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線維筋痛症をめぐるWolfe医師と私の論争

2015 Aug;42(8):1494-501. doi: 10.3899/jrheum.141519. Epub 2015 Jun 15.

The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity.

Abstract

OBJECTIVE:

The polysymptomatic distress (PSD) scale is derived from variables used in the 2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for survey and clinical research. The scale is useful in measuring the effect of PSD over the full range of pain-related clinical symptoms, not just in those who are FM criteria-positive. However, no PSD scale categories have been defined to distinguish severity of illness in FM or in those who do not satisfy the FM criteria. We analyzed the scale and multiple covariates to develop clinical categories and to further validate the scale.

METHODS:

FM was diagnosed according to the research criteria modification of the 2010 ACR FM criteria. We investigated categories in a large database of patients with pain (2732 with rheumatoid arthritis) and developed categories by using germane clinic variables that had been previously studied for severity groupings. By definition, FM cannot be diagnosed unless PSD is at least 12.

RESULTS:

Based on population categories, regression analysis, and inspections of curvilinear relationships, we established PSD severity categories of none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). Categories were statistically distinct, and a generally linear relationship between PSD categories and covariate severity was noted.

CONCLUSION:


PSD categories are clinically relevant and demonstrate FM type symptoms over the full range of clinical illness. Although FM criteria can be clinically useful, there is no clear-cut symptom distinction between FM (+) and FM (-), and PSD categories can aid in more effectively classifying patients.

この論文はダウンロード可能。これに対して私が公開質問状を出しました。私の公開質問状も、Wolfe医師の回答もダウンロード可能。PDFファイルには引用文献も記載されています。

2016 Feb;43(2):453. doi: 10.3899/jrheum.150861.

What Is the Significance of Change of Cutpoint from 13 to 12 If Polysymptomatic Distress Is Not a Diagnostic Criterion?

Comment in

Comment on

  • The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity. [J Rheumatol. 2015]


    What Is the Significance of Change of Cutpoint from 13 to 12 IfPolysymptomatic Distress Is Not a Diagnostic Criterion?

    To the Editor:

    Dr. Wolfe, et al reported a new idea aboutpolysymptomatic distress (PSD)1. I am afraid that some persons misunderstand that 12 onthe PSD scale is a diagnostic criterion for fibromyalgia (FM). He stated thatPSD was not a diagnostic criterion2. The diagnostic criteria of the 2010 criteria and themodified 2010 criteria for FM are the Widespread Pain Index (WPI) 7 and theSymptom Severity Scale (SSS) 5 or WPI 3–6 and SSS 93​,4. I understand that the PSD scale is useful to evaluateFM severity. If PSD is a diagnostic criterion, change of cutpoint from 13 to 12has significance. However, PSD is not a diagnostic criterion of FM. Thediagnostic criteria are WPI 7 and SSS 5 or WPI 3–6 and SSS 9. What is thesignificance of the change of cutpoint from 13 to 12 when PSD is not adiagnostic criterion?

    The treatment of chronic widespread pain (CWP) andchronic regional pain, incomplete forms of FM, is usually identical with thatof FM. This is true for CWP, especially, around the world5. Therefore, diagnostic criteria of FM are not clinicallyuseful. If the treatment of 2 or more diseases (or disorders) is the same, itis not clinically useful in distinguishing between diseases (or disorders). Ibelieve that the purpose of the diagnostic criteria is to maintain similarpatients in conferences and/or articles. FM, CWP, chronic regional pain, andlow back pain are continuum disorders. All diagnostic criteria make incompleteforms of FM. If we consider patients at 5 on the PSD scale (or the number ofthe tender points is 0) as having FM, presentations and articles will causegreat confusion. What is the significance of the diagnostic criteria of FM?

