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[(\(among other things\). )17.7 (W)79.9 (e have relevant data from the 1990)]TJ
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[(Criteria study)64.8 (. )17.7 (W)39.9 (idespread pain \(as defined then\) was 97.6%)]TJ
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(ciated with neck, back, and regional pain problems, and a few)Tj
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(had RA. Fatigue was 81.4% sensitive, 60.8% specific.)Tj
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(Application of other criteria identified clinically similar)Tj
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[(groups, trading sensitivity for specificity)64.8 (.)]TJ
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(How many of the FM-like subjects in the current study)Tj
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(treatment program to date?\323 Should such patients be immuno-)Tj
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0.0591 Tw T*
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(intercellular messengers performing a great variety of func-)Tj
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[(tions. )17.8 (T)35 (umor necrosis factor is one of these. It has been exten-)]TJ
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(in glial cells)Tj
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[(. )17.7 (The ef)17.7 (fects of etanercept have now been)]TJ
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(who)Tj
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(did not do tender point counts!)Tj
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(This concern has been)Tj
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(22)Tj
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(.)Tj
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(Many of my colleagues will not accept referrals of patients)Tj
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[(with FM. )17.7 (There are a number of reasons, relating to time,)]TJ
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[(economics, and the need to concentrate their ener)17.7 (gies on)]TJ
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(patients liable to improve under their care, or who have condi-)Tj
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[(tions matching their research interests. )17.8 (This is understandable,)]TJ
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(but the blunt fact is that they are seeing such patients, and)Tj
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(failing to recognize evidence of major mechanical problems)Tj
0.1947 Tw T*
(in the lowest part of the lower cervical and lumbar spine,)Tj
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(\322problems which have not been specifically identified and)Tj
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(dealt with in the treatment program to date.\323)Tj
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(In clinical research studies, patients should be pleased to)Tj
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[(be higher than in routine practice. But in very lar)17.7 (ge scale)]TJ
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[(studies, they may become objects, not subjects. )54.9 (Assessments)]TJ
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(may take place solely on the basis of uniform, brief question-)Tj
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[(naires, suitable for computer input and analysis. )17.7 (The patient\325)54.8 (s)]TJ
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(uniqueness is unrecognized, or is a nuisance variable.)Tj
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[(HUGH A. )-54.8 (SMYTHE,)]TJ
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(2 Heathbridge Park,)Tj
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[(T)69.9 (oronto, Ontario M4G 2Y6, Canada.)]TJ
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(E-mail: hasmythe@rogers.com)Tj
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[(Addr)36.8 (ess r)36.8 (eprint r)36.8 (equests to Dr)110.7 (. Smythe.)]TJ
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(REFERENCES)Tj
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[(1.)-875.1 (Potter S. )17.7 (The theory and practice of gamesmanship, or the art of)]TJ
1.675 -1.25 Td
(winning games without actually cheating. London: Rupert Hart-)Tj
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(Davis; 1947.)Tj
-1.675 -1.25 Td
[(2.)-875.1 (White KP)110.7 (, )17.7 (Thompson J. Fibromyalgia syndrome in an )54.8 (Amish)]TJ
1.675 -1.25 Td
(community: a controlled study to determine disease and symptom)Tj
T*
(prevalence. J Rheumatol 2003;30:1835-40.)Tj
-1.675 -1.25 Td
[(3.)-875.1 (Hadler NM. \322Fibromyalgia\323 and the medicalization of misery)64.8 (. )]TJ
1.675 -1.25 Td
(J Rheumatol 2003;30:1668-70.)Tj
-1.675 -1.25 Td
[(4.)-875.1 (Ehrlich GE. Pain is real; fibromyalgia isn\325)17.7 (t. J Rheumatol)]TJ
