From the Journal of Clinical and Experimental Rheumatology. E-published 18 March 2015.
A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data
Leombruni P(1), Miniotti M(1), Colonna F(1), Sica C(1), Castelli L(2), Bruzzone M(3), Parisi S(3), Fusaro E(3), Sarzi-Puttini P(4), Atzeni F(5), Torta RG(1).
1) Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.
2) Department of Psychology, University of Turin, Turin, Italy.
3) Rheumatology Department, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.
4) Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
5) IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
Abstract
OBJECTIVES
Fibromyalgia syndrome (FMS) is a chronic disorder characterised by widespread musculoskeletal pain, troubled sleep, disturbed mood, and fatigue. Recently published reviews have demonstrated that it is influenced by various psychological aspects, and antidepressants are now considered the treatment of choice for most patients. The aim of this randomised controlled trial was to compare the effects of duloxetine and acetyl L-carnitine on pain, depression, anxiety and well-being in FMS patients.
METHODS
Sixty-five female outpatients with FMS diagnosed by a rheumatologist were recruited between January 2011 and May 2012, and randomised to receive duloxetine 60 mg/day or acetyl L-carnitine 1500 mg/day (500 mg t.i.d.). Drug efficacy and side effects were assessed by the same psychiatrist at baseline, and four and 12 weeks later.
RESULTS
Both drugs led to a general clinical improvement, with positive effects on pain and depressive symptoms; but neither induced a significant improvement in anxiety. Both drugs had a positive effect on the physical component of the quality of life, but only duloxetine improved the psychological component.
CONCLUSIONS
Although they need to be confirmed by further studies, these preliminary findings confirm the efficacy of duloxetine, and suggest that acetyl L-carnitine is also efficacious in improving depressive symptoms, pain, and the quality of life of FMS patients.
From the Open Journal of Gastroenterology. 9 April 2015 (full text available).
Functional Dyspepsia and Chronic Gastritis Associated with Enteroviruses
John K. Chia, Andrew Y. Chia, David Wang, Rabiha El-Habbal
EV Med Research LLC, Lomita, USA
Abstract
After decades of research, functional dyspepsia (FD) remains one of the most elusive gastrointestinal disorders. Endoscopic appearance of mild inflammation of the gastric mucosa without ulceration and microscopic evidence of mild chronic inflammation are often considered as normal findings since no etiology could be found other than H.
pylori.
Enteroviruses infect the gastrointestinal tract and have been shown to persist in the stomach of symptomatic patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
In this study, we evaluated FD patients with and without the diagnosis of ME/CFS, and were able to support the viral protein staining with finding of double-stranded RNA in 63% of the same stomach biopsies by immunoperoxidase staining.
Furthermore, we clarified the possible cross-reaction with creatine kinase brain subtype (CKB), present in parietal cells, using antibody competition experiments and western blot analysis of stomach proteins. Viral protein+ and dsRNA+ biopsies were infectious in SCID mice.
More research is needed to elucidate the mechanism of enterovirus infection of the stomach associated with FD and chronic gastritis.