    Dr. Wolfe, et al stated that FM criteria can beclinically useful1. However, in another article, he stated as follows:“Underlying these challenges to FM is the conviction that the FM idea isharmful”6. He showed problems caused by FM (increasing disability,corrupting scientific research, changing psychosomatic illness into compensabledisease, etc.)6. I often provide an opinion brief for patients with FMafter traffic accidents in court. In all likelihood, the insurance companiesconsisted that the presence of FM is extremely questionable based on hisopinion6. Sometimes patients with FM after traffic accidents losea suit in Japan. A few physicians accept the idea of FM in Japan. Somephysicians including pain clinicians do not accept the idea of FM in Japan;Wolfe’s opinion is one of the reasons. He is a first author of articles thatinclude the diagnostic criteria of FM3,4​,7

    . I am very confused. Could Dr. Wolfe explain thediscrepancy?



    Dr. Wolfe replies

    To the Editor:

    This is the fifth letter to me from Dr. Toda in the form of a letter to the editor since the publication of the 2010 criteria. Here is another answer. By either the American College of Rheumatology 2010 or the modified criteria of 2011, the only way to satisfy fibromyalgia (FM) criteria is by meeting 1 of the following conditions: widespread pain (WPI) ≥ 7 and symptom severity scale (SSS) ≥ 5 or WPI 3–6 and SSS ≥ 91​,2. If one adds together the WPI and SSS, the result is the polysymptomatic distress (PSD) score or, as the scale has also been called, the FM symptom (FS) scale or score. Dr. Toda is correct that the PSD is “useful to evaluate FM severity.” Because the probability of meeting the FM criteria increases with increasing PSD score, the PSD can serve as an approximate measure of FM diagnosis. In my review of the literature, the FS scale misclassifies 4% to 8% of cases when compared [(WPI ≥ 7 and SSS ≥ 5) or (WPI 3–6 and SSS ≥ 9)], so that it is probably not a good idea to use cutpoints for diagnosis in the individual patient.

    I believe that Dr. Toda is confused when he speaks of a “change of cutpoint from 13 to 12.” We did not change cutpoints. The PSD cutpoint is the cutpoint that leads to the least misclassification of cases and non-cases when many patients are studied, and it can vary from study to study. So, in some studies that might be 12 and in others 13, and still others yet a different number. The cutpoint is not a number that I or some criteria determine. It is determined by the distribution of scores and cases in the study sample. For example, suppose there are 200 cases: 100 non-cases with PSD scores between 0 and 11, and 100 cases with PSD scores between 12 and 31. In that case, the cutpoint will be 12 and there will be no misclassification. However, in another sample there are 100 non-cases with PSD scores between 0 and 11, and 50 non-cases with PSD scores between 12 and 15, and 50 cases with PSD scores between 16 and 31. It is clear that a cutpoint of 12 would misclassify 50 cases, but a cutpoint of 16 would misclassify no cases.

    As to what is the clinical value of a difference in the PSD score of 1 unit, I refer Dr. Toda to an article in The Journal that gives insight into differences in PSD scores (and also Figure 1 of that article, a good example of standard criteria vs PSD cutpoint as criteria)3. Ultimately, the importance of differences is a decision for clinicians.

    There is not enough space to reply to your question about the meaning of FM. But we have done this elsewhere and we recommend that article to you4.



    Wolfe医師の回答によると私の勘違いとのこと。
    PSD 13を12に変更し、それがあたかも診断基準と誤解される記載をWolfe医師がしたためそれを指摘しました。
    後半の質問はWolfe医師が以前線維筋痛症という概念が医学に混乱を引き起こしたという記載と、線維筋痛症は重要な疾患という記載が矛盾しているのでそれを説明せよという質問。彼は質問に対する答えをしていない。Wolfe医師は線維筋痛症の診断基準が記載された3つの論文の筆頭著者。にもかかわらず以前線維筋痛症という概念が医学に混乱を引き起こしたと記載した



