Search

Objective Overlapping chronic pain syndromes, including fibromyalgia, are heterogeneous and often treatment‐resistant entities carrying significant socioeconomic burdens. Individualized treatment approaches from both a somatic and psychological side are necessary to improve patient care. The objective of this study was to identify and visualize patient clusters in refractory musculoskeletal pain syndromes through an extensive set of clinical variables, including immunologic, psychosomatic, wearable, and sleep biomarkers. Methods Data were collected during a multimodal pain program involving 202 patients. Seventy‐eight percent of the patients fulfilled the criteria for fibromyalgia, 77% had a concomitant psychiatric‐mediated disorder, and 22% a concomitant rheumatic immune‐mediated disorder. Five patient phenotypes were identified by hierarchical agglomerative clustering as a form of unsupervised learning, and a predictive model for the Brief Pain Inventory (BPI) response was generated. Based on the clustering data, digital personas were created with DALL‐E (OpenAI). Results The most relevant distinguishing factors among clusters were living alone, body mass index, peripheral joint pain, alexithymia, psychiatric comorbidity, childhood pain, neuroleptic or benzodiazepine medication, and response to virtual reality. Having an immune‐mediated disorder was not discriminatory. Three of five clusters responded to the multimodal treatment in terms of pain (BPI intensity), one cluster responded in terms of functional improvement (BPI interference), and one cluster notably responded to the virtual reality intervention. The independent predictive model confirmed strong opioids, trazodone, neuroleptic treatment, and living alone as the most important negative predictive factors for reduced pain after the program. Conclusion Our model identified and visualized clinically relevant chronic musculoskeletal pain subtypes and predicted their response to multimodal treatment. Such digital personas and avatars may play a future role in the design of personalized therapeutic modalities and clinical trials.

BackgroundDigital therapeutics (DTx) in the form of mobile health (mHealth) self-management programs have demonstrated effectiveness in reducing disease activity across various diseases, including fibromyalgia and arthritis. However, the content of online self-management programs varies widely, making them difficult to compare.AimThis study aims to employ generative artificial intelligence (AI)-based knowledge graphs and network analysis to categorize and structure mHealth content at the example of a fibromyalgia self-management program.MethodsA multimodal mHealth online self-management program targeting fibromyalgia and post-viral fibromyalgia-like syndromes was developed. In addition to general content, the program was customized to address specific features and digital personas identified through hierarchical agglomerative clustering applied to a cohort of 202 patients with chronic musculoskeletal pain syndromes undergoing multimodal assessment. Text files consisting of 22,150 words divided into 24 modules were used as the input data. Two generative AI web applications, ChatGPT-4 (OpenAI) and Infranodus (Nodus Labs), were used to create knowledge graphs and perform text network analysis, including 3D visualization. A sentiment analysis of 129 patient feedback entries was performed.ResultsThe ChatGPT-generated knowledge graph model provided a simple visual overview with five primary edges: “Mental health challenges”, “Stress and its impact”, “Immune system function”, “Long COVID and fibromyalgia” and “Pain management and therapeutic approaches”. The 3D visualization provided a more complex knowledge graph, with the term “pain” appearing as the central edge, closely connecting with “sleep”, “body”, and “stress”. Topical cluster analysis identified categories such as “chronic pain management”, “sleep hygiene”, “immune system function”, “cognitive therapy”, “healthy eating”, “emotional development”, “fibromyalgia causes”, and “deep relaxation”. Gap analysis highlighted missing links, such as between “negative behavior” and “systemic inflammation”. Retro-engineering of the self-management program showed significant conceptual similarities between the knowledge graph and the original text analysis. Sentiment analysis of free text patient comments revealed that most relevant topics were addressed by the online program, with the exception of social contacts.ConclusionGenerative AI tools for text network analysis can effectively structure and illustrate DTx content. Knowledge graphs are valuable for increasing the transparency of self-management programs, developing new conceptual frameworks, and incorporating feedback loops.

