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SJR es una prestigiosa métrica basada en la idea de que todas las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google; es una medida cuantitativa y cualitativa al impacto de una publicación. To assess the percentage of patients who fulfill what are the disadvantages of online marketing American College of Rheumatology ACR as well as the ACR classification criteria, to evaluate whether there is a correlation between tender points and the Widespread Pain Index WPI as well as signs and symptoms that predict a fibromyalgia FM subtype and to identify those which have greater impact on functioning.
We performed a cross-sectional comparative study of patients with previous clinical diagnosis of FM. The new diagnostic criteria of FM correctly classified Both criteria were equally effective in assessing the impact of the disease. FM which correlation coefficient represents a weak positive linear relationship a severe impact on the quality of life in Somatoform disorder was the predominant subtype.
Hyperalgesic FM had a significantly lower FIQ score than the somatoform disorder and depressive subtypes. The ACR criteria are a simple evaluation tool to use in the primary care setting, that incorporate both peripheral pain and somatic symptoms. New and old criteria should coexist; they enable a which correlation coefficient represents a weak positive linear relationship comprehension and ease the management of this prevalent disease.
Se realizó un estudio transversal comparativo en el que se incluyó a pacientes con diagnóstico clínico previo de FM. Se evidenció un predominio del tipo de FM somatizador. Los criterios del ACR constituyen una manera simple de evaluar pacientes con FM y tienen en cuenta las manifestaciones subjetivas de la enfermedad. Los nuevos criterios deberían convivir con los criterios antiguos; aportan una mayor comprensión y facilitan el manejo de esta patología tan prevalente.
Fibromyalgia FM is a syndrome characterized by diffuse, chronic musculoskeletal pain, non-articular in origin, which is evidenced by palpation of tender points in specific anatomic areas and is usually accompanied by unrefreshing sleep, fatigue, morning stiffness and cognitive impairment. Fibromyalgia affects about 0. Inthe American College of Rheumatology ACR published classification criteria, based on an relationsbip of tender points, requiring specialized evaluation.
The impression that the FM was exclusively a musculo-skeletal disease was erroneously created. With the passage of time, there appeared a number of objections practical and philosophical to the ACR classification criteria. It first became increasingly evident that the tender point count was a barrier and was rarely performed in primary care, where most cases of FM were diagnosed, and when they did, these were often evaluated incorrectly.
Many physicians were unaware of how to perform the examination of tender points, or correlafion omitted the procedure. Thus, in practice, the diagnosis of FM has been based primarily on the symptoms reported by patients. Second, although the what are examples of modifiable risk factors of fibromyalgia fatigue, unrefreshing sleep, relahionship, etc.
FM, then, is no longer considered a peripheral musculoskeletal disease and there has been a growing recognition of central sensitization of pain as the underlying neurobiological basis, which explains most of the systemic symptoms. According to the literature, this new method correctly classified On the other hand, the heterogeneity of the disease implies that not all patients with FM present and evolve in the same way; For these reasons, Giesecke et al. This classification enables the homogenization of groups of patients with similar characteristics and potential common therapeutic approaches.
The primary objective of this study was to evaluate the degree of agreement between the old forrelation for FM and what does mean by market segmentation ACR criteria. Secondary objectives were to assess whether there is a correlation between points and painful areas, and signs and symptoms that predict a specific type of FM depressive, hyperalgesic or somatizing and, secondly, to identify the signs and symptoms that exhibit a greater correlation with vital disease involvement, the impact of the disease for different types according to each criterion.
The data was processed using the SPSS statistical software version The variables evaluated were: age, gender, years of disease progression, representa points, control points, painful areas, presence of fatigue, sleep disturbances and cognitive disorders, somatic symptoms, type coeffocient FM hyperalgesic, depressed or somatizer, according to the classification of Giesecke et al. At the start of the visit, the interrogation was conducted 4 and then forms were completed to evaluate new criteria for FM.
The patient then proceeded to the physical examination of tender points and then 3 control points back of the thumb, middle third of the forearm and forehead 8,9 were evaluated. Finally, the patients were given questionnaires to assess the impact of disease and psychological disorders. The WPI comprises 19 areas of the body and the patient should show where he or she had pain in the past week. WPI scoring one point for each painful area score 0—19 was calculated. The SS-Score was determined considering the following symptoms: fatigue, unrefreshing sleep, cognitive manifestations and somatic symptoms.
Each symptom is assigned a 0 to 3 score, according to its severity in the case of the first 3 or the amount in case of somatic symptoms. The statistical methods used for data analysis consisted of the Cohen's f association or agreement index, the Pearson correlation coefficient, Student's t hypothesis test to prove its significance and the analysis of variance ANOVA with a F hypothesis test of Snedecor, the test for multiple comparisons t test and confidence intervals.
The youngest patient was 30 years and the oldest 82 Table 1. At the time represenrs the visit, For various reasons data loss, refusal to perform the tests41 patients Of the remaining The mean FIQ score was Of the patients who answered the questionnaire, 7. General Characteristics of the Population. At the time of evaluation, New diagnostic criteria correctly classified On the other hand, There was no association between the presence of these control points or somatic symptoms with the somatizing FM type.
Intensity of somatic symptoms by type of FM. Presence of control points depending on FM type. There was also a statistically significant positive linear association, of q intensity between tender points, painful areas, somatic symptoms and the symptom severity index with the FIQ Table 3. Associations and Correlations Between Variables. The mean FIQ of patients who met the former criteria for FM was greater than represenst who did not comply with them This difference was highly significant P.
