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Objective. To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS).Methods. One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. F M S was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL).Results. Although no patient had a chronic pain syndrome prior to the trauma, F M S was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. F M S was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with F M S (n = 22) had more tenderness, had more severe and prevalent FMS- Conclusion. F M S was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.

Chronic widespread pain, the cardinal symptom of fibromyalgia (FM), is common in the general population, with comparable prevalence rates of 7.3% to 12.9% across different countries. The prevalence of FM in the general population was reported to range from 0.5% to 5% and up to 15.7% in the clinic. The common association of FM with other rheumatic disorders, chronic viral infections, and systemic illnesses has been well documented in several studies. Up to 65% of patients with systemic lupus erythematosus meet the criteria for FM. FM is considered a member of the family of functional somatic syndromes. These syndromes are very common and share a similar phenomenology, epidemiologic characteristics, high rates of occurrence, a common pathogenesis, and similar management strategies. A high prevalence of FM was demonstrated among relatives of patients with FM and it may be attributed to genetic and environmental factors.

We examined the relationship between body mass index (BMI) and measures of tenderness, quality of life, and physical functioning in female fibromyalgia (FMS) patients. A random sample of 100 female FMS patients from a database of 550 FMS individuals was interviewed and assessed according to a structured questionnaire that included FMS-related symptoms, measures of tenderness (point count and dolorimetry), quality of life (SF-36), physical functioning, and BMI. Weight was defined as normal, overweight, and obesity according to BMI. Twenty-seven percent of the FMS patients had normal BMI, 28% were overweight, and 45% were obese. BMI was negatively correlated with quality of life (r = -0.205, P = 0.044) and tenderness threshold (r = -0.238, P = 0.021) and positively correlated with physical dysfunctioning (r = 0.202, P = 0.047) and point count (r = 0.261, P = 0.011). Obese FMS patients display higher pain sensitivity and lower levels of quality of life. In designing studies that explore factors affecting tenderness, BMI should be included in addition to sex, age, etc.

Enthesitis is a cardinal feature of spondylarthropathy (SpA) (1). One of the most challenging issues in the treatment of SpA concerns refractory heel pain caused by Achilles enthesopathy, retrocalcaneal bursitis, and plantar fasciitis (2). Early reports suggest that the anti-tumor necrosis factor ␣ monoclonal antibody, infliximab, is very efficacious in patients with severe SpA (3,4). We now report our experience with 2 HLA-B27-positive SpA patients who had refractory erosive calcaneal enthesitis without any other articular or axial symptoms, and who experienced significant remission, documented by ultrasonography, following initiation of treatment with infliximab.Both patients received a 3-mg/kg infusion of infliximab at weeks 0, 2, and 6, which was well tolerated. Control examinations were subsequently performed at weeks 10 and 14. At each visit, heel pain was measured on a visual analog scale (VAS), clinical and ultrasound examinations were performed by independent examiners, and the serum level of C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were determined. Ultrasound examination was performed with real-time high-resolution equipment (AU5 Harmonic; Esaote, Genova, Italy) using a 13-MHz linear array transducer. Inflammatory activity was evaluated using the power Doppler mode at the following settings: medium flow optimum, low wall filter, dynamic range 50 dB, pulse repetition frequency 750 Hz.The first patient, a 21-year-old man, presented with a 10-year history of inflammatory right heel pain and a 3-year history of left heel pain, corresponding with radiographically evident erosions of both calcanei. Prior treatments had included nonsteroidal antiinflammatory drugs (NSAIDs), sulfasalazine (SSZ) for 2 years, multiple local injections of corticosteroids, local radiotherapy, and even local surgery, all of which proved unsuccessful. The patient had stopped working as a baker because of the disabling heel pain. The level of pain on a 100-point VAS was 76 for the right heel and 56 for the left heel. Physical examination at baseline revealed bilateral painful and tender heels at the insertion of the Achilles tendon and plantaris fascia. Magnetic resonance imaging showed bilateral edema and erosions of the entheseal portion of the calcaneus, inflammatory aspects of the Achilles tendon and plantaris fascia. Ultrasound examination revealed bilateral hypoechoic thickening of the Achilles tendon at the entheses, with calcific deposits and bone cortex erosion of the calcaneus ( Figure 1A). Power Doppler sonography showed increased blood flow from the periosteal bone to the entheses of the Achilles tendon and plantaris fascia, predominantly in the left side ( Figure 1A).Partial clinical improvement was noticeable as early as week 2 after the initiation of infliximab treatment (heel pain [for each heel] scored 33 on a 100-point VAS), and complete clinical remission (heel pain scored 0; negative physical findings) was achieved after the second infusion of infliximab (week 6) and was maintained at ...