Current Rheumatology Reviews - Volume 12, Issue 2, 2016

Restless legs syndrome (RLS) or Willis-Ekbom Disease is a common, but frequently under- recognized and misdiagnosed condition seen in many subspecialty practices including neurology, sleep medicine, primary care and rheumatology. Periodic limb movements are a frequent co-morbid diagnosis in RLS. Despite prior beliefs that the condition was “benign”, it has been demonstrated to have a considerable impact on sufferers quality of life, physically and psychologically, as well as socially. This chapter is meant as a comprehensive review of RLS encompassing epidemiology, pathophysiology, diagnosis, and treatment considerations.

Migraine is a very common neurologic disorder, characterized by recurrent attacks of severe headache, autonomic nervous system dysfunction and in some patients by an aura. Background: Migraine is a very common neurologic disorder of neuro-vascular origin, being amongst the 20 most disabling diseases. Migraine attacks are characterized by severe headache, associated to autonomic nervous system dysfunction and in some patients by aura. Pathophysiology and Role of Central Sensitization: Abnormal neuronal excitability may subtend altered processing of sensory stimuli, leading to cortical spreading depression and trigeminal activation. A dysfunction of pain modulation enhances central sensitization phenomena, contributing to acute allodynia and headache persistence. The peculiarity of migraine pain facilitates the use of analgesics, and causes an adjunctive invalidating tendency toward drug over-use. Comorbidity: Chronic migraine patients are frequently affected by diffuse pain, framed in fibromyalgia diagnosis. This comorbidity seems to be supported by common pathophysiological mechanisms. It may aggravate migraine invalidity being worth of consideration for therapeutic management. Migraine Management: Acute and preventive treatments need to be tailored to single cases. Main comorbidity and factors facilitating central sensitization should be taken into account. The management of migraine patients should include a link between headache centers and general practitioner, in order to provide for a better patient information and treatment just at the onset of the disease. Conclusions: Despite its high epidemiologic impact, migraine is frequently underestimated and destined to evolve into chronic form and drugs abuse. A more focused attention to factors facilitating central sensitization and invalidating comorbidities, should reduce the global burden of the disease. Key words: migraine, pathophysiology, central sensitization, fibromyalgia comorbidity, acute and preventive therapy, patients – centered approach.

Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale management. This primary headache remains a challenge into its management for clinicians. This review aims to provide an updated and critical discussion on what is currently known and supported by scientific evidence about TTH and which gaps there still may be in our understanding of this condition. Clinical features of TTH resemble common manifestations of muscle referred pain. Episodic TTH may evolve into the chronic form by different aspects and several triggers may be involved at the same time. Both peripheral and central sensitization mechanisms seem to be clearly involved in this process. Individuals with episodic TTH exhibit higher levels of peripheral excitability whereas chronic TTH clearly show central sensitization manifestations. The role of associated muscle hyperalgesia seems to be important factors in TTH. Therapeutic management of individuals with TTH should be multimodal including appropriate use of pharmacological and non-pharmacological interventions to reduce the nociceptive peripheral drive to the central nervous system. If properly applied, treatment may not only reduce the number of TTH attacks but may also prevent or delay the transition from episodic to chronic TTH. Scientific evidence of pharmacological and nonpharmacological treatment is discussed in this review.

The aim of this narrative review of the epidemiology of central sensitivity syndromes is to provide a summary of the role of early life adversity and psychosocial / psychological factors, in the epidemiology of six main syndromes: (i) fibromyalgia / chronic widespread pain; (ii) headache / migraine; (iii) irritable bowel syndrome; (iv) temporomandibular joint disorder; (v) interstitial cystitis; and (vi) endometriosis / vulvodynia / chronic pelvic pain. The occurrence of each of the above syndromes vary between each other, and between studies. Prevalence ranges from interstitial cystitis, with a prevalence of approximately 14.5 per 100,000, to headache, with some estimates of lifetime prevalence to be around 66%. Precise risk estimates vary between studies, conditions, and exposures, although there is consistent evidence to suggest an association between early life adversity and central sensitivity syndromes (based on the six syndromes under investigation). In further support of this, a number of studies have also demonstrated dose-risk associations. There is also considerable consistency in the literature to suggest a strong association between negative psychological and psychosocial factors, and the occurrence of central sensitivity syndromes and, again, there is some evidence of a dose-risk relationship. The majority of studies in this field are cross-sectional or retrospective in design, and caution is advised when interpreting results. It is possible – indeed there is some evidence – that some findings may be subject to recall bias, and reverse causation is also a potential concern. However, there are also a number of prospective studies which provide more robust evidence.

Systemic Lupus Erythematosus is considered a prototype of an autoimmune disorder. The greatly compromise immune system reflects in a global loss of self-tolerance and an array of autoantibodies which are the hallmark of the disease. Diagnosis and clinical management are a challenge to physicians owing its complex clinical course. Specific correlation between immunodysregulation and the clinical manifestations have been studied and we intended in this paper to review recent studies, highlighting new discoveries in this matter.

Objective: We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. Materials and Methods: This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. Results: A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). The logistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p = 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. Conclusion: Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation between PPI use and low bone mineral density and/or the length of PPI use.