Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.008
Aodhán S. Breathnach
Endocarditis is a rare but serious condition, with a high associated mortality. Risks include congenital and acquired valvular disease, poor dentition, injecting drug use, the presence of prosthetic heart valves and prolonged intravascular access (e.g. dialysis). Most cases are caused by staphylococci, oral streptococci or enterococci. Patients can present with any combination of features of sepsis, local cardiac valvular abnormalities and embolic phenomena. Diagnosis depends on combined evidence of infection (clinical sepsis, emboli, bacteraemia) and cardiac imaging (echocardiography, positron emission tomography CT). Treatment usually involves prolonged courses of intravenous antibiotics in synergistic combinations; many patients also need surgery, usually involving valve replacement. Specific preventive measures include prophylactic antibiotics for high-risk patients during dental procedures, although the benefit is disputed. Non-infective conditions that mimic infective endocarditis include marantic endocarditis and Libman–Sacks endocarditis.
{"title":"Infective endocarditis and infections of cardiac devices","authors":"Aodhán S. Breathnach","doi":"10.1016/j.mpmed.2025.11.008","DOIUrl":"10.1016/j.mpmed.2025.11.008","url":null,"abstract":"<div><div>Endocarditis is a rare but serious condition, with a high associated mortality. Risks include congenital and acquired valvular disease, poor dentition, injecting drug use, the presence of prosthetic heart valves and prolonged intravascular access (e.g. dialysis). Most cases are caused by staphylococci, oral streptococci or enterococci. Patients can present with any combination of features of sepsis, local cardiac valvular abnormalities and embolic phenomena. Diagnosis depends on combined evidence of infection (clinical sepsis, emboli, bacteraemia) and cardiac imaging (echocardiography, positron emission tomography CT). Treatment usually involves prolonged courses of intravenous antibiotics in synergistic combinations; many patients also need surgery, usually involving valve replacement. Specific preventive measures include prophylactic antibiotics for high-risk patients during dental procedures, although the benefit is disputed. Non-infective conditions that mimic infective endocarditis include marantic endocarditis and Libman–Sacks endocarditis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 96-101"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.009
Catharina M Mulders-Manders, Albrecht Betrains
Pyrexia or fever of unknown origin is defined as prolonged fever in an immunocompetent person that has an unknown cause despite standard investigations. Infections, non-infectious inflammatory diseases, malignancy and other diseases can all cause pyrexia of unknown origin. The diagnostic work-up is based on the identification of potential diagnostic clues, and further investigation is based on the differential diagnosis of these clues. When diagnostic clues are absent, 18F-FDG-PET-CT is the single test with the highest contributory value, helping the final diagnosis in half of all patients. In Western Europe, up to 50% of patients remain without a diagnosis despite extensive investigation. Mortality is low in undiagnosed cases, and spontaneous resolution of fever is relatively common.
{"title":"Pyrexia of unknown origin","authors":"Catharina M Mulders-Manders, Albrecht Betrains","doi":"10.1016/j.mpmed.2025.11.009","DOIUrl":"10.1016/j.mpmed.2025.11.009","url":null,"abstract":"<div><div>Pyrexia or fever of unknown origin is defined as prolonged fever in an immunocompetent person that has an unknown cause despite standard investigations. Infections, non-infectious inflammatory diseases, malignancy and other diseases can all cause pyrexia of unknown origin. The diagnostic work-up is based on the identification of potential diagnostic clues, and further investigation is based on the differential diagnosis of these clues. When diagnostic clues are absent, <sup>18</sup>F-FDG-PET-CT is the single test with the highest contributory value, helping the final diagnosis in half of all patients. In Western Europe, up to 50% of patients remain without a diagnosis despite extensive investigation. Mortality is low in undiagnosed cases, and spontaneous resolution of fever is relatively common.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 130-134"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.003
Andrew Woodhouse
Bacterial meningitis and brain abscess are serious infections of the central nervous system associated with high mortality and morbidity. Outcomes from these infections are improved by early diagnosis and treatment. If bacterial meningitis is suspected, it should be considered a medical emergency with an emphasis on early lumbar puncture (LP) and prompt initiation of empirical antibiotic treatment together with corticosteroids. The requirement for neuroimaging in suspected meningitis before LP is limited to a small number of situations. Published guidelines should be followed to reduce unnecessary scanning and delays in performing LP and starting antibiotics. Conversely, the diagnosis of brain abscess requires early cerebral imaging and a multidisciplinary approach between emergency physicians, radiologists, infection specialists and neurosurgeons to optimize outcomes.