0 Tc 0 Tw 1.675 -1.25 Td
(2003;30:1666-7.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(5.)-875.1 (W)79.9 (olfe F)79.7 (.)-0.1 ( Stop using the )54.8 (American College of Rheumatology criteria)]TJ
1.675 -1.25 Td
(in the clinic. J Rheumatol 2003;30:1671-2.)Tj
-1.675 -1.25 Td
[(6.)-875.1 (W)79.9 (olfe F)79.7 (, Smythe HA, )36.8 (Y)110.8 (unus MB, et al. )17.7 (The )54.8 (American College of)]TJ
1.675 -1.25 Td
(Rheumatology 1990 Criteria for the Classification of Fibromyalgia.)Tj
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[(Report of the Multicenter Criteria Committee. )54.8 (Arthritis Rheum)]TJ
0 Tc 0 Tw T*
(1990;33:160-72.)Tj
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[(7.)-875.1 (Boswell, James. )17.7 (The life of Samuel Johnson. Ch. 2. L.L.D. Roger)]TJ
1.675 -1.25 Td
[(Ingpen, editor)54.8 (. London: Sir Isaac Pitman & Sons, Ltd.; 1907:23-4.)]TJ
-1.675 -1.25 Td
[(8.)-875.1 (Cheyne, Dr)54.8 (. G. English malady)64.8 (, or a treatise on nervous diseases of)]TJ
1.675 -1.25 Td
(all kinds, as spleen, vapours, lowness of spirits, hypochondriacal)Tj
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(and hysterical distempers. London: G. Strahan and J. Leake; 1733.)Tj
-1.675 -1.25 Td
[(9.)-875.1 (Penfield )17.7 (W)91.9 (, Rasmussen )17.7 (T)74 (.)-0.1 ( )17.7 (The cerebral cortex of man. New )36.7 (Y)99.8 (ork:)]TJ
1.675 -1.25 Td
(Macmillan; 1955:214.)Tj
-2.175 -1.25 Td
[(10.)-875.1 (Kellgren JH. Deep pain sensibility)64.8 (. Lancet 1949;1:943-9.)]TJ
0.0369 -1.25 Td
[(1)36.8 (1)-0.1 (.)-875.1 (Kellgren JH. Pain. In: Copeman )17.7 (WSC, editor)54.9 (. )17.7 (T)69.9 (extbook of the)]TJ
2.1381 -1.25 Td
[(rheumatic diseases. 3rd ed. Edinbur)17.7 (gh, London: E&S Livingstone;)]TJ
0 Tc 0 Tw T*
(1964:24.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.2375 Td
[(12.)-875.1 (Smythe HA. )17.7 (The C6-7 syndrome \321 clinical features and treatment)]TJ
2.175 -1.2375 Td
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-2.175 -1.2375 Td
[(13.)-875.1 (Smythe HA. Fibromyalgia: Can one distinguish it from)]TJ
2.175 -1.2375 Td
(malingering? More work needed; more tools supplied. J Rheumatol)Tj
0 Tc 0 Tw 0 -1.2375 TD
(2000;27:2536-40.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.2375 Td
[(14.)-875.1 (Moldofsky H, Scarisbrick P)110.7 (,)-0.1 ( England R, Smythe H.)]TJ
2.175 -1.2375 Td
(Musculoskeletal symptoms and non-REM sleep disturbance in)Tj
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(patients with \322fibrositis syndrome\323 and healthy subjects.)Tj
0 Tc T*
(Psychosom Med 1975;37:341-51.)Tj
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[(15.)-875.1 (Y)110.8 (unus M, Masi )54.8 (A)110.8 (T)74 (, Calabro JJ, Miller KA, Feigenbaum SL.)]TJ
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[(matched normal controls. Semin )54.8 (Arthritis Rheum 1981;1)36.8 (1:151-71.)]TJ
-2.175 -1.2375 Td
[(16.)-875.1 (Clauw DJ, Schmidt M, Radulovic D, Singer )54.8 (A, Katz P)110.8 (, Bresette J.)]TJ
2.175 -1.2375 Td
(The relationship between fibromyalgia and interstitial cystitis. )Tj
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(J Psychiatr Res 1997;31:125-31.)Tj
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[(17.)-875.1 (Clarke RJ, Partridge )17.7 (TC, Granger DE, Caf)17.7 (fe MW)91.7 (. Dating the)]TJ
2.175 -1.2375 Td
(Sterkfontein fossils. Science 2003;301:596-7.)Tj
-2.175 -1.2375 Td
[(18.)-875.1 (Jones GT)73.9 (, Herrick )54.8 (AL, )17.7 (W)79.9 (oodham SE, Baildam EM, Macfarlane GF)79.7 (,)]TJ
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[(Silman )54.8 (AJ. Occurrence of Raynaud\325)54.8 (s phenomenon in children ages)]TJ
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(12\32015 years: Prevalence and association with other common)Tj
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[(symptoms. )54.8 (Arthritis Rheum 2003;48:3518-21.)]TJ
-2.175 -1.2375 Td
[(19.)-875.1 (W)79.9 (olfe F)79.7 (, Michaud K. Severe rheumatoid arthritis, worse outcomes,)]TJ
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(comorbid illness and socio-demographic disadvantage characterize)Tj
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(rheumatoid arthritis patients with fibromyalgia. J Rheumatol)Tj
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(2004;31;695-701.)Tj
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[(20.)-875.1 (Sweitzer S, Martin D, DeLeo JA. Intrathecal interleukin-1 receptor)]TJ
2.175 -1.2375 Td
(antagonist in combination with soluble tumor necrosis factor)Tj
T*
(receptor exhibits an anti-allodynic action in a rat model of)Tj
T*
(neuropathic pain. Neuroscience 2001;103:529-39.)Tj
-2.175 -1.2375 Td
[(21.)-875.1 (Shubayev )17.7 (VI, Myers RR. )54.8 (Anterograde )17.7 (TNF alpha transport from rat)]TJ
2.175 -1.2375 Td
(dorsal root ganglion to spinal cord and injured sciatic nerve.)Tj
T*
(Neurosci Lett 2002;320:99-101.)Tj
-2.175 -1.25 Td
[(22.)-875.1 (Sokka )17.7 (T)74 (, Pincus )17.7 (T)74 (. Eligibility of patients in routine care for