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Background The impact of delayed diagnosis (DD) on fibromyalgia (FM) patients’ symptomatology and disease outcome has not yet been systematically studied. Objective To analyze the predictors of DD and the influence of DD on FM aggravation and disease evaluation measures. Methods 370 FM patients were interviewed prospectively for this study. The following information was obtained: DD, widespread pain index (WPI), symptom severity scale (SSS), polysymptomatic distress scale (PDS) scale (SSS + WPI), and tender points. We identified three groups of patients: early diagnosis (ED: 2 years; 83 patients), late diagnosis (LD: > 2–7 years; 198 patients), and very late diagnosis (VLD: > 7 years; 89 patients). Results The patients’ average age was 33.9 (9.8) years, and 79% were female. The SSS, PDS, and tender point means were 7.8 (1.6), 16.46 (4.1), and 14.31 (2.3), respectively. The correlation between DD and SSS (r = 0.14), the PDS scale (r = 0.37), and FM tender points (r = 0.16) was significant, but not with WPI (r = 0.06). When the three groups were examined, the SSS mean was 7.54 (1.6), 7.73 (1.4), and 8.25 (1.7), respectively (P 0.008), while the PDS mean was 15 (3.8), 15.95 (3.8), and 18.96 (4.4), respectively (P 0.008). (P 0.001). Conclusion Early FM diagnosis is associated with lower SSS, total severity scale, and FM tender points, indicating a less severe condition.

BackgroundPes anserine bursitis is one of the causes of painful knee syndromes. It limits physical activity and impairs the quality of life of a patient. Obesity and osteoarthritis (OA) of the knee are common predisposing factors for pes anserine bursitis. It is treated with non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy, injections of local anesthetics, and corticosteroids. This study examines the efficacy of local corticosteroid injection, Platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and improve function in patients with pes anserine bursitis.ObjectivesThis study examines the efficacy of local corticosteroid injection, Platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and improve function in patients with pes anserine bursitis.MethodsThis randomized comparative clinical trial was performed between July 2021 and June 2022 in the rheumatology and rehabilitation department at Al-Azhar University hospitals in Egypt on 180 patients diagnosed with chronic pes anserine bursitis according to Larson and Baum criteria. The enrolled patients were divided into three groups, each including sixty patients. Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml (n = 60); Group II received a PRP injection (n = 60); and in Group III, ESWT (n = 60) was used. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie score for tenderness were recorded at the baseline, after 1 week, and after 8 weeks.ResultsThere are significant differences between the corticosteroid group compared to the PRP group (10.6± 2.5) and the ESWT group (9.7 ±2.6) regarding the WOMAC pain score and WOMAC physical function score one week after the application of procedures. There is a highly statistically significant (p= 0.001) decreased 8-week WOMAC pain score in the corticosteroid group (5.7 ± 2.7) when compared to the PRP group (9.4± 2.4) and ESWT group (7.1± 1.5)Table [1].As regards VAS, there isn’t a statistically significant difference (p = 0.636) between the studied groups as regards baseline VAS or 8-week VAS after the procedure.ConclusionAn examination of Pes anserine bursitis is essential and shouldn’t be missed in knee OA patients complaining of pain. Our findings show that local corticosteroid injection is more effective than PRP injection and ESWT for pain relief.DeclarationsThe authors declare that they have no competing interests.Table (1):Post hoc analysis for multiple comparisons between studied groups as regard 1-week WOMAC score (pain & physical function) after the application of procedures.1 weekCorticosteroid vs PRPCorticosteroid vs ESWTPRP vs ESWTWOMAC pain scoreLSD3.062.10.93p-value< 0.001 HS0.001 S0.126 NSWOMAC physical function scoreLSD3.29.16.0p-value0.120 NS< 0.001 HS0.004 SS: p-value < 0.05 is considered significant.HS: p-value < 0.001 is considered highly significant.LSD: Least sig. difference. NS: p-value > 0.05 is considered non-significant.Disclosure of InterestsNone Declared.

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