纤维肌痛综合征52例临床分析

目的 分析纤维肌痛综合征(FMS)的临床特点、诊断和治疗等,提高对该病的认识.方法 回顾性分析我院2008年7月至2011年7月诊治的52例FMS的临床资料,并结合文献,探讨其临床特点、实验室检查、治疗和预后等.结果 52例FMS患者中女性和男性的比例约为9∶1,平均确诊时间4年,疼痛呈弥漫性,压痛多呈对称性,疲劳和睡眠障碍为最常见症状,无特异性的实验室检查,37例单纯药物治疗患者中有21例(57％)症状缓解,15例联合治疗患者中,有12例(80％)症状缓解.结论 FMS发病率高,临床表现多样,应引起临床医生的足够重视,由于本研究样本数量的限制,尚不能得出联合治疗优于单纯药物治疗的结论.     

住院1型糖尿病患者742例临床分析

目的了解住院1型糖尿病（T1DM）的临床特点。方法回顾性分析1986年1月至2012年2月在解放军总医院住院治疗的所有T1DM患者的临床资料。以年龄≥18岁为成年的切点,将患者分为成年起病组（516例）和非成年起病组（226例）,比较两组间临床指标差异。新诊断患者根据起病时是否伴有糖尿病酮症酸中毒（DKA）分为伴DKA组（68例）及不伴DKA组（257例）,比较两组间临床和生化特点。计量资料符合正态分布且方差齐者采用最小有意义差异t检验,计量资料非正态分布者采用秩和检验。结果26年间我院收治的T1DM患者共742例,所有患者中男性402例（54．2％）,女性340例（45．8％）;平均发病年龄为23（1～61）岁,154例（20．8％）患者有糖尿病家族史。年龄≥18岁的患者516例（69．5％）,其体质指数（BMI）为（16±9）kg／m。。与非成年起病组比较,成年起病组血尿酸水平[（274±122）比（243±97）Ixmol／L,t=2．631]、高血压发生率（14．9％比7．1％,）（2=8．818）均明显增高（均P〈0．05）,而成年起病组的糖化血红蛋白（9．7％±3．1％比10．7％±2．8％,t=3．221）、起病时发生DKA（20．9％比24．3％,t=4．276）及使用胰岛素泵（0．2％比16．4％,）（2=16．269）和多次胰岛素注射（57．6％比64．6％,x2=1．517）治疗的患者比例及胰岛素用量[（0．7±0．3）比（0．9±0．4）U／kg,t=5．061]均明显低于非成年起病组（均P〈0．05）;与不伴DKA组比较,伴DKA组的空腹血糖[（23±10）比（19±8）mmol／L,t=3．688]明显增高,两组间性别构成、年龄、糖尿病家族史、餐后血糖、糖化血红蛋白水平差异均无统计学意义（均P〉0．05）;417例患者在入院时已明确诊断为T1DM,分别有37．4％和26．9％的患者合并糖尿病视网膜病变和肾脏病变;30例（4．0％）的患者合并其他自身免疫性疾病,其中70％（21例）为自身免疫性甲状腺病。结论我院住院的T1DM呈逐年增多的趋势并以成年起病者多见,成年起病的T1DM患者高血压的发生率及血尿酸水平高于非成年起病者,起病时糖化血红蛋白水平低于非成年起病者。     

成人斯蒂尔病研究进展

成人斯蒂尔病（aduh—onset still’s disease．AOSD）是一组病因、发病机制不清，临床上以高热、皮疹、关节痛和（或）关节炎、咽痛、肌痛为表现，伴有周围粒细胞增高。肝、脾、淋巴结肿大等多系统受累的一种临床综合征。本是指全身性起病的幼年型慢性关节炎，但相似的疾病也可发生于成年人。故称成人斯蒂尔病。     

成人腹型过敏性紫癜的临床和内镜特征

背景：成人过敏性紫癜（HSP）少见,以消化道症状为首发表现时较易误诊。目的：分析成人腹型HSP的临床、内镜特征和治疗方法,以提高该病的早期诊断和治疗水平。方法：2005年1月～2010年12月于北京友谊医院确诊为“腹型紫癜”的22例成人患者纳入研究,对其临床资料进行回顾性分析。结果：本组成人腹型HSP患者以青年为主．14例（63．6％）有明显发病诱因。所有患者均出现皮肤紫癜伴腹痛,多数患者腹痛程度与腹部体征不相符,7例（31．8％）患者腹痛先于皮肤紫癜出现,18例（81．8％）患者有消化道出血表现（显性出血7例,隐血11例）。内镜检查见病变主要累及小肠,病变黏膜散在鲜红色或暗红色出血斑,伴糜烂、浅溃疡。21例患者接受糖皮质激素治疗,激素治疗后腹痛、消化道出血明显缓解。结论：了解成人腹型HSP的临床和内镜特征有助于提高首诊诊断率。激素治疗对腹型HSP的消化道症状有效。     