[PR]

by fibromyalgia11 | 2016-05-30 21:59 | FMの診断

肺移植患者におけるむずむず脚症候群

肺移植者におけるRLSの有病率を調べるとともに、RLSと免疫抑制薬暴露との関連を調べた。デザイン:患者はthe University ofWisconsin Hospital and Clinics Lung Transplant Clinic (N = 125)から集めた. 参加者(N= 81)は、4つのRLSの診断基準、不眠強度指数、およびSheehan障害尺度を含む睡眠のアンケートを完了。RLSとの関連を評価するために、area underthe curve (AUC)を計算することにより、62人の者で累積. Tacrolimus暴露量を計算した。結果:RLSの有病率は35%。累積の平均±SEM tacrolimus暴露量は RLS患者 versus RLSではない者(各々17446±1855 ng days/mL vs. 15303 ± 1643ng days/mL,; p = 0.42)で同程度. 不眠強度指標点数 (12.5 ± 1.0 vs 6.8 ± 0.7, p <0.0001)および Sheehan 障害点数(7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003)は各々、RLS患者の方がRLSではない者よりも有意に高い。まとめ:我々のデータによると以前の報告よりも肺移植患者のRLSの有病率が高い。RLS症状はtacrolimus暴露量とは関連しない。

Prog Transplant. 2016 Jun;26(2):149-156. Epub2016 Apr 13.

Restless Legs Syndrome FollowingLung Transplantation: Prevalence and Relationship With Tacrolimus Exposure.

Menninga NJ1, Rohde KA1, Schlei ZW1, Katers KM1, Weber AK1, Brokhof MM2, Hawes DS2, Radford KL2, Francois ML2, Cornwell RD3, Benca R4, Hayney MS1, Dopp JM5.

  • 1Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
  • 2University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA.
  • 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.
  • 4Wisconsin Sleep Center and Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • 5Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA john.dopp@wisc.edu.



[PR]

by fibromyalgia11 | 2016-05-30 12:41 | むずむず脚症候群

慢性腰痛症に対するサインバルタの効果(二重盲検法)

日本人の慢性腰痛症(chronic low back pain:CLBP)患者の14週の、無作為振り分け、多施設、偽薬対照研究で、無作為に、1日1回のduloxetine 60 mg又は偽薬に振り分ける。方法:一次的な効果判定は、ベースラインから14週までの、the Brief Pain Inventory (BPI) 平均の痛み点数の変化。二次的な効果計測には、BPI の痛み(最悪の痛み,最小の痛み, 現在の痛み), Patient's Global Impression of Improvement (PGI-I), Clinical Global Impressions of Severity (CGI-S),および Roland-Morris Disability Questionnaire (RDQ)や安全性や耐用性を含む。結果:458人の患者を無作為に duloxetine (n = 232) 又は偽薬(n = 226)に振り分け. The BPI の平均痛み点数は14週の時点でduloxetine群の方が偽薬群より有意に改善(各々-2.43 ± 0.11 vs-1.96 ± 0.11; 群間の差[95%信頼区間], - 0.46 [-0.77 to-0.16]; p = 0.0026). duloxetine群は偽薬群に比べて、BPIの痛み (最も軽い痛み、現在の痛み) (群間の差:-1.69 ± 0.10, p = 0.0009;各々 -2.42 ± 0.12, p = 0.0230), PGI-I (2.46 ± 0.07, p = 0.0026), CGI-S (-1.46 ± 0.06, p = 0.0019),および RDQ (-3.86 ± 0.22, p = 0.0439)を含む多くの二次的な計測が、有意に改善. 副作用はduloxetine群の方が有意に発生率が高く、眠気、便秘、吐気、めまい、口渇などがあり、それらは軽度から中等度であり解消又は改善した。まとめ:Duloxetine 60 mgは日本人のCLBP患者には有効であり耐用性あり。Spine (Phila Pa 1976). 2016 May 23. [Epub ahead of print]A Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Duloxetine Monotherapy in Japanese Patients with Chronic Low Back Pain.Konno S1, Oda N, Ochiai T, Alev L.• 1*Department of Orthopedic Surgery, Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295, Japan †Shionogi & Co. Ltd, 12F, Hankyu Terminal Bldg., 1-4 Shibata 1-chome, Kita-ku, Osaka 530-0012, Japan ‡Medicines Development Unit, Medical Science, Eli Lilly Japan K.K., Sannomiya Plaza Bldg., 7-1-5 Isogamidori, Chuo-ku, Kobe 651-0086, Japan.
[PR]