{"title":"Bacterial meningitis and brain abscess","authors":"Andrew Woodhouse","doi":"10.1016/j.mpmed.2025.11.003","DOIUrl":"10.1016/j.mpmed.2025.11.003","url":null,"abstract":"<div><div>Bacterial meningitis and brain abscess are serious infections of the central nervous system associated with high mortality and morbidity. Outcomes from these infections are improved by early diagnosis and treatment. If bacterial meningitis is suspected, it should be considered a medical emergency with an emphasis on early lumbar puncture (LP) and prompt initiation of empirical antibiotic treatment together with corticosteroids. The requirement for neuroimaging in suspected meningitis before LP is limited to a small number of situations. Published guidelines should be followed to reduce unnecessary scanning and delays in performing LP and starting antibiotics. Conversely, the diagnosis of brain abscess requires early cerebral imaging and a multidisciplinary approach between emergency physicians, radiologists, infection specialists and neurosurgeons to optimize outcomes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 73-80"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.09.005
Mark Gibson, Oseme Etomi, Elena Nikiphorou
Pregnancy in patients with inflammatory rheumatic diseases (IRMDs) presents unique challenges requiring multidisciplinary, individualized care. Historically associated with poor maternal and fetal outcomes, pregnancy in this population is now safer because of improved disease control and therapeutic strategies. However, risks vary by diagnosis and disease activity, with active disease at conception being a key predictor of adverse outcomes. Physiological changes during pregnancy, such as immune modulation, hormonal shifts and cardiovascular adaptations, can affect disease course and treatment decisions. Conditions such as systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis require particular attention because of heightened risks of flares, thrombosis and poor fetal growth. Pre-conception counselling is essential to optimize disease stability, adjust medications and assess risk. Many conventional disease-modifying antirheumatic drugs and tumour necrosis factor inhibitors are safe for use in pregnancy and breastfeeding, while teratogenic agents such as methotrexate and mycophenolate must be discontinued in advance. Regular monitoring, including disease activity assessments and fetal surveillance, is vital throughout pregnancy. Postpartum disease flares are common and require proactive management. With appropriate planning and coordinated care, most women with IRMDs can experience successful pregnancies and healthy postpartum outcomes, highlighting the importance of balancing disease control with maternal and neonatal safety.
{"title":"Management of pregnancy in patients with rheumatic disease","authors":"Mark Gibson, Oseme Etomi, Elena Nikiphorou","doi":"10.1016/j.mpmed.2025.09.005","DOIUrl":"10.1016/j.mpmed.2025.09.005","url":null,"abstract":"<div><div>Pregnancy in patients with inflammatory rheumatic diseases (IRMDs) presents unique challenges requiring multidisciplinary, individualized care. Historically associated with poor maternal and fetal outcomes, pregnancy in this population is now safer because of improved disease control and therapeutic strategies. However, risks vary by diagnosis and disease activity, with active disease at conception being a key predictor of adverse outcomes. Physiological changes during pregnancy, such as immune modulation, hormonal shifts and cardiovascular adaptations, can affect disease course and treatment decisions. Conditions such as systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis require particular attention because of heightened risks of flares, thrombosis and poor fetal growth. Pre-conception counselling is essential to optimize disease stability, adjust medications and assess risk. Many conventional disease-modifying antirheumatic drugs and tumour necrosis factor inhibitors are safe for use in pregnancy and breastfeeding, while teratogenic agents such as methotrexate and mycophenolate must be discontinued in advance. Regular monitoring, including disease activity assessments and fetal surveillance, is vital throughout pregnancy. Postpartum disease flares are common and require proactive management. With appropriate planning and coordinated care, most women with IRMDs can experience successful pregnancies and healthy postpartum outcomes, highlighting the importance of balancing disease control with maternal and neonatal safety.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 792-795"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.09.011
Mark Gibson, Elena Nikiphorou