BACKGROUND: Chronic musculoskeletal pain syndromes, including fibromyalgia, are heterogeneous entities with a major socioeconomic burden. Multimodal treatment programmes have shown greater efficacy than conventional approaches for these patients, at least in the short term. A profound understanding of chronic musculoskeletal pain syndrome patients treated in multimodal treatment programmes is important for their development and to provide insight into these conditions. AIM: To provide a comprehensive and objective description of medical, psychosocial and sleep characteristics of the treatment-refractory chronic musculoskeletal pain syndrome patients treated at the multimodal treatment programmes provided by our tertiary service in Switzerland. METHODS: This was a cross-sectional analysis of 202 refractory chronic musculoskeletal pain syndrome patients with or without a concomitant autoimmune disorder hospitalised between 2018 and 2022 in a 12-day Swiss multimodal treatment programme. They underwent a comprehensive self-assessment with eight different questionnaires and assessments by a psychiatrist, rheumatologist, pain specialist, occupational therapist and physiotherapist. Sleep assessment was performed via actigraphy. Clinical and demographic variables were selected by consensus of three experienced rheumatologists and chronic pain specialists. The Fibromyalgia Rapid Screening Test (FiRST), American College of Rheumatology (ACR)-2010 criteria (ACR2010) and Toronto Alexithymia Scale-20 (TAS-20) were also applied. RESULTS: The mean age of the patients was 47 years (SD = 10), 73% were female, and 30% were obese. Half (50%) were not from Switzerland, and 12% came from conflict zones. Almost half (40%) lived alone. Back pain was the principal site (90%). Of the patients, 78% fulfilled the ACR2010 criteria for fibromyalgia, and 17% were diagnosed with an underlying immune-mediated disorder, mostly spondylarthritis. Pain since childhood occurred in 45% of the patients, and 68% had pain since adolescence. Disability financial aid had been pursued by 69%, and 46% were still awaiting a response. Psychiatric comorbidities were highly prevalent (73%), of which 56% consisted of depression. Of all patients, 15% were diagnosed with enduring personality changes after a catastrophic experience (EPCACE), and 10% had post-traumatic stress disorder. Alexithymia affected 34% of patients. Objective sleep disorder was observed in 78% of patients, and 41% were under opioid therapy. CONCLUSION: This analysis reveals the complex psychosomatic and socioeconomic patterns of the patients treated in Switzerland with refractory chronic musculoskeletal pain syndromes, often originating in childhood and adolescence. Obesity, immigration, social isolation, psychiatric comorbidities, sleep deprivation and opiate use, among others, stood out as target characteristics for further research.

BackgroundPersistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30% of patients with post–COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. ObjectiveThis research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app’s design and functionality, the study intends to facilitate better self-management practices and improve adherence. MethodsUsing an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients’ expectations regarding design features, content, and usability to steer the iterative app development. ResultsThe study uncovered crucial insights from patient surveys and usability testing, which influenced the app’s design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. ConclusionsIncorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID)RR2-10.2196/32193

Abstract Background Cryoglobulins (CG) are immunoglobulins which precipitate at low temperature. The analysis of IgG subclass composition of CG is poorly reported. The aim of this study was to determine the subclasses of IgG-containing type I and mixed type II and III CG in relation to clinical manifestations. Methods Out of a previous series of 1675 patients, inclusion criteria were a cryoprecipitate > 1 mL and a total IgG > 300 mg/L. IgG subclasses were quantified by immunoturbidimetry, rheumatoid factor (RF), and C4 by immunonephelometry. Clinical parameters were collected from hospital charts. Results CG samples from 86 patients were included, 10 type I CG and 76 mixed CG. Type I CG subclasses were IgG1 (6/10) and IgG2/IgG3 (4/10), never IgG4. IgG subclass in type II vs. III CG were 73.3 ± 15.2% vs. 52.5 ± 20.7% for IgG1 (p

BackgroundPost–COVID-19 syndrome, also referred as “long covid,” describes persisting symptoms after SARS-CoV-2 infection, including myalgia, fatigue, respiratory, or neurological symptoms. Objective symptoms are often lacking, thus resembling a fibromyalgia-like syndrome. Digital therapeutics have shown efficiency in similar chronic disorders such as fibromyalgia, offering specific disease monitoring and interventions such as cognitive behavioral therapy or physical and respiratory exercise guidance. ObjectiveThis protocol aims to study the requirements and features of a new mobile health (mHealth) app among patients with fibromyalgia-like post–COVID-19 syndrome in a clinical trial. MethodsWe created a web application prototype for the post–COVID-19 syndrome called “POCOS,” as a web-based rehabilitation tool aiming to improve clinical outcomes. Patients without organ damage or ongoing inflammation will be included in the study. App use will be assessed through user experience questionnaires, focus groups, and clinical data analysis. Subsequently, we will analyze cross-sectional and longitudinal clinical data. ResultsThe developed mHealth app consists of a clinically adapted app interface with a simplified patient-reported outcome assessment, monitoring of medical interventions, and disease activity as well as web-based instructions for specific physical and respiratory exercises, stress reduction, and lifestyle instructions. The enrollment of participants is expected to be carried out in November 2021. ConclusionsUser experience plays an important role in digital therapeutics and needs to be clinically tested to allow further improvement. We here describe this process for a new app for the treatment of the fibromyalgia-like post–COVID-19 syndrome and discuss the relevance of the potential outcomes such as natural disease course and disease phenotypes. International Registered Report Identifier (IRRID)PRR1-10.2196/32193