by fibromyalgia11 | 2016-05-30 12:38 | 抗うつ薬

急性肢外傷に対する静注アセトアミノフェンの鎮痛効果

方法:無作為振り分け二重盲検臨床研究で、救急外来の急性の肢外傷で痛みが3/10を超える全患者(18歳以上)を集めた; 1 g IV paracetamol 又は0.1 mg/kg IV morphine sulfate 15分かけて点滴.一次的な結果は点滴後01530分時のnumerical rating scaleで計測した痛み点数。救急鎮痛薬の必要性と副作用の頻度を計測。結果:60人の患者を無作為にIV paracetamol (n = 30) 又はIV morphine (n = 30)に振り分け.分時のnumericalrating scale痛み強度点数の低下の平均はparacetamol 3.86 (±1.61)morphine2.16 (± 1.39).しかし, 鎮痛はparacetamol群の方がmorphine 群より有意に高かった(P <0.001). paracetamol群の4人の患者とmorphine群の15人の患者は救急鎮痛薬が必要であり有意差あり (P = 0.05).

TraumaMon. 2016 Feb 6;21(1):e19649. doi: 10.5812/traumamon.19649.eCollection 2016.

Efficacy of Intravenous Paracetamol VersusIntravenous Morphine in Acute Limb Trauma.

Jalili M1, MozaffarpourNoori A2, SedaghatM3, Safaie A1.

  • 1Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.
  • 2Department of Emergency Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran.
  • 3Department of Community Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.

[PR]

by fibromyalgia11 | 2016-05-30 12:35 | アセトアミノフェン、NSAID

線維筋痛症へのリフレックス、レメロンの鎮痛効果

日本人のFM患者におけるmirtazapine の効果と安全性を評価するために、57の場所で201211月から20142月まで平行、無作為振り分け、偽薬対照のIIa研究を行った. FMACR1990診断基準に合致した2064歳の患者であり偽薬の期間に安定した強い痛みのあった者を無作為にコンピューターで (1:1) mirtazapine のみ(15mg/day1週間、その後30 mg/day) 又はマッチさせた偽薬を12週間、に振り分け. 一次的な評価項目は、ベースラインから最終時点 (Week 12又は早期中断)までのnumerical rating scale (NRS)痛み点数の変化の平均. 無作為に振り分けた430人の患者(各群n=215)のうち,422 (各群n=211)が一次的な評価項目を解析。最終評価時、mirtazapineは偽薬に比べて、平均NRS痛み点数が有意に大きく低下(0.44; 95% 信頼区間, -0.72 to -0.17; p=0.0018). 6週から前方へ、mirtazapineによる痛みの低下は偽薬に比べて、有意に大きいま.mirtazapineによって治療された者はベースラインから30%以上NRSが低下した者が多い(45.5% vs 30.8%). Mirtazapineは、FIQおよび the Short-Form 36 Questionnaireの日本語版で評価した痛みに関連した生活の質も向上させた. mirtazapine の方が偽薬よりも副作用は多く(68.8% vs 56.7%), 眠気 (32.1% vs 7.4%), 体重増加(17.7% vs 0.9%), および食欲増加(11.6%vs 3.3%)を含む. まとめとして、mirtazapineは日本人のFM患者において有効で安全な治療。

Pain. 2016 May21. [Epub ahead of print]

Efficacy of mirtazapine for the treatment offibromyalgia without concomitant depression: A randomized, double-blind,placebo-controlled phase IIa study in Japan.

Miki K1, MurakamiM,Oka H, Onozawa K, Yoshida S, Osada K.

  • 1aDepartment of Orthopaedic Surgery, Amagasaki Central Hospital, 1-12-1 Shioe, Amagasaki, Hyogo 661-0976, Japan bDepartment of Psychosomatic Medicine, Nihon University Hospital, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan cDepartment of Rheumatology, Hachioji Medical Center, Tokyo Medical University, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan dClinical Research Planning Department, Meiji Seika Pharma Co., Ltd., 2-4-16 Kyobashi, Chuo-ku, Tokyo 104-8002, Japan eClinical Research Planning Department, Meiji Seika Pharma Co., Ltd., 2-4-16 Kyobashi, Chuo-ku, Tokyo 104-8002, Japan fDepartment of Neuropsychiatry, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.

