https://www.gastrojournal.org/article/0016-5085(95)90708-4/pdf

Intestinal permeability: an overview.

Fibromyalgia and Overlapping Disorders: The Unifying Concept of Central Sensitivity Syndromes

Background
Fibromyalgia (FM) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This is an update of a review published in Issue 2, 2002.

Objectives
The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FM.

Search methods
We searched MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005. We also reviewed reference lists from reviews and meta-analyses of treatment studies.

Selection criteria
Randomized trials that were selected focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FM.

Data collection and analysis
Two of four reviewers independently extracted data for each study. All discrepancies were rechecked and consensus was achieved by discussion. Methodological quality was assessed by two instruments: the van Tulder and the Jadad methodological quality criteria. We used the American College of Sport Medicine (ACSM) guidelines to evaluate whether interventions had provided a training stimulus that would effect changes in physical fitness. Due to significant clinical heterogeneity among the studies we were only able to meta-analyze six aerobic-only studies and two strength-only studies.

Main results
There were a total of 2276 subjects across the 34 included studies; 1264 subjects were assigned to exercise interventions. The 34 studies comprised 47 interventions that included exercise. Effects of several disparate interventions on global well-being, selected FM signs and symptoms, and physical function in individuals with FM were summarized using standardized mean differences (SMD). There is moderate quality evidence that aerobic-only exercise training at recommended intensity levels has positive effects global well-being (SMD 0.49, 95% CI: 0.23 to 0.75) and physical function (SMD 0.66, 95% CI: 0.41 to 0.92) and possibly on pain (SMD 0.65, 95% CI: -0.09 to 1.39) and tender points (SMD 0.23, 95% CI: -0.18 to 0.65). Strength and flexibility remain under-evaluated.

Authors' conclusions
There is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FM symptoms. Strength training may also have benefits on some FM symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FM is needed.

Exercise for treating fibromyalgia syndrome.

Objective. To compare the levels of biogenic amines in the cerebrospinal fluid (CSF) of primary fibromyalgia syndrome (PFS) patients with those in the CSF of controls.

Methods. Metabolites of serotonin, norepinephrine, and dopamine were identified in CSF, using high performance liquid chromatography with coulometric detection.

Results. CSF levels of metabolites from all 3 neurotransmitters were lower in PFS patients than in controls.

Conclusion. A low rate of turnover of several neurotransmitters supports the proposed hypothesis of a metabolic defect in PFS and suggests that the defect occurs at a neuroregulatory level.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780350509

Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis

Kaposi9s sarcoma–associated herpesvirus (KSHV) was found in the bone marrow dendritic cells of multiple myeloma patients but not in malignant plasma cells or bone marrow dendritic cells from normal individuals or patients with other malignancies. In addition the virus was detected in the bone marrow dendritic cells from two out of eight patients with monoclonal gammopathy of undetermined significance (MGUS), a precursor to myeloma. Viral interleukin-6, the human homolog of which is a growth factor for myeloma, was found to be transcribed in the myeloma bone marrow dendritic cells. KSHV may be required for transformation from MGUS to myeloma and perpetuate the growth of malignant plasma cells.

Kaposi's Sarcoma-Associated Herpesvirus Infection of Bone Marrow Dendritic Cells from Multiple Myeloma Patients

The clinical symptoms of 55 patients with primary fibromyalgia (PF) were studied and compared with 30 patients with rheumatoid arthritis (RA). The PF patients expressed a more intense feeling of illness than did the RA patients. Stiffness occurred just as often in PF as in RA. Trigger points occurred less frequently in RA patients. Muscular fatigue appeared to be one of the most disabling symptoms in PF. Neurophysiological studies indicated that the fatigue was at least partly of central origin. Ischemic forearm exercise test gave no evidence of impaired glycogenolysis. Laboratory investigation revealed normal 25-hydroxyvitamin D, cobalamin, folate, estrogen, testosterone, and myoglobin in the PF patients.

Primary Fibromyalgia: A Clinical and Laboratory Study of 55 Patients

16 patients with classical rheumatoid arthritis (RA) selected at random underwent fasting for 7--10 days, followed by a 9-week period on a lactovegetarian diet. 10 RA patients acted as controls, taking normal diet. Pain, stiffness, medication, and clinical and biochemical findings were recorded before fasting, on the first day after the conclusion of the fasting period, and at the end of the lactovegetarian period. After fasting, 5 of 15 patients showed objective signs of improvement, compared with only one of the controls. The fasting patients showed reduced pain, stiffness, consumption of analgetics, several clinical variables, and serum concentration of orosomucoid. At the conclusion of the lactovegetarian diet period only one Diet patient showed objective improvement. No differences were found between the Diet patients and the controls concerning symptoms, drug consumption, or clinical and biochemical variables. We conclude that fasting may produce subjective and objective improvements in RA, though of short duration, but the findings of this investigation do not indicate that lactovegetarian diet has any beneficial effects.

Effect of fasting and lactovegetarian diet on rheumatoid arthritis.

We have investigated the influence of fasting and lactovegetarian diet on intestinal and non-intestinal permeability in 5 patients with rheumatoid arthritis. We used low-molecular weight polyethyleneglycols (PEG 400) as probe molecules and a deterministic mathematical model to assess the permeability characteristics. Both intestinal and non-intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime. Concomitantly it appeared that disease activity, as shown by a clinical six-joint score, first decreased and then increased again. The results indicate that, unlike lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non-intestinal permeability in rheumatoid arthritis.

Folke D. Lindström

Papers

Primary Fibromyalgia: A Clinical and Laboratory Study of 55 Patients

Effect of fasting and lactovegetarian diet on rheumatoid arthritis.

Influence of Fasting on Intestinal Permeability and Disease Activity in Patients with Rheumatoid Arthritis

Muscle biopsy findings of possible diagnostic importance in primary fibromyalgia (fibrositis, myofascial syndrome)

Multiple myeloma or benign monoclonal gammopathy? A study of differential diagnostic criteria in 44 cases