM), and distinguish them from patients with RA, SLE, and ankylosing spondylitis (AS) seen in a usual care setting in Korea.
Methods: All patients seen at a Korean rheumatology setting complete an MDHAQ/
RAPID3 (routine assessment of patient index data), which includes scores for physical function, visual analog scales (VAS) for pain, global status and fatigue, and a list of 60 symptoms as a checklist review of symptoms.
Results: Data were available concerning 32 patients with FM, 18 with AS, 17 with SLE and 277 with RA. Overall, 53% of patients with FM had scores of 2 or 3 of these cri- teria, compared to 5.5% with AS, 20.2% with RA and 5.8% with SLE (p =0.001). ROC area was 0.734, with standard error of 0.047 and 95% confi dence interval of 0.642- 0.826. A score of 2, which does not require any physician data, was associated with a positive likelihood ratio for FM of 2.9, sensitivity of 53.1 and specifi city of 81, with 79% correctly classifi ed.
Conclusions: A cumulative score analogous to classifi cation criteria for RA or SLE may be useful in helping to identify FM. A limitation of this study is that it did not identify patients with a diagnosis of RA, SLE,or AS who might also have FM, who may account for patients with infl ammatory rheumatic diseases and scores of 2 or 3 on the prelim- inary FM index.
PS 0657 Rheumatology
Clinical Correlation of Dense Speckled Patterned Anti- nuclear Antibody in Patients with Fibromyalgia
Hyun-Sook KIM1, KiSik KIM1, Bo Young KIM1 Soonchunhyang University Hospital Seoul, Korea1
Background: Fibromyalgia(FM) has been reported high prevalence of psychologic distress, comorbidity, infl ammatory autoimmune characteristics. Despite of its high prevalence, there is still no standardized laboratory test to suggest FMG or its severity.
Anti-dense fi ne speckled 70(Anti-DFS70) antibodies were initially identifi ed as an ANA from a patient with interstitial cystitis. Anti-DFS70 antibodies are found in 10% of healthy individuals, but only in a tiny population of with autoimmune rheumatic dis- ease.
Methods: It was based on the 39 FM patients over the age of 20 and for the disease comparison group of 17 systemic lupus erythematosus patients, and for the normal comparison group of 19 healthy individuals. The patients were checked BMI, disease duration, tender point, FIQ(Fibromyalgia Impact Questionnaire), VAS(Visual Analogue Scale), somatic symptom and anti-DFS70 antibodies. We used the American college of rheumatology 1990 classifi cation criteria of FM for diadnosis.
Results: In the group with FM, SLE and healthy indivisuals, anti-DFS70 antibodies were no signifi cant differences. The comparison between anti-DFS70 antibodies and age, height, weight, BMI, disease duration, tender point, FIQ(Fibromyalgia Impact Question- naire), VAS(Visual Analogue Scale), and somatic symptom which were evaluated. It shows the positive correlation between anti-DFS70 antibodies and VAS.
Conclusions: The anti-DFS70 antibodies were found to show no signifi cance differ- ence in the FM. But it shows the positive correlation with VAS. We need more large scaled study for further evaluation.
PS 0658 Rheumatology
Basal FMRI Differences Between Milnacipran Respond- ers and Non-Responder in Fibromyalgia
Seong-Ho KIM1, Sunggun LEE1 Inje University Haeundae Paik Hospital, Korea1
Background: There were comparison studies of regional cerebral blood fl ow between the responder group and the poor responder group to gabapentin and pregabalin in fi bromyalgia (FM). Other brain imaging studies, such as positron emission tomography and fMRI, were needed to clarify the pathophysiology of FM and the characteristics of responders to gabapentin or pregabalin treatment. We studied basal fMRI differences between milnacipran responders and non-responder in patients with FM.
Methods: This research included 20 FM patients and 11 normal persons. We selected only females who were age and education level-matched in both groups to avoid bias.
Tests were divided into clinical evaluation and fMRI imaging. Clinical evaluation was accomplished by principal investigator (rheumatology doctor) and included Korean fi - bromyalgia impact questionnaire (KFIQ), brief fatigue inventory (BFI), disease duration, widespread pain index (WPI), state anxiety inventory (SAI), and trait anxiety inventory (TAI). Changes in cerebral activation area were measured using BOLD contrast fMRI after application of both medium and high pressure stimuli to the left thumbnail bed.
Results: After treatment with milnacipran, 10 patients were considered ‘responders’, with decrease in pain of greater than 50% as evaluated by visual analogue scale. The remaining 10 patients were considered ‘poor responders’. The results showed that there were more increased activities in left insula and right inferior frontal gyrus of respond- er group in response to high pressure stimuli (p < 0.05) and in anterior cingulate and left cingulate gyrus of non-responder group in response to high pressure stimuli (p <
0.005).
Conclusions: These regions can be susceptible to pain perception in these milnacipran treated FM patients.
PS 0659 Rheumatology
How a Diagnosis of Viral Exathem Changed to Sweet Syndrome
Bashir Faisal BUTT1 Tan Tock Seng Hospital, Singapore1
30 yrs. old unmarried gentleman works as chef with no signifi cant past medical his- tory presented with 4 days history of oral ulcers and rash that was started from face than spread to arms and later to involve trunk and legs.fever only develops on the day of presentation.
No h/o recent sexual contact,travel history.
No red fl ags no h/o weight loss.
No family history of malignancy
On examination he was febrile,tachycardiac with stable vitals.
On examination he was having extensive cutaneous lesions it was tender with in- fl amed papeulse, plaques and nodules.also noted extensive oral ulcers over hard pal- ate, tongue.
Biopsy of the skin lesions shows netriphilic dermatosis (Sweet Syndrome) Patient was worked up to rule out hematological malignancy /solid organ malignancy Periperal blood smear does not shows any malignant cells
Pan CT scan also negative for malignancy Autoimmune workup also negative.
Patient was started on oral prednisolone and patient responded to treatment very well.