[PR]

by fibromyalgia11 | 2016-05-30 12:31 | FMの薬物治療各論

妊婦へのリリカ投与の危険性

方法:この多施設、観察前向きコホート研究で、pregabalinに暴露された女性の妊娠の結果とマッチさせた対照群(催奇形性のある薬や抗けいれん薬のいずれにも暴露されていない)を比較. Teratology(奇形学)Information Servicesの情報を系統的に2004年から2013年まで集めた。結果:pregabalinに暴露された164 人と656人の対照群のデータを集めた。染色体異常症候群を除外するとpregabalin群は重大な先天異常の割合が有意に高く, 妊娠の第一期に暴露された症例を別個に解析すると(7/116 [6.0%] vs 12/580[2.1%]; odds ratio 3.0, 95% confidence interval 1.2-7.9, p = 0.03)pregabalin 群は生児出生率が低く(71.9% vs85.2%, p < 0.001),選択的な(9.8% vs5.0%, p = 0.02)および 医学的に適用のある(5.5% vs 1.8%, p = 0.008)妊娠中絶の割合が高い.コックス比例特異的原因ハザードでは、pregabalin 暴露は自然流産の危険性の有意な高さとは関連せず。

Neurology. 2016 May 18. pii:10.1212/WNL.0000000000002767. [Epub ahead of print]

Pregnancy outcome following maternal exposureto pregabalin may call for concern.

Winterfeld U1, Merlob P2, Baud D2, Rousson V2, Panchaud A2, Rothuizen LE2, Bernard N2, Vial T2, Yates LM2, Pistelli A2, Ellfolk M2, Eleftheriou G2, de Vries LC2, Jonville-Bera AP2, Kadioglu M2, Biollaz J2, Buclin T2.

  • 1From STIS (Swiss Teratogen Information Service) and Division of Clinical Pharmacology (U.W., A.P., L.E.R., J.B., T.B.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; BELTIS Rabin Medical Center and Sackler School of Medicine (P.M.), University of Tel-Aviv, Israel; Materno-Fetal and Obstetrics Research Unit (D.B.) and Institute of Social and Preventive Medicine (IUMSP) (V.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Centre Régional de Pharmacovigilance (N.B., T.V.), Hospices Civils de Lyon, France; UKTIS (L.M.Y.), Regional Drug and Therapeutics Centre, Newcastle upon Tyne Hospitals NHS Trust, UK; Centro di Riferimento Regionale di Tossicologia Perinatale (A.P.), Azienda Ospedaliero Universitaria Careggi, Florence, Italy; HUCH Teratology Information Service (M.E.), HUCH Emergency Care, Helsinki, Finland; Poison Control (G.E.), Bergamo, Italy; TIS (L.C.d.V.), Netherlands Pharmacovigilance Centre Lareb, Den Bosch; Unit of Pharmacotherapy & Pharmaceutical Care, Department of Pharmacy, University of Groningen, the Netherlands; Centre de Pharmacovigilance de Tours (A.-P.J.-B.), CHRU, Tours, France; and Department of Pharmacology (M.K.), Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. ursula.winterfeld@chuv.ch.
  • 2From STIS (Swiss Teratogen Information Service) and Division of Clinical Pharmacology (U.W., A.P., L.E.R., J.B., T.B.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; BELTIS Rabin Medical Center and Sackler School of Medicine (P.M.), University of Tel-Aviv, Israel; Materno-Fetal and Obstetrics Research Unit (D.B.) and Institute of Social and Preventive Medicine (IUMSP) (V.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Centre Régional de Pharmacovigilance (N.B., T.V.), Hospices Civils de Lyon, France; UKTIS (L.M.Y.), Regional Drug and Therapeutics Centre, Newcastle upon Tyne Hospitals NHS Trust, UK; Centro di Riferimento Regionale di Tossicologia Perinatale (A.P.), Azienda Ospedaliero Universitaria Careggi, Florence, Italy; HUCH Teratology Information Service (M.E.), HUCH Emergency Care, Helsinki, Finland; Poison Control (G.E.), Bergamo, Italy; TIS (L.C.d.V.), Netherlands Pharmacovigilance Centre Lareb, Den Bosch; Unit of Pharmacotherapy & Pharmaceutical Care, Department of Pharmacy, University of Groningen, the Netherlands; Centre de Pharmacovigilance de Tours (A.-P.J.-B.), CHRU, Tours, France; and Department of Pharmacology (M.K.), Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