Rheumatoid arthritis (RA) is a chronic inflammatory disease that, if untreated, can cause irreversible joint damage and long-term disability. Early intervention using a treat-to-target strategy – aiming for remission or low disease activity – has transformed outcomes, especially when initiated within the therapeutic window of opportunity. Methotrexate remains the anchor conventional synthetic disease-modifying antirheumatic drug (DMARD), often used in combination with other conventional synthetic DMARDs and short-term corticosteroids. For patients not achieving disease control, escalation to biologic or targeted synthetic DMARDs is recommended. Biosimilars have improved access to biologics, while Janus kinase inhibitors, a newer targeted synthetic DMARD class, offer oral administration and rapid onset. However, concerns about cardiovascular and cancer risks have prompted regulatory cautions. RA is associated with multiple co-morbidities, including cardiovascular disease, infections and malignancies, necessitating structured reviews and proactive management. A subset of patients develop difficult-to-treat RA, where persistent symptoms and psychosocial factors complicate care. Chronic pain and mental health impacts further impair quality of life, highlighting the need for a comprehensive, multidisciplinary approach. Personalized medicine and biomarker-driven strategies may improve outcomes and reduce disease burden. Overall, optimal RA management must balance effective pharmacological control with holistic care addressing the full spectrum of physical and psychosocial challenges.
{"title":"Management of rheumatoid arthritis","authors":"Mark Gibson, Elena Nikiphorou","doi":"10.1016/j.mpmed.2025.09.011","DOIUrl":"10.1016/j.mpmed.2025.09.011","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease that, if untreated, can cause irreversible joint damage and long-term disability. Early intervention using a treat-to-target strategy – aiming for remission or low disease activity – has transformed outcomes, especially when initiated within the therapeutic window of opportunity. Methotrexate remains the anchor conventional synthetic disease-modifying antirheumatic drug (DMARD), often used in combination with other conventional synthetic DMARDs and short-term corticosteroids. For patients not achieving disease control, escalation to biologic or targeted synthetic DMARDs is recommended. Biosimilars have improved access to biologics, while Janus kinase inhibitors, a newer targeted synthetic DMARD class, offer oral administration and rapid onset. However, concerns about cardiovascular and cancer risks have prompted regulatory cautions. RA is associated with multiple co-morbidities, including cardiovascular disease, infections and malignancies, necessitating structured reviews and proactive management. A subset of patients develop difficult-to-treat RA, where persistent symptoms and psychosocial factors complicate care. Chronic pain and mental health impacts further impair quality of life, highlighting the need for a comprehensive, multidisciplinary approach. Personalized medicine and biomarker-driven strategies may improve outcomes and reduce disease burden. Overall, optimal RA management must balance effective pharmacological control with holistic care addressing the full spectrum of physical and psychosocial challenges.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 787-791"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.10.004
Tonia L Vincent, Fiona E Watt
Osteoarthritis (OA) is the most common form of joint disease, and its impact is set to grow as the prevalence of obesity rises and the elderly population increases. Many clinicians regard OA as simply a disease of ‘wear and tear’, and by implication one in which disease modification is not possible. Such prejudices previously led to significant academic apathy, reflected not only in the poor understanding of disease pathogenesis, but also in the failure to classify the disease with greater precision and develop sensitive tools for diagnostic and prognostic assessment. The identification of key degradative enzymes in cartilage, the appreciation that damaged articular cartilage has repair capabilities and the recognition that ‘good’ and ‘bad’ mechanical stress activates/regulates different molecular pathways have greatly changed the outlook in recent years. Evidence-based management of the condition is outlined in international guidelines: education, weight control/loss and physical activity/exercise (general, joint specific) are core interventions. Analgesia and non-pharmacological and surgical approaches favourably affecting joint biomechanics are used for treating painful OA unresponsive to core interventions. The disease remains the most common reason for joint replacement surgery. There are no licensed disease-modifying OA drugs but recent clinical trials suggest that these may be within reach.