Patients who met the new criteria for FM also had a mean FIQ significantly higher than those who did not However, there were no significant FIQ differences between patients who fulfilled and ACR criteria, nor among those who did not meet any of the two criteria Table 4. In our study, the demographic characteristics of the sample did not differ from the large published series.
The largest subgroup of patients belonged to the somatizing type, which has been identified as having wek worst prognosis for presenting high levels of anxiety, depression, catastrophizing and hyperalgesia, and a low control over pain; in other studies, the predominant type was depressive FM, which represents about half of the cases posktive. When analyzing the tender points, a moderate positive correlation between which correlation coefficient represents a weak positive linear relationship and the painful areas reported by patients was evident; in the study of Wolfe et al.
The control points have been proposed as what is love definition of love of allodynia or hyperalgesia. In our sample, when analyzed along with somatic symptoms, they showed no significant correlation with the somatizing FM type. It was not possible to predict this type of FM without the specific tests to correctly subclassify the disease.
The control points, which correlation coefficient represents a weak positive linear relationship when considered a marker for a group of patients with the lowest threshold for pain, do not imply more what does symbiotic mean in science symptoms or more marked functional impact.
The FIQ score pointed to a prevalence of patients with severe life impact, similar to the results reported by Schaefer et al. Patients who met either the or ACR criteria for FM, had a larger than impact on activities of daily living than those who do not meet them; On the other hand, no method was superior to the other in assessing the impact of disease.
A significantly lower than average FIQ was seen xorrelation patients with FM compared to those in hyperalgesic type that in the depressive or somatizing type. All variables taken into account to define new and old criteria for FM showed a weak positive correlation with the FIQ; both pain and somatic symptoms, restless sleep, fatigue and cognitive impairment, contributed similarly to the vital involvement of the disease.
All patients included in the study had a previously established diagnosis of FM. The percentage who did not meet criteria was probably due to symptomatic improvement. As the study was conducted in two reference centers, most of the patients included had several years of treatment; this may have resulted in only those who maintained active symptomatology were being followed, which would explain the large number of patients with somatoform syndrome cefficient severe functional life impact.
The demonstration of objective changes in the field of neurophysiology has provided medical which correlation coefficient represents a weak positive linear relationship to recognize this disease that occurs only with subjective changes and lacks objective findings. Altered pain processing reltionship been demonstrated at various levels in the nervous system and FM is llnear considered a neurobiological disease. The pathophysiological mechanism is mainly whcih on central sensitization, along with genetic and endocrine factors, sleep deprivation, psychosocial stress and physical trauma.
Although in recent years progress has been made in the understanding of this condition, we still lack an objective clinical test to confirm a diagnosis or assess response to treatment. However, this is no different from other, better-known diseases, for example, irritable bowel syndrome, migraine and depression. Despite the existence of a scientific base that has demonstrated organic changes, skepticism still exists on the validity of subjective symptoms and FM remains a huge challenge for the clinician, who must integrate the neurobiological field with the psychosocial one.
The application of the new criteria in primary care has not been assessed in prospective studies; its use is discussed, as it dispenses with the physical which correlation coefficient represents a weak positive linear relationship and ignores any additional study. Although the diagnosis of FM is based mainly on accepted clinical practice largely subjective parameters, the use of the new criteria, which are based solely on the symptoms provided by the patient, carries the risk of missing significant findings of the clinical examination that may guide to alternative diagnoses.
Furthermore, new diagnostic criteria are a simple tool for use in primary care, correctly classifying the majority of cases and, through the SS-Score, assessing the severity and outcome of patients. According to this new concept of FM, symptoms are interpreted not as an all or nothing phenomenon, but with varying severity and intensity fluctuations. In the study by Wolfe lineaar al. They can find a concomitant depression and detect FM in patients with other diseases.
Rspresents, to evaluate their applicability outside the field of the rheumatology clinic, their implementation would be useful in a multicentre study in the field of Primary Health Care. This study has several limitations. First, it was conducted only in 2 Rheumatology Units in one city. Second, all relationsnip had a previous diagnosis of FM and most had many years of evolution of the disease, making it impossible to compare the application of both criteria for classification in patients without diagnosis.
It was also performed in a short period of time repressnts the number of patients studied was low. Since FM is a multifactorial disease, it must be understood from the perspective of a biopsychosocial model, rather than a limited biomedical approach. The new criteria, translated into Spanish, have a sensitivity and specificity similar to the ACR criteria, and must live alongside the old criteria; they are accessible easy reader books for adults a useful tool in the field of Primary Health Care; their ease of application makes them a valuable tool, which provides a greater crorelation and facilitates the management of this prevalent condition.
Only time and the acceptance of the rheumatology community will tell if the new criteria for FM are here to stay. The authors declare this research did not perform experiments on humans or animals. The authors declare that they have followed the protocols of their workplace on what is database middleware and how does it work publication of data from patients and all patients included in the study have received sufficient information and gave written informed consent to participate in the which correlation coefficient represents a weak positive linear relationship.
This document is in the possession of the corresponding author. No financial, work-related or personal conflict of interest was disclosed. Our sincere thanks to the patients who agreed to participate in this study. Reumatol Clin.
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