成人腹型过敏性紫癜11例临床分析

2005年1月~2006年6月,我院收治成人腹型过敏性紫癜患者11例。现将其临床特点、内镜表现及诊治情况进行回顾性分析。临床资料:11例中,男9例,女2例;年龄22~74岁,平均年龄48岁。均以腹痛、便血等胃肠道为首发和突出表现,分别于起病后1~6 d就诊。腹痛部位:全腹痛6例,下腹痛3例,脐周     

未确定型结肠炎的特征分析

目的通过对未确定型结肠炎（indeterminate colitis，IC）患者的临床特点的分析，加深对该型结肠炎的认识。方法对2000年1月至2005年3月期间住院病历中符合炎症性肠病的217例患者的特点进行回顾性分析。结果未确定型结肠炎22例（10．2％），首发症状为腹泻54．5％，血便54．5％，腹痛31．8％，发热27．3％，有肠外表现59．1％，全结肠病变63．6％，回肠病变36．4％，节段型22．7％，直肠赦免50％，使用免疫抑制剂18．2％，手术31．8％。克罗恩病共60例，首发症状为腹痛76．7％，腹泻33．3％，发热25．0％，血便8．3％，有肠外表现38．3％，全结肠病变18．3％，节段型81．7％，回肠病变58．3％，使用免疫抑制剂11．7％，手术88．3％。溃疡性结肠炎135例，首发症状为脓血便78．5％，腹泻54．8％，腹痛29．6％，发热3．7％，有肠外表现18．5％，全结肠病变56．3％，节段型2．2％，回肠病变3．7％，使用免疫抑制剂的12．6％，手术6．7％。结论与克罗恩病及溃疡性结肠炎相比较，未确定型结肠炎有一些自己的特点，有可能是一个独立病变。     

老年人非典型急性心肌梗死的早期诊断

目的探讨老年非典型急性心肌梗死（AMI）的早期诊断。方法全部病例为我院近5年问所收治392例AMI患者的病历资料，其中非老年（〈60岁）98例，老年（≥60岁）294例，老年临床表现典型者219例，非典型者75例，并着重对非典型患者的资料进行系统回顾性分析。结果75例老年非典型AMI患者临床表现复杂多样，可归纳为8个亚型，分别是：（1）无痛型26例（34．6％），（2）异位痛型22例（29．3％），（3）心衰型6例（8．0％），（4）心律失常型5例（6．6％），（5）中枢型5例（6．6％），（6）周围型4例（5．3％），（7）肺型4例（5．3％），（8）腹型3例（4．0％）；本组病例误（漏）诊情况：非老年病例门（急）诊正确诊断率100％，老年典型病例，误（漏）诊9例（4．1％），老年非典型病例，误（漏）诊13例（17．3％）；预后：非老年组全部临床治愈出院，老年典型组死亡16例（7．3％），老年非典型组死亡12例（16．0％）。结论充分认识老年AMI患者中的不典型表现，只有将临床表现、ECG演变、心肌酶学改变进行综合性分析．才能有助于提高早期诊断率。     

少年特发性多发性肌炎12例临床分析

目的探讨少年特发性多发性肌炎OIPM）的临床、血清学特点及治疗。方法回顾性分析12例JIPM患者的临床资料。结果（1）JIPM患者中男女比例为2：1。（2）JIPM患者的发热、肌肉疼痛显著高于成人特发性多发性肌炎（AIPM）（P〈0．05）。（3）JIPM可合并心脏损害（5／12）。（4）JIPM的抗核抗体（ANA）阳性者2/8,但无抗Jo-1抗体阳性者。⑤12例JIPM患者对皮质类固醇激素，免疫抑制剂治疗均有效，其中3例患者治愈，其余9例症状改善。结论JIPM少见。发热、肌肉疼痛发生率高。血清ANA、抗Jo-1抗体阳性率低于AIPM，心脏损害是主要合并症，皮质类固醇激素治疗有效。     

肝硬化并发自发性细菌性腹膜炎90例分析

2002～2005年6月，我们收治90例肝炎肝硬化并发自发性腹膜炎（SBP）患者，现分析如下。临床资料：本组90例慢性乙型肝炎（CHB）肝硬化患者，男68例，女22例；年龄25～77岁，≥40岁66例（73．3％）。主要临床表现为发热（66例，体温37．2～39℃）、腹泻（6例）、腹胀（68例）、腹痛（10例）、腹部压痛（30例）、反跳痛（22例）。24例无发热及腹部症状和体征。     