{"title":"Osteoarthritis","authors":"Tonia L Vincent, Fiona E Watt","doi":"10.1016/j.mpmed.2025.10.004","DOIUrl":"10.1016/j.mpmed.2025.10.004","url":null,"abstract":"<div><div>Osteoarthritis (OA) is the most common form of joint disease, and its impact is set to grow as the prevalence of obesity rises and the elderly population increases. Many clinicians regard OA as simply a disease of ‘wear and tear’, and by implication one in which disease modification is not possible. Such prejudices previously led to significant academic apathy, reflected not only in the poor understanding of disease pathogenesis, but also in the failure to classify the disease with greater precision and develop sensitive tools for diagnostic and prognostic assessment. The identification of key degradative enzymes in cartilage, the appreciation that damaged articular cartilage has repair capabilities and the recognition that ‘good’ and ‘bad’ mechanical stress activates/regulates different molecular pathways have greatly changed the outlook in recent years. Evidence-based management of the condition is outlined in international guidelines: education, weight control/loss and physical activity/exercise (general, joint specific) are core interventions. Analgesia and non-pharmacological and surgical approaches favourably affecting joint biomechanics are used for treating painful OA unresponsive to core interventions. The disease remains the most common reason for joint replacement surgery. There are no licensed disease-modifying OA drugs but recent clinical trials suggest that these may be within reach.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 834-843"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.09.010
Chung Mun Alice Lin, Kenneth F Baker
Rheumatoid arthritis is a chronic, destructive, immune-mediated inflammatory disease that affects 1% of the UK population. Advances in our understanding of the underlying aetiopathology have highlighted the heterogeneous nature of this disease, with multifactorial contributions from both genetic and environmental factors among others.
{"title":"Aetiopathology of rheumatoid arthritis","authors":"Chung Mun Alice Lin, Kenneth F Baker","doi":"10.1016/j.mpmed.2025.09.010","DOIUrl":"10.1016/j.mpmed.2025.09.010","url":null,"abstract":"<div><div>Rheumatoid arthritis is a chronic, destructive, immune-mediated inflammatory disease that affects 1% of the UK population. Advances in our understanding of the underlying aetiopathology have highlighted the heterogeneous nature of this disease, with multifactorial contributions from both genetic and environmental factors among others.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 777-781"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.09.004
Anthony Lockett
In the context of healthcare digital twins are computer-generated simulations of an organ, person or healthcare process designed to improve or evaluate healthcare. They offer much promise in personalized medicine, but there have been limits caused by the complexity of data involved and the integration with real-world evidence. Agentic artificial intelligence (AI) has recently been proposed as a solution, but this brings the issues of lack of transparency and bias. Until these issues are resolved, digital twins will be limited in their applicability to healthcare.
{"title":"Digital twins – their future in healthcare","authors":"Anthony Lockett","doi":"10.1016/j.mpmed.2025.09.004","DOIUrl":"10.1016/j.mpmed.2025.09.004","url":null,"abstract":"<div><div>In the context of healthcare digital twins are computer-generated simulations of an organ, person or healthcare process designed to improve or evaluate healthcare. They offer much promise in personalized medicine, but there have been limits caused by the complexity of data involved and the integration with real-world evidence. Agentic artificial intelligence (AI) has recently been proposed as a solution, but this brings the issues of lack of transparency and bias. Until these issues are resolved, digital twins will be limited in their applicability to healthcare.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 844-845"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.10.003
Ashley Elliott
Psoriatic arthritis (PsA) is a chronic seronegative inflammatory arthritis associated with psoriasis. It affects up to 0.3–1% of the population, typically in middle age. This review provides an overview of PsA and associated peripheral seronegative arthritides. Key epidemiological data are discussed, highlighting that PsA occurs in 20–30% of individuals with psoriasis and can be underdiagnosed. We outline the pathophysiology of PsA, emphasizing the role of genetic predisposition and immune pathways (e.g. interleukin (IL-23)/IL-17 axis) leading to synovitis, enthesitis and joint damage. The spectrum of clinical presentations is described, from peripheral joint oligoarthritis with dactylitis to axial spondylitis and arthritis mutilans. The diagnostic approach focuses on history (psoriasis, nail changes, pattern of arthritis) and examination (enthesitis, dactylitis), supported by imaging, particularly musculoskeletal ultrasonography for early detection of subclinical disease. We summarize management strategies, including non-steroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs and biologic agents, and address tailored approaches for related conditions.