[PR]

by fibromyalgia11 | 2016-05-22 11:21 | 抗痙攣薬

むずむず脚症候群における徐放性ガバペンチンの有効性

方法:強度の成人一次性RLS (ベースラインのInternational RestlessLegs Scale (IRLS) 全点数≥24)における、gabapentin enacarbil (GEn)600-mg, GEn 1200-mg, および偽薬治療を用いた、3つの12-週の、二重盲検、偽薬対照、無作為振り分け研究(NCT00298623,NCT00365352,NCT01332305)のデータを統合。12週時点での2つの一次的な評価項目は、IRLS 総点数のベースラインからの変化の平均、およびthe investigator-ratedClinical Global Impression - Improvement (CGI-I)尺度の反応者("much"/verymuch"改善)の割合.個々のIRLS項目(つまり、睡眠、気分、生活の質、痛み、安全性)の結果を評価。結果:強度の一次性RLS患者309(偽薬,n = 110; GEn 600 mg, n = 80; GEn 1200 mg, n = 119). GEn 600 mg および1200 mg 12週での平均最小二乗IRLS全点数versus偽薬を有意に改善(偽薬,-12.3; GEn 600 mg, -16.3; GEn 1200 mg, -18.0;治療の差vs.偽薬, 両方p <0.01).GEn 600 mg (64%) および1200 mg(74%)で治療を受けた強度の一次性RLS患者は、12週の時点で偽薬よりもCGI-I 反応者が有意に多かった(42%;両方のGenの投与量p <0.01). 12週の時点で、両方のGEn の投与量は有意にその他の結果を改善した。治療が誘発した副作用(treatment-emergentadverse eventsTEAEs)で最も多い物は眠気(GEn, 21-24%;偽薬, 3%) およびめまい(GEn,14-19%;偽薬, 3%).まとめ:GEn (600 mg or 1200 mg)11回は強度の一次性RLSにおいてRLS症状とその他の症状を有意に改善した。最も多いTEAEsは眠気とめまい.

Sleep Med. 2016 Mar;19:50-6. doi:10.1016/j.sleep.2015.11.002. Epub 2015 Nov 14.

Efficacy of gabapentin enacarbil in adultpatients with severe primary restless legs syndrome.

Lee DO1, Buchfuhrer MJ2, Garcia-Borreguero D3, Avidan AY4, Ahmed M5, Hays R6, Ondo WG7, Jaros MJ8, Kim R9, Shang G9.

  • 1Baptist Health Neurology, 789 Eastern Bypass Suite 16, Richmond, KY 40475, USA. Electronic address: daniel.lee@bhsi.com.
  • 2Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
  • 3Sleep Research Institute, Alberto Alcocer 19, 28036 Madrid, Spain.
  • 4UCLA Sleep Disorders Center, Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, Los Angeles, CA 90095, USA.
  • 5Cleveland Sleep Research Center, 17900 Jefferson Park Road, Suite 102, Middleburg Heights, OH 44130, USA.
  • 6University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8508, USA.
  • 7University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1010, Houston, TX 77030, USA.
  • 8Summit Analytical, LLC, 2422 Stout Street, Denver, CO 80205, USA.
  • 9XenoPort, Inc., 3410 Central Expressway, Santa Clara, CA 95051, USA.

