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To investigate mechanisms underlying the reduced work capacity of fibromyalgia (FM) patients were compared to healthy controls at specified workloads, using P-31 magnetic resonance spectroscopy (MRS).The forearm flexor muscle group was examined with MRS at rest, at sub maximal and at maximal controlled dynamic work as well as at maximal isometric contraction. Aerobic fitness was determined by bicycle ergonometry.Metabolite concentrations and muscle pH were similar for patients and controls at lower workloads. At maximal dynamic and static contractions the concentration of inorganic phosphate was lower and at static contractions the pH decrease was smaller in patients. The performed work by patients was only 50% compared to controls and the patients experienced more pain. Maximal oxygen uptake was lower in the fibromyalgia group. Expired gas-analysis in this group showed ventilatory equivalents at similar relative levels of maximal work capacity.Fibromyalgia patients seem to utilise less of the energy rich phosphorous metabolites at maximal work despite pH reduction. They seemed to be less aerobic fitted and reached the anaerobic threshold earlier than the controls.

To evaluate the subjective and objective response to intravenous regional administration of a glucocorticoid (IVRAG) on rheumatoid arthritis (RA), twenty RA-patients received, in a randomised, double-blind crossover and placebo-controlled fashion, either 50 mg methylprednisolone in mepivacaine 0.25% or mepivacaine (placebo) in one hand only using a Bier-block technique. The other hand was given the opposite. One week later the procedure was repeated but the previous placebo hand was now treated with the glucocorticoid. About 50% of the patients experienced a subjective improvement at 1 and 6 weeks. After one week a significant reduction was recorded in grip diastasis with no difference between the glucocorticoid and the placebo. In the other outcome measures (grip strength, handvolume, rest pain, and movement provoked pain) no differences were recorded between the glucocorticoid and placebo. At six weeks a significant reduction in grip diastasis and movement provoked pain as well as a significant increase in grip strength were noted. Hand volume was unchanged. IVRAG is a safe, easy and well-tolerated technique. The beneficial results are probably due to both a systemic and a regional effect. The findings of benefit in both hands at the end of one week seem to suggest that mepivacaine can give some short term improvement.

The intestinal permeability to polyethyleneglycols (PEGs) of varying size in patients with rheumatoid arthritis has been investigated. Permeability was determined by measuring the 6-hour urinary recovery of different-sized PEGs after oral intake of PEG 400, PEG 1000, or PEG 3000. Patients with rheumatoid arthritis excreted significantly less PEG 400 and PEG 1000 than healthy individuals, whereas the excretion of PEG 3000 was the same or even greater than in healthy individuals. These findings point to the possibility that intestinal permeability is altered in rheumatoid arthritis.

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.

The lymphocyte-stimulating capacity of bacterial antigens from Yersinia enterocolitica and Chlamydia trachomaris was studied in 14 patients with Reiter's syndrome and compared with 16 healthy controls. The influence of HLA-B27 was evaluated. There was an increased reactivity in patients compared with controls. The most pronounced reactivity was seen in HLA-B27-positive patients. These findings support the hypothesis that there is an impaired T-cell function in HLA-B27-associated diseases.

Extensive bacteriological testing was performed in 25 patients with complete or incomplete Reiter's syndrome. In 21 patients (84%), evidence of antecedent infection was found, based on culture and/or serological findings. Thus, infection with Chlamydia trachomatis (17 patients), Yersinia enterocolitica, serotype 3 (4 patients), and Campylobacter jejuni (1 patient) was identified.

Seventy-seven muscle biopsies from 57 patients with primary fibromyalgia and 17 biopsies from 9 healthy controls were examined by routine histopathological and histochemical methods. All patients fulfilled strict diagnostic criteria. 42 biopsies from patients were deemed normal or borderline, while 35 showed discrete pathological changes (degeneration, regeneration, inflammatory infiltrates, ragged red fibres, and 'moth-eaten' fibres in muscles other than m. trapezius). Biopsies from controls were normal or borderline in 14 and showed mild focal abnormalites in 3 cases. 'Moth-eaten' fibres were found in 35 of 41 trapezius biopsies taken from patients and in 9 of 10 trapezius biopsies from controls. Ragged red fibres were found in 15 of 41 trapezius biopsies taken from patients. In the deltoid muscle, 'moth-eaten' fibres were found in 3 and ragged red fibres in 2 of 9 biopsies from patients. Frequency of type I and type II fibres and the area of muscle fibres were the same in patients as in controls. Capillary density was the same in both groups. These changes, although not sufficient to constitute a diagnostic test for PF, indicate that this condition has an organic basis.

A 36-year-old HLA B 27 positive woman developed reactive type arthritis a week after enterocolitis. Stool culture and serological tests indicated Campylobacter jejuni infection. Serological evidence of previous Chlamydial infection was also obtained. The arthritis ran a benign course of 6 months, leaving no residual symptoms.