I guess, all things considered, Philadelphia was not a bad place to be last week.
Philadelphia hosted the American College of Rheumatology annual scientific meeting, and while there were certainly no earth-shattering revelations, there were still many thought-provoking discussions. The mission remains: To help those suffering from rheumatic illness.
Rheumatologists are still grappling with figuring out fibromyalgia: One research presentation discussed the development of a Fibromyalgia Responder Index, as it is important to determine which fibromyalgia symptoms and expressions of function drive how an individual patient determines whether or not there is improvement with treatment. Not surprisingly, the analysis of the data showed that modulating pain, fatigue, and sleep were associated most strongly with improvement in fibromyalgia.
Likewise, the cost of repairing the damage due to fibromyalgia continues to be a significant burden on society. Indirect costs due to unemployment or time away from work accounts for the largest proportion of these costs.
I was interested in particular in some of the data presented for the drug, sodium oxybate. Even more interesting is the fact that sodium oxybate is in fact GHB, a known drug of abuse which is currently indicated for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy:
1. A controlled clinical trial found substantial reductions in pain in over 40% of the study subjects compared to the control group. In addition, patients on sodium oxybate also experienced greater overall "global" senses of improvement.
2. A multicenter, randomized, placebo-controlled clinical trial of sodium oxybate again proved of interest, as pain was found to be significantly improved as early as one week into the treatment regimen, and pain relief was maintained over the duration of this 14 week study. Fatigue was similarly improved. And patient global sense of improvement started at week 4, persisting throughout the study. Patients also showed significant improvements in sleep-related daytime functioning compared with placebo; sleep disturbance itself was greatly reduced by week 4, and the improvement continued throughout the study. Positive correlations were found between reduction in pain and sleep disturbance, and pain and fatigue. Finally, a positive correlation was also found in patients' assessment of sleep disturbance and fatigue with the global impression of improvement.
It is hoped that the findings at this year's meetings will germinate into available treatments for those patients suffering from the persistent and refractory symptoms of pain, fatigue, sleepiness which so well characterize the fibromyalgia patient. Let us hope that new treatments will continue to lessen the burden of fibromyalgia, for both patient and society.