[PR]

by fibromyalgia11 | 2016-05-22 11:15 | むずむず脚症候群

プロトンポンプ阻害薬による腎障害

退役軍人局の全国データベースを用いてPPIの新規使用者 (n=173,321) およびhistamine H2-receptorantagonistsの新規使用者 (H2blockers;n=20,270)の一次的なコホートを作成し、これらの患者を5年間経過観察し腎臓の結果を確認。補正コックス生存モデルを用いると、H2blockers群と比べて, PPI群はeGFR<60ml/min per 1.73 m2になる危険性と慢性腎疾患(CKD)になる危険性 (各々hazard ratio [HR], 1.22; 95% confidenceinterval [95% CI], 1.18 to 1.26; よびHR,1.28; 95% CI, 1.23 to 1.34)が高い. PPIで治療を受けた患者は血清クレアチニンレベルが2倍になる (HR, 1.53; 95% CI, 1.42 to 1.65), eGFR30%を超えて低下(HR, 1.32; 95% CI, 1.28 to 1.37), および末期腎不全(End Stage Renal DiseaseESRD(HR, 1.96; 95% CI, 1.21to 3.18)の危険性が有意に増加.さらに, 30日以下の暴露の者に比べて、PPI 31-90,91-180, 181-360, および361-720日間使用した者の中で、PPI暴露期間と腎臓の結果の間に段階的な関連を見つけた。1:1で傾向点数をマッチさせたH2blockers 摂取者とversus PPI摂取者のコホート、およびPPI摂取者と versus対照群の腎臓の結果の危険性を調べると、同じ結果。我々の結果によると、PPIへの暴露は CKDの発生,CKDの進展、およびESRDの危険性を増加させる.

J Am SocNephrol. 2016 Apr 14. pii: ASN.2015121377. [Epub ahead of print]

Proton Pump Inhibitors and Risk ofIncident CKD and Progression to ESRD.

Xie Y1, Bowe B1, Li T2, Xian H3, BalasubramanianS1, Al-Aly Z4.

  • 1Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri;
  • 2Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri;
  • 3Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri; Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri; and.
  • 4Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri; Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri; Division of Nephrology, Department of Medicine, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri zalaly@gmail.com ziyad.alaly@va.gov.

[PR]

by fibromyalgia11 | 2016-05-22 11:12 | その他

抗うつ薬による骨祖鬆症

方法:1988 人の女性(年齢57-67)が、郵便調査に反応し大腿骨頸部の骨密度(bone mineral densityBMD) 1999年と2004年に再度計測したthe Kuopio Osteoporosis Risk Factor and Prevention Study(OSTPRE)コホートに参加した. 抗うつ薬使用のデータはthe NationalPrescription Registerから得た. 多変量回帰技法を用いて、身体計測、医療、身体、および生活スタイルの要因で補正前後の関連を検査。結果:5年間の経過観察で、319(16.0%)の女性が抗うつ薬を購入。全研究群の大腿骨頸部のBMDのベースラインの平均は881mg/cm2 (SD 123) であり5年間の平均骨量の減少は6.0mg/cm2 (SD 4.7). 補正後, TCA使用者は非使用者よりも年間のBMD喪失が大きい(-3.6mg/cm2 vs.-1.1mg/cm2; P=0.031). 骨量の減少の加速は、用量反応様式でSSRI使用 (P=0.001)およびその他の抗うつ薬の使用と関連し, 後者は研究期間中に体重が減った低体重又は正常体重の女性でのみ起こる。まとめ:SSRIs使用は用量反応様式で閉経後の骨量減少を促進するようだ。TCAおよびその他の抗うつ薬使用と骨量減少の関連も存在するようだ。

Bone. 2016 May11. pii: S8756-3282(16)30130-2. doi: 10.1016/j.bone.2016.05.003. [Epub ahead ofprint]

Effects of antidepressants on postmenopausalbone loss - A 5-year longitudinal study from the OSTPRE cohort.

Rauma PH1, HonkanenRJ2, WilliamsLJ3, TuppurainenMT4, Kröger HP5, Koivumaa-HonkanenH6.