{"title":"Psoriatic arthritis and related spondylarthritides","authors":"Ashley Elliott","doi":"10.1016/j.mpmed.2025.10.003","DOIUrl":"10.1016/j.mpmed.2025.10.003","url":null,"abstract":"<div><div>Psoriatic arthritis (PsA) is a chronic seronegative inflammatory arthritis associated with psoriasis. It affects up to 0.3–1% of the population, typically in middle age. This review provides an overview of PsA and associated peripheral seronegative arthritides. Key epidemiological data are discussed, highlighting that PsA occurs in 20–30% of individuals with psoriasis and can be underdiagnosed. We outline the pathophysiology of PsA, emphasizing the role of genetic predisposition and immune pathways (e.g. interleukin (IL-23)/IL-17 axis) leading to synovitis, enthesitis and joint damage. The spectrum of clinical presentations is described, from peripheral joint oligoarthritis with dactylitis to axial spondylitis and arthritis mutilans. The diagnostic approach focuses on history (psoriasis, nail changes, pattern of arthritis) and examination (enthesitis, dactylitis), supported by imaging, particularly musculoskeletal ultrasonography for early detection of subclinical disease. We summarize management strategies, including non-steroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs and biologic agents, and address tailored approaches for related conditions.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 822-828"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.mpmed.2025.09.006
Anisur Rahman
Chronic pain syndromes are characterized by pain that is present every day and not explained by any specific physical injury or disease. The pain is related to central sensitization of the central nervous system pain mechanisms such that pain is amplified. ‘Chronic widespread pain’ (CWP) means that the pain is present on both sides of the body, both above and below the waist and in the spinal region. Fibromyalgia is a subgroup of CWP in which, as well as pain, patients suffer from typical symptoms including fatigue, unrefreshing sleep and ‘fibro-fog’. It is estimated that 11% of the population suffer from CWP and 2–6% have fibromyalgia. CWP and fibromyalgia are clinical diagnoses based primarily on the history. Investigations are useful only to exclude other diagnoses or look at specific areas where the pain is out of proportion to the rest of the body. There is no cure for CWP or fibromyalgia, and treatments are designed to improve quality of life rather than remove the symptoms. Patient education and encouragement of exercise are key. There is only weak evidence for any medications. However, amitriptyline, tramadol and duloxetine are useful in some patients.
{"title":"Chronic widespread pain and the fibromyalgia syndrome","authors":"Anisur Rahman","doi":"10.1016/j.mpmed.2025.09.006","DOIUrl":"10.1016/j.mpmed.2025.09.006","url":null,"abstract":"<div><div>Chronic pain syndromes are characterized by pain that is present every day and not explained by any specific physical injury or disease. The pain is related to central sensitization of the central nervous system pain mechanisms such that pain is amplified. ‘Chronic widespread pain’ (CWP) means that the pain is present on both sides of the body, both above and below the waist and in the spinal region. Fibromyalgia is a subgroup of CWP in which, as well as pain, patients suffer from typical symptoms including fatigue, unrefreshing sleep and ‘fibro-fog’. It is estimated that 11% of the population suffer from CWP and 2–6% have fibromyalgia. CWP and fibromyalgia are clinical diagnoses based primarily on the history. Investigations are useful only to exclude other diagnoses or look at specific areas where the pain is out of proportion to the rest of the body. There is no cure for CWP or fibromyalgia, and treatments are designed to improve quality of life rather than remove the symptoms. Patient education and encouragement of exercise are key. There is only weak evidence for any medications. However, amitriptyline, tramadol and duloxetine are useful in some patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 12","pages":"Pages 829-833"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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