This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

BackgroundWork and workplace factors are important in fibromyalgia management. We investigated factors associated with sick leave in professionally active women living with fibromyalgia.MethodsA questionnaire for fibromyalgia patients in employment was developed by pain and occupational physicians and patients’ organizations. Women in full-time work, screened for fibromyalgia with the FiRST questionnaire, were recruited for a national online survey. Sick leave over the preceding year was analyzed.ResultsIn 5 months, we recruited 955 women, with a mean of 37 days of sick leave in the previous year: no sick leave (36%), up to 1 month (38%), 1 to 2 months (14%), more than 2 months (12%). In the groups displayed no differences in demographic characteristics, fibromyalgia symptoms, functional severity and psychological distress were observed. However, they differed in workplace characteristics, commute time, stress and difficulties at work, repetitive work, noisy conditions, career progression problems and lack of recognition, which were strong independent risk factors for longer sick leave. Sedentary positions, an extended sitting position, heavy loads, exposure to thermal disturbances and the use of vibrating tools did not increase the risk of sick leave.ConclusionsWomen with fibromyalgia frequently take sick leave, the risk factors for which are related to the workplace rather than fibromyalgia characteristics.PerspectiveThis is the first study to assess the impact of occupational and clinical factors on sick leave in women living with fibromyalgia. Risk factors were found to be related to the workplace rather than fibromyalgia and personal characteristics. Workplace interventions should be developed for women with fibromyalgia.

BackgroundNeoangiogenesis is a crucial event to promote the development of the hyperplasic proliferative pathologic synovium in Rheumatoid arthritis (RA). Ultrasound (US) is sensitive for detection of power Doppler (PD) vascularization.ObjectiveTo explore the associations between a set of complementary circulating angiogenic markers and a comprehensive US assessment in patients with RA.Patients and methodsSerum levels of eight angiogenic markers were measured by quantitative ELISAs in a total of 125 patients with RA, who were all systematically assessed in parallel by PDUS, performed on 32 joints.ResultsSerum levels of soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and Tie-2 were more likely to be increased in patients with synovial hyperemia detected on at least one joint (Power Doppler grade ≥1). sVCAM-1, Tie-2 and Angiostatin concentrations gradually increased together with the grade of the semiquantitative PDUS scale and concentrations of these three markers were markedly increased in patients with moderate to marked hyperemia (Power Doppler grade 2 and 3). Levels of sVCAM-1, Tie-2, and Angiostatin correlated with a global arthritis sum score, defined by the sum of the semiquantitative PDUS scores for all joints examined. Levels of Tie-2 and Placenta Growth Factor (PlGF) were associated with PDUS features indicating residual disease activity.ConclusionOur results support the relevance of measuring serum levels of vascular markers to evaluate the intensity and extent of synovial vascularization. Angiogenic markers, and particularly Tie-2, could be a valuable surrogate of active synovitis and their place in relation to PDUS in clinical practice deserve further investigation.

Objectives: Some patients with chronic low back pain are not eligible to intensive rehabilitation program because of the intensity of their pain. We assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain. Methods:Patients aged 18 to 75 years with chronic low back pain were included. The rehabilitation program took place during a five-day hospitalisation in the rheumatology department of the Rouen University Hospital involving patients receiving multidisciplinary management with collective and individual workshops with special focus on education along with structured rehabilitation exercises. On the fifth day, patients and caregivers established goals to achieve within the six-month period. Patients had a follow-up visit six months later. The objective was to evaluate whether or not the goals were achieved at 6 months later.Results: Ninety-nine patients were included, and 78 were re-evaluated after six months. The patients achieved 74% of the goals that they had established, with significant behavioural changes. Clinically and functionally: significant decrease in pain VAS during the program, significant decrease in the fingertip-to-floor distance during the program and at the 6 months follow-up, significant improvement in the functional questionnaire. Conclusion:With to the educational part of their program, the patients achieved a mean of 74% of the goals. Moreover, the training course improved pain and function. For patients with a high level of pain and/or disability our short program with multidisciplinary management and an educational approach seems to be interesting as a first step before a more intensive rehabilitation.Keywords: Chronic low back pain; Therapeutic education; Multidisciplinary management; Rehabilitation Key Points1. Some of the chronic low back pain patients rapidly develop a high level of chronic pain and disability and therefore are not eligible for back school and intensive back pain rehabilitation; for these severe patients, based on the European recommendations and the biopsychosocial model, we created a "low back pain" training session with a special reinforcement on therapeutic education. 2.The training session is a one week multidisciplinary management, with multiple individual and group workshops on the various aspects of the chronic low back pain and its consequences in the different aspects of life.3. We asked patients to set goals to achieve by the sixth month following the training course in order to give them a starting point for following their efforts once they completed the week of training, the patients achieved a mean of 75% of the goals they had set individually.4. After the week training session, the pain scale significantly decrease as well as the finger-to-floor distance, the modified Schober's test and the functional questionnaire (Roland Morris Disability Questionnaire and Dallas Pain Questionnaire)

No abstract