  • 1Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland. Electronic address: pr.rauma@gmail.com.
  • 2Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland. Electronic address: risto.honkanen@fimnet.fi.
  • 3School of Medicine, Deakin University, Geelong, Australia. Electronic address: lanaw@barwonhealth.org.au.
  • 4Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland; Department of Obstetrics and Gynaecology, KUH, Kuopio, Finland. Electronic address: marjo.tuppurainen@kuh.fi.
  • 5Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland; Department of Orthopaedics, Traumatology and Handsurgery, KUH, Kuopio, Finland. Electronic address: heikki.kroger@kuh.fi.
  • 6Institute of Clinical Medicine, Psychiatry, UEF, Kuopio, Finland; Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland; Departments of Psychiatry, Kuopio University Hospital (KUH), South-Savonia Hospital District, Mikkeli, Finland; Departments of Psychiatry, North Karelia, Central Hospital, Joensuu, Finland; Departments of Psychiatry, SOSTERI, Savonlinna, Finland; Departments of Psychiatry, SOTE, Iisalmi, Finland; Departments of Psychiatry, Lapland, Hospital District, Rovaniemi, Finland; Departments of Psychiatry, University of Oulu, Finland. Electronic address: heli.koivumaa@kuh.fi.

[PR]

by fibromyalgia11 | 2016-05-22 11:09 | 抗うつ薬

抗不安薬は疾患のある人に処方されやすい

BZD処方は副作用の危険因子と関連があるかどうか調べた。デザイン:201171日から2012630日までの縦断コホート研究。参加者:研究ネッワークに基づく病院受診およびprimary care受診の地域に基づいた受診の患者。主要な結果:標準的なおよび高用量のBZD処方の患者の特定の疾患を持つオッズ比; 患者100人当たりの外来受診、救急外来受診および入院の割合。主要な結果:65,912人の患者の中で,医師は15 % の人(9821)に少なくとも1つのBZDを処方.BZDを処方された者の中で, 5 % は高用量の処方. 非処方者と比較して, BZD処方者は抑うつ(OR,2.7; 95 % CI, 2.6-2.9), 物質乱用 (OR, 2.2;95 % CI, 1.9-2.5), 喫煙(OR, 1.7;95 % CI, 1.5-1.8),骨祖鬆症 (OR, 1.6;95 % CI, 1.5-1.7), 慢性閉塞性肺疾患(OR, 1.6;95 % CI, 1.5-1.7), アルコール乱用 (OR, 1.5;95 % CI, 1.3-1.7), 睡眠時無呼吸(OR, 1.5;95 % CI, 1.3-1.6), および喘息(OR, 1.5;95 % CI, 1.4-1.5)と診断されやすい. BZDの低用量処方者と比較して、BZDの高用量処方者は以下の疾患と診断されやすい: 物質乱用(OR, 7.5; 95 % CI, 5.5-10.1), アルコール乱用 (OR, 3.2; 95 % CI, 2.2-4.5), 喫煙(OR, 2.7; 95 % CI, 2.1-3.5), および慢性閉塞性肺疾患(OR, 1.5; 95 % CI,1.2-1.9). BZD処方者は患者100人当たりのprimary care受診(408 vs. 323), 専門外来受診(815 vs.578), 救急外来受診(47 vs. 29),および入院(26 vs. 15; p < .001すべての比較)が多い。まとめ: BZDが関連した副作用の危険性が高い患者に、医師はBZD又は高用量のBZDの処方を頻繁にした。BZD使用は医療利用の増加と関連。

J Gen Intern Med. 2016 May13. [Epub ahead of print]

Benzodiazepines arePrescribed More Frequently to Patients Already at Risk for Benzodiazepine-RelatedAdverse Events in Primary Care.

Kroll DS1,2, Nieva HR3,4, Barsky AJ3,5, Linder JA3,4.

  • 1Harvard Medical School, Boston, MA, USA. dskroll@partners.org.
  • 2Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02120, USA. dskroll@partners.org.
  • 3Harvard Medical School, Boston, MA, USA.
  • 4Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • 5Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02120, USA.

[PR]

by fibromyalgia11 | 2016-05-18 17:09 | 抗不安薬の常用量依存
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世界標準の線維筋痛症を専門家が説明します


by fibromyalgia11
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