Abstract Background The Hand Mobility in Scleroderma (HAMIS) test was created to measure the degree of dysfunction of hand movements imposed by systemic sclerosis (SSc). The modified version (mHAMIS), with 4 of the 9 original items, was developed later. The goal of the present study was to translate and validate HAMIS and mHAMIS into Brazilian Portuguese and culture. Methods After direct and reverse translation and comprehension test in 10 SSc patients, HAMIS-Br was applied to another 32 patients with SSc. To evaluate internal consistency, intraobserver and interobserver agreement, and intraobserver and interobserver reliability, we used respectively the Cronbach’s α coefficient, kappa concordance and intraclass correlation (ICC). The correlation between HAMIS-Br and mHAMIS-Br was evaluated and a factorial analysis was performed. Results HAMIS-Br showed excellent internal consistency (Cronbach’s α = 0.997), good intraobserver agreement (kappa between 0.78 [95%CI =0.57–0.99] and 1) and intraobserver and interobserver reliability (ICC = 0.993, 95% CI = 0.973–0.993 and ICC = 0.994, 95% CI = 0.987–0.997, respectively). The mHAMIS-Br presented similar results and excellent correlation with HAMIS-Br (r = 0.923). The factorial analysis extracted three groups of questions that explain 84.4% of the total variance, and that can be understood through the influence of certain movements in the interpretation of others: [1] questions whose interpretation is influenced by the extension of the fingers, [2] questions whose interpretation is influenced by flexion of the fingers, [3] volar flexion of the fingers, with similar correlation with both other factors. Conclusions HAMIS-Br and mHAMIS-Br showed good agreement, intraobserver and interobserver reliability, and internal validity. It is necessary to be attentive to the influence of certain limitations of movements in the interpretation of others.

FUNDAMENTOS: A esclerodermia é uma colagenose relativamente rara, cujo perfil de autoanticorpos está associado a diferentes manifestações clínicas. A prevalência de autoanticorpos na esclerodermia sofre influência racial e genética. OBJETIVO: Estudar a prevalência dos anticorpos anti-Scl-70, anticentrômero e anti-U1-RNP em pacientes com esclerodermia do sul do Brasil e verificar suas associações às manifestações clínicas. MÉTODOS: Estudo retrospectivo de análise de 66 pacientes com esclerodermia para presença de anti-Scl-70, anticentrômero (ACA) e anti-U1-RNP e de manifestações clínicas como: Raynaud, cicatrizes estelares, necrose digital, telangiectasias, calcinose, fibrose pulmonar, pleurites, pericardites, miocardiopatias, artralgias e artrites, grau de esclerose da pele, contraturas articulares e atritos de tendão, hipertensão pulmonar, manifestações esofágicas e crise renal. RESULTADOS: A prevalência do anti-Scl-70 foi de 17,8%, a do ACA, de 33,3%, e a do U1 RNP foi de 11,8 %. O anti-Scl-70 estava associado à forma difusa da doença (p=0,015), presença de miocardiopatias (p=0,016) e de cicatrizes estelares (p=0,05); o anticentrômero foi mais comum na forma limitada, embora sem significância estatística e mostrou-se protetor para as miocardiopatias (p=0,005). O anti-U1-RNP foi mais comum nas formas de superposição (p=0,0004). CONCLUSÃO: A prevalência e o perfil de associações clínicas dos autoanticorpos em esclerodermia de pacientes brasileiros assemelham-se aos da literatura mundial.BACKGROUND: Scleroderma is a fairly rare connective tissue disease whose autoantibody profile is associated with different clinical manifestations. The prevalence of autoantibodies in scleroderma is influenced by race and genetics. OBJECTIVE: To study the prevalence of anti-Scl-70, anti-centromere (ACA) and anti-U1-RNP antibodies in patients with scleroderma in southern Brazil and verify their association with clinical manifestations of the disease. METHODS: A retrospective study involving 66 patients with scleroderma for the presence of anti-Scl-70, anti-centromere and anti-U1-RNP and of clinical manifestations such as Raynaud's phenomenon, digital micro scars, digital necrosis, telangiectasias, calcinosis, pulmonary fibrosis, pleuritis, pericarditis, cardiomyopathy, arthralgia and arthritis, skin sclerosis, joint contractures, tendon friction rubs, pulmonary hypertension, esophageal disorders and renal crisis. RESULTS: The prevalence of anti-Scl-70 was 17.8% , that of ACA was 33.3% and the prevalence of U1 RNP was 11.8%. Anti-Scl-70 was associated with the diffuse form of the disease (p = 0.015), presence of cardiomyopathies (p = 0.016) and digital micro scars (p = 0.05). Anti-centromere was more common in the limited form, although it was not statistically significant, and had a protective role associated with cardiomyopathies (p = 0.005). Anti-U1-RNP was more common in the overlap forms (p = 0.0004). CONCLUSION: The prevalence and profile of clinical associations of autoantibodies in Brazilian patients with scleroderma are similar to those found in the literature.

