This 52 year old patient who, for the past 4 years, has presented joint-pains in
the hands, elbows, shoulders, hips and knees. Clinical and biological data (with
the presence of specific antibodies) led the regional rheumatology department to
diagnose rheumatoid arthritis. Treatment with Plaquenil was prescribed with only
a moderate improvement.
Clinical Description
The pain diffused, but prevalent in the shoulder girdle and in the neck, elbows
and hands. The average daily pain threshold is 7/10. There is also a predominant
stiffness in the shoulders and neck (see Video 1).
Video 1
Magnetic Stimulation and Evolution
After wide field and peripheral transcranial magnetic stimulation at 5 Hz, the
stiffness completely disappeared (see video 2). During the following days the
pain decreased to a threshold of just 3/10. This improvement continued for a
period of 4 weeks and when the symptoms began to gradually reappear. The
stimulation sessions were repeated every month and a half with always the same
efficiency.
Video 2
Comments
Magnetic stimulation was proposed given the hypothesis of fibromyalgia
associated with rheumatoid arthritis. This stimulation can have no effect on the
clinical signs of rheumatoid arthritis. The dramatic improvement found shows
that the bulk of the symptoms of this patient were actually related to
functional neurological pathology, in this case a fibromyalgia.
Fibromyalgia and Rheumatoid Arthritis - Patient 2
Dominique Parain MD PhD
History
This 19-year-old patient shows a severe history of rheumatoid arthritis over the
past 2 years. Followed in the rheumatology department of the CHU in Rouen and,
despite antimitotic polytherapy, her condition worsens and imposes the use of a
wheelchair to move about. She will present discomfort with trunk shaking and
loss of consciousness that required her to be hospitalised in the epilepsy unit
for a prolonged EEG video recording over several days.
Clinical Description
The patient presented diffused pain and very severe walking difficulties.
Several seizures were recorded that are characteristic of non-epileptic seizures
(see video 1)
Video 1
Magnetic Stimulation and Evolution
Transcranial and peripheral magnetic stimulation resulted in an immediate and
definitive cessation of non-epileptic seizures and, surprisingly, the patient
was able to walk again independently (and even run) with greater flexibility and
with a decrease in pain (see video 2). Stimulations needed to be continued every
2 or 3 months in order to maintain any improvement for the pain and the motor
capacity.
Video 2
Comments
This patient evidently has an association of both rheumatoid arthritis and
fibromyalgia. The latter clearly played a prominent role in the symptomatology.
It is probably clinically very difficult to distinguish between what amounts to
arthritis and fibromyalgia. This type of stimulation can have a diagnostic
interest since it can only improve the symptoms of fibromyalgia. The combination
of 2 types of neurological functional disorders (fibromyalgia and non-epileptic
seizures) is classical. Magnetic stimulation can have an efficacy on both types
of TNF.