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Objective. To determine the prevalence of sexual abuse in women diagnosed as having fibromyalgia (FM) compared with controls.Methods. A self-administered questionnaire designed to obtain information regarding demographics, health care utilization, and history of sexual and physical abuse was completed by 40 women with FM and by 42 women who had no evidence of connective tissue disease or other major medical condition.Results. Women with FM reported more physical symptoms and were significantly different on multiple indices of health compared with controls. Twenty-six FM subjects (65%) reported sexual abuse, in comparison with 22 controls (52%). The prevalence and type of abuse were not significantly different between groups. Sexually abused FM subjects reported significantly more symptoms than did non-sexually abused FM women, but did not differ in the number of symptoms for which they sought medical treatment.Conclusion. Sexual abuse does not appear to be a specific factor in the etiology of FM, but is correlated with the number and severity of associated symptoms.Fibromyalgia (FM) is commonly encountered in outpatient rheumatology practice. In addition to characteristic tender points, FM patients have multiple somatic complaints, including fatigue, stiffness, myalgias, arthralgias, headaches, and irritable bowel syndrome (IBS), as well as feelings of hopelessness (1,2). The frequent association of FM and IBS has been previously described (3,4). Using strict criteria, Veale (6) published data suggesting that there is an increased prevalence of physical and sexual abuse in women diagnosed as having functional IBS compared with those who had organic gastroenterologic disorders.Over the last several decades, reports of violence against children, adolescents, and women have been steadily climbing (7,8). A history of physical and/or sexual abuse is often associated with physical and psychological symptoms: increased rates of depression, suicide, alcoholism, anxiety, and somatic disorders (i.e., abdominal pain, headaches) (9,lO). Because many of the somatic complaints reported by sexually abused women overlap with those seen in patients with FM, and in light of findings by Drossman relating sexual abuse to functional gastrointestinal disorders, we undertook the present study to evaluate the prevalence of sexual and physical abuse in an FM population. It was hypothesized that subjects with FM would more frequently report sexual or physical abuse than would healthy community controls, and that those FM patients with a history of sexual/physical abuse would report greater levels of somatic complaints and more frequent use of the health care system. PATIENTS AND METHODSStudy subjects. Forty women who met the American College of Rheumatology 1990 criteria for FM (2) and had no evidence of other rheumatologic disorders were identified through the Medical College of Wisconsin Rheumatology Division. Subjects were contacted personally and all patients who qualified for the study agreed to participate.Forty-two women were rec...

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Cyclophosphamide, azathioprine, and hydroxychloroquine sulfate were prescribed for 31 patients (26 women and five men) with rheumatoid arthritis refractory to conventional therapy. Maintenance drug dosages (mean +/- SD) were as follows: cyclophosphamide, 30 +/- 24 mg/day; azathioprine, 74 +/- 44 mg/day; and hydroxychloroquine sulfate, 210 +/- 92 mg/day. Disease suppression began in 30 patients within three to 24 months (mean, nine months). Results after 43 months (range, 12 to 102 months) were as follows: 16, complete remission; seven, near remission; seven, partial disease suppression; one, no response. None remained in prolonged remission without some form of therapy. Treatment was discontinued in three patients because of pulmonary infection (two) or thrombocytopenia (one). Four patients had five malignant neoplasms (surgical cures) before therapy (two breast, one colon, one melanoma, one endometrial); four patients developed a malignant neoplasm during combined drug therapy (one colon, one endometrial, one lung, one erythroleukemia); and three died. The absolute risk of malignancy from combined drug therapy is still unclear. We concluded that combined use of remittive agents may have promise in treatment of severe rheumatoid arthritis; cyclophosphamide should be replaced with a nonalkylating agent; and the place of combined drug therapy remains uncertain in the absence of controlled trials.

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