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Background Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and, at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice. The aim of this study was to develop an up-to-date consensus and evidence-based clinical practice guidelines for a treat-to-target management of fibromyalgia. Fifteen key clinical questions were identified by a scientific committee according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize the evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (ranks 7–9) ranged from 85 to 100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. An algorithm for the management of fibromyalgia has been suggested. Conclusions These recommendations provide an updated consensus on both the non-pharmacological and the pharmacological treatments of fibromyalgia. The provided strategies to reach optimal treat-to-target outcomes in common clinical scenarios are based on a combination of evidence and expert opinions. Best treatment decisions should be tailored to each individual patient situation.

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Background Musculoskeletal complications of the hand may be very debilitating for the diabetic patient. The most commonly recognized complications are trigger finger, tenosynovitis, Dupuytren’s contrcture, carpal tunnel syndrome (CTS), and limited joint mobility (LJM). Increased glycosylation has been suggested as the pathogenesis of soft tissue lesions of the hand in diabetic patients. Glycosylation of basement membrane explains the associated microangiopathy and impaired micro-circulation. Diabetic autonomic neuropathy of the sympathetic system has been implicated in the pathogenesis of different diabetic complications as a consequence of impaired tissue perfusion. This may raise the possibility of an association between diabetic hand soft tissue lesions and diabetic autonomic neuropathy. Objectives To investigate the relationship between sympathetic dysfunction and soft tissue rheumatism of the hand in diabetic patients. Methods the study included 2 groups:group 1 included 20 diabetic patients with at least one hand soft tissue lesion and group 2 were 20 diabetic patients without any hand pathology. All patients were thoroughly evaluated clinically and were assessed for the presence of diabetic sympathetic neuropathy using tilt table test before proceeding to the electrophysiological measurements. Electrodiagnostic techniques included sensory conduction studies of median, ulnar, and superficial radial nerves, and motor conduction studies of median and ulnar nerves and testing sympathetic skin response (SSR) of the hand. In addition, the axillary F central loop latencies for the median and ulnar nerves were determined. Results Six patients in group 1 had CTS, 5 had trigger fingers, 2 had tenosynovitis, 2 had LJM, and one had Dupuytren’s contracture. In addition, 4 patients had combined CTS and LJM. Abnormal SSR was detected in 10 patients in group 1 and in 10 patients in group 2. There was no statistically significant difference between group 1 and 2 regarding the frequency of SSR abnormalities. There was a statistically significant relationship between the presence of CTS in group1 patients and abnormal SSR results. There was a statistically significant relationship between positive tilt table test results in group 1 patients and abnormal SSR in the same group. The presence of SSR abnormalities was related to prolonged duration of diabetes in group1 patients. Conclusions Diabetic patients with CTS tend to have prolonged SSR of the hand. Otherwise, the presence of soft tissue lesions of the hand is not related to autonomic sympathetic neuropthy in patients with diabetes. Disclosure of Interest None Declared