A síndrome de Sjögren (SS) primária é uma doença autoimune cujo espectro de manisfestação clínica estende-se desde um acometimento órgão-específico (exocrinopatia auto-imune) até um processo sistêmico. O envolvimento da pele é bastante comum, e a freqüência de doença vascular inflamatória é estimada entre 20% e 30%. Duas formas clínicas específicas de vasculite cutânea, a púrpura palpável e urticária crônica são predominantes, mas eritema multiforme, eritema perstans, eritema nodoso, mácula eritematosa e nódulo subcutâneo também já foram descritos. Os autores descrevem o caso de uma paciente de 46 anos, que desenvolveu quadro de síndrome de Sjögren primária, com manifestações oculares, orais, articulares e alterações laboratoriais (FAN, anti-Ro, fator reumatóide positivos, e hipergamaglobulinemia). Após dez anos do diagnóstico, apresentou úlceras em membro inferior, cuja biópsia confirmou tratar-se de lesão tipo vasculítica, com excelente resposta ao tratamento com ciclofosmida endovenosa. Foram descritos na literatura apenas dois relatos de caso de pacientes com úlceras em membros inferiores, como acometimento cutâneo da SS. Os autores ressaltam a importância do diferencial de úlceras em membros inferiores como acometimento cutâneo da SS primária.Primary Sjögren's Syndrome (pSS) is an autoimmune disease with a large spectrum of clinical manifestations extending from an organ-specific involvement to a systemic process. The skin is affected quite commonly and the estimated frequency of inflammatory vascular lesions is from 20% to 30%. Two specific, clinically recognizable forms of cutaneous vasculitis predominate, palpable purpura and chronic urticaria, but erythema multiforme, erythema perstans, erythema nodosum, erithematous macules and subcutaneous nodules have also been described. The authors report the case of a 46-year-old female patient, diagnosed as primary SS, who presented ocular and oral symptoms, poliarthritis and laboratory alterations (with a positive ANA, anti-SSA, rheumatoid factor, and hypergammaglobulinemia). Ten years after the diagnosis, she presented leg ulcers. The biopsy confirmed the presence of vasculitic process, and the ulcers improved rapidly after the treatment with endovenous cyclophosphamide. There are only two reports of chronic ulceration of the legs as cutaneous manifestation of SS. The authors stress the importance of considering ulcers in the differential diagnosis of cutaneous involvement of primary SS.

Both celiac disease and scleroderma have autoimmune etiology and affect the bowel causing diarrhea. As an association of autoimmune disease in a single individual is not rare, it is important to know if a patient with scleroderma may also have celiac disease. To analyze this we studied 105 scleroderma patients and 97 volunteers for IgA-EmA by indirect immunofluorescence assay. We could not find a higher prevalence of this autoantibody in scleroderma patients. The authors conclude that there is no need to screen scleroderma patients with diarrhea for celiac disease unless there is a clear clinical indication for this.