远程心电监测记录的临床应用

目的 探讨远程心电监测SM-100型记录仪的临床意义。方法 分析126例接受SM-100型心电图仪检查患者的临床及心电图资料，其中因心悸及心律失常检查者113例，因头晕、胸闷以及心前区不适等检查者13例。结果 未见异常者61例（48．4％）。异常者65例，其中房性期前收缩和室性期前收缩24例、阵发性室上性心动过速3例和房性心动过速2例（此5例既往均未捕捉到发作时的心律失常）、心房扑动1例、心房颤动和窦性心动过缓各8例、起搏心电图和一度房室传导阻滞各4例、心室预激图形1例，其余10例为异常Q波及ST—T改变等。126例共发送心电图1671行，除123行（7．4％）图形欠佳外，其余1548行（92．6％）记录良好。结论 SM-100型远程心电图仪操作方便，可通过手机和固定电话发送心电图。实施远程心电记录，对临床诊断特别是心律失常诊断具有重要意义。     

Fibromyalgia syndrome: experience in a pediatric rheumatology clinic

OBJECTIVE: To report our experience of fibromyalgia syndrome (FMS) in pediatric rheumatology clinic settings. METHODS: Clinical and laboratory data were reviewed in all patients with FMS between March 1992 and March 1996. Patients with FMS and an underlying rheumatic disease were excluded from the study. At presentation and follow-up visits, all patients had a tender points (TP) count that was conducted by thumb palpation. Both the children and their parents were questioned concerning the presence of widespread pain or aching. All the patients fulfilled the ACR criteria for the diagnosis of primary FMS. All children were evaluated by a protocol that included relevant information on FMS. Telephone survey questionnaires were used for patients who missed some of their follow-up visits. RESULTS: There were 59 children (47 F and 12 M) diagnosed with primary FMS. The mean age at onset was 13.7 years, and the mean age at diagnosis was 15.5 years. The mean duration of follow-up was 18.3 months. Diffuse aching was reported in 57 patients (97%), headaches in 45 (76%), and sleep disturbances in 41 (69%). Less common were stiffness in 17 (29%), subjective joint swelling in 14 (24%), fatigue in 12 (20%), abdominal pain in 10 (17%), and joint hypermobility and depression in 8 (14%) and 4 (7%) patients, respectively. The mean ESR was 15 mm/h, RF was negative in all patients, and ANA was positive (mean titer 1:160) in 17 patients. The mean initial TP count was 14.6. Nine patients were not available for follow-up. There were 50 patients available for follow-up and survey analysis, and of these 30 (60%) had improved, while 18 (36%) remained unchanged, and 2 (4%) became worse when compared with initial presentation. At the end of study follow-up, 37 patients (74%) were still taking medication (20 of them daily). Out of 25 patients whose TP counts were available at the end of follow-up, the mean TP dropped from 14.12 to 12.04 (p = 0.09) for the total group, and 14.05 to 10.84 (p < 0.01) for the patients who had improved. 22 out of 30 patients in the improved group and 7 out of 20 in the unchanged or worse group had continued active exercise programs (p < 0.001). CONCLUSION: The clinical spectrum of FMS in children is similar to that of adults but with better outcomes. The TP count correlates with clinical status only in patients who had improved. Active exercise programs seem to correlate with better outcomes. Prospective and larger patient population studies, and a longer follow-up of children with FMS are needed to clarify these findings.     

Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: A multisite,single‐blind,randomized, controlled clinical trial

Objective

Juvenile fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence‐based treatments. The objective of this multisite, single‐blind, randomized clinical trial was to test whether cognitive–behavioral therapy (CBT) was superior to fibromyalgia (FM) education in reducing functional disability, pain, and symptoms of depression in juvenile FMS.

Methods

Participants were 114 adolescents (ages 11–18 years) with juvenile FMS. After receiving stable medications for 8 weeks, patients were randomized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions. Assessments were conducted at baseline, immediately following the 8‐week treatment phase, and at 6‐month followup.

Results

The majority of patients (87.7%) completed the trial per protocol. Intent‐to‐treat analyses showed that patients in both groups had significant reductions in functional disability, pain, and symptoms of depression at the end of the study, and CBT was significantly superior to FM education in reducing the primary outcome of functional disability (mean baseline to end‐of‐treatment difference between groups 5.39 [95% confidence interval 1.57, 9.22]). Reduction in symptoms of depression was clinically significant for both groups, with mean scores in the range of normal/nondepressed by the end of the study. Reduction in pain was not clinically significant for either group (<30% decrease in pain). There were no study‐related adverse events.

Conclusion

In this controlled trial, CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS.

     

Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial

OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain and lowered pain threshold. Other prominent symptoms include disordered sleep and fatigue. FMS affects an estimated 2% of the population, predominantly women. This trial was designed to evaluate the efficacy and safety of pregabalin, a novel alpha(2)-delta ligand, for treatment of symptoms associated with FMS. METHODS: This multicenter, double-blind, 8-week, randomized clinical trial compared the effects of placebo with those of 150, 300, and 450 mg/day pregabalin on pain, sleep, fatigue, and health-related quality of life in 529 patients with FMS. The primary outcome variable was the comparison of end point mean pain scores, derived from daily diary ratings of pain intensity, between each of the pregabalin treatment groups and the placebo group. RESULTS: Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo (-0.93 on a 0-10 scale) (P /=50% improvement in pain at the end point (29%, versus 13% in the placebo group; P = 0.003). Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality, fatigue, and global measures of change. Pregabalin at 450 mg/day improved several domains of health-related quality of life. Dizziness and somnolence were the most frequent adverse events. Rates of discontinuation due to adverse events were similar across all 4 treatment groups. CONCLUSION: Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo. Pregabalin was well tolerated and improved global measures and health-related quality of life.     

Schritte zu einer symptombasierten Diagnose des Fibromyalgiesyndroms

BACKGROUND: A symptom-based diagnosis of fibromyalgia syndrome (FMS) without tender point examination is helpful for primary medical care. We tested whether a symptom-based diagnosis of FMS can be based on the symptoms of musculoskeletal pain and fatigue. METHODS: The most frequent and severe symptoms in FMS patients from four different settings (n= 464 from a self-help organization, n=162 from medical expertise, n= 33 from a private rheumatology practice, n=36 from a tertiary-care pain department) were assessed using the Giessen Subjective Complaints List GBB 24. The most frequent and severe symptoms were assessed and compared to those of a representative German population sample. A k-means cluster analysis was performed to identify sub-groups with and without additional vegetative symptoms within the total sample of FMS patients. RESULTS: The most frequent and severe symptoms in all four sub-samples were low back pain, limb pain and fatigue. The greatest mean differences between FMS patients and the general population were found in the subscales "limb pain" and "fatigue". Cluster analysis identified three sub-groups of patients which were all characterized by severe limb pain and fatigue, as well as varying degrees of vegetative symptoms. SUMMARY: Following the exclusion of inflammatory rheumatoid, endocrinological and neurological diseases, a symptom-based clinical diagnosis of FMS can be based on of the key symptoms of chronic widespread musculoskeletal pain, as well as chronic fatigue.     

Lack of correlation between the mean tender point score and self-reported pain in fibromyalgia

Objectives . To study the validity and nature of self-assessed symptoms among patients with fibromyalgia syndrome (FMS) and to compare our data with findings reported in the US. To determine whether tender point scores correlate with self-reported pain and other symptoms and to study the influence of disease duration. Methods . Tender point scores were assessed in 113 consecutive patients with FMS. All patients completed 2 self-assessment questionnaires (an extended Campbell list, the Enschede Fibromyalgia Questionnaire, and the Dutch Arthritis Impact Measurement Scales). Results . The self-assessed symptoms of the Dutch FMS patients seem to be valid and are comparable with those of American patients. No association between disease duration and number of self-reported symptoms was found. An association between self-reported pain and mean tender point score was lacking for patients with disease of shorter duration and was weak for patients with disease of longer duration. Conclusions . The use of a self-report questionnaire for patients with FMS is feasible and appears to be valid. Tender point scores and self-reported pain represent very different aspects of pain in FMS.     

Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia

OBJECTIVE: Trauma and dissociation tend to be interrelated. The objective of this study was to examine the frequency of traumatic experiences and somatoform dissociation in patients with fibromyalgia syndrome (FMS) or rheumatoid arthritis (RA), two conditions that are both characterized by pain and disability. METHODS: Patients with a diagnosis of FMS (2 male, 26 female; mean age 42 +/- 11 years) or RA (5 male, 46 female; mean age 46 +/- 10 years) completed the Fibromyalgia Impact Questionnaire (FIQ), the Somatoform Dissociation Questionnaire (SDQ), and the Traumatic Experience Checklist (TEC). RESULTS: Patients with FMS reported significantly higher levels of various forms of traumatization and dissociation than patients with RA. In patients with FMS, but not in patients with RA, there was a significant correlation between traumatization and dissociative symptoms. A possible dissociative disorder was indicated in 10% of the patients with FMS and 2% of the patients with RA. CONCLUSION: Traumatization experiences are frequent in FMS, but as compared to conversion disorder or dissociative identity disorder only a small subgroup of patients with FMS or RA shows the combination of traumatization and somatoform dissociation. The observation of somatoform dissociation calls for a broad treatment approach with a special role of the psychologist or psychiatrist.     

Increased rates of fibromyalgia following cervical spine injury. A Controlled study of 161 cases of traumatic injury

Objective. To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS). Methods. One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL). Results. Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning. Conclusion. FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.     

Pregabalin for the treatment of fibromyalgia syndrome: Results of a randomized,double‐blind,placebo‐controlled trial

Objective

Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain and lowered pain threshold. Other prominent symptoms include disordered sleep and fatigue. FMS affects an estimated 2% of the population, predominantly women. This trial was designed to evaluate the efficacy and safety of pregabalin, a novel α₂‐δ ligand, for treatment of symptoms associated with FMS.

Methods

This multicenter, double‐blind, 8‐week, randomized clinical trial compared the effects of placebo with those of 150, 300, and 450 mg/day pregabalin on pain, sleep, fatigue, and health‐related quality of life in 529 patients with FMS. The primary outcome variable was the comparison of end point mean pain scores, derived from daily diary ratings of pain intensity, between each of the pregabalin treatment groups and the placebo group.

Results

Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo (−0.93 on a 0–10 scale) (P ≤ 0.001), and significantly more patients in this group had ≥50% improvement in pain at the end point (29%, versus 13% in the placebo group; P = 0.003). Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality, fatigue, and global measures of change. Pregabalin at 450 mg/day improved several domains of health‐related quality of life. Dizziness and somnolence were the most frequent adverse events. Rates of discontinuation due to adverse events were similar across all 4 treatment groups.

Conclusion

Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo. Pregabalin was well tolerated and improved global measures and health‐related quality of life.

     

Lactose tolerance despite hypolactasia in adult coeliac disease

Although symptoms of milk intolerance are common in primary (genetically determined) hypolactasia it is a clinical impression that such symptoms are infrequent in adult patients with hypolactasia secondary to damage of the mucosa of the small intestine. This study was designed to determine whether a lactose (50 g) challenge is better tolerated by patients with coeliac disease and secondary hypolactasia than patients with primary hypolactasia. Based on intestinal histology and disaccharidase levels, three groups of adults were studied: controls ( n = 20), patients with primary hypolactasia ( n = 20) and patients with hypolactasia secondary to newly diagnosed coeliac disease ( n = 15). The response to a challenge with 50 g lactose was assessed by a score of five symptoms and breath hydrogen production. Despite an equivalent level of hypolactasia, symptoms affected fewer patients with coeliac disease (33%) than subjects with primary hypolactasia (90%). Further, a positive lactose breath hydrogen test was noted in all (100%) patients with primary hypolactasia but in only six (40%) of those patients with newly diagnosed coeliac disease. These results suggest the presence of a considerable absorptive reserve for lactose in the distal small bowel of many patients with coeliac disease.     

A prospective long-term study of fibromyalgia syndrome

Objective. To ascertain the long-term natural history of fibromyalgia syndrome (FMS). Methods. Patients with a history of FMS, seen in an academic rheumatology referral practice, were originally surveyed soon after onset of symptoms, and then were reinterviewed 10 years later in a prospective followup cohort study. A validated telephone survey was administered that inquired into current symptoms, medical care and treatments used, and work disability. The results were compared with the prior surveys. Results. Of the original 39 patients, there were 4 deaths. Of the remaining 35 patients, 29 (83%) were reinterviewed. Mean age at current survey was 55 years, and mean duration of symptoms was 15.8 years. All patients had persistence of some fibromyalgia symptoms, although almost half (48%) had not seen a doctor for them in the last year. Moderate to severe pain or stiffness was reported in 55% of patients; moderate to a lot of sleep difficulty was noted in 48%; and moderate to extreme fatigue was noted in 59%. These symptoms showed little change from earlier surveys. In 79% of patients, medications were still being taken to control FMS symptoms. Despite continuing symptoms, 66% of patients reported that FMS symptoms were a little or a lot better than when first diagnosed. Fifty-five percent of patients said they felt well or very well in terms of FMS symptoms, and only 7% felt they were doing poorly. With the exception of sleep trouble, which was persistent, baseline survey symptoms correlated poorly with symptoms at the 10-year followup. Conclusion. FMS symptoms last, on average, at least 15 years after illness onset. However, most patients experience some improvement in symptoms after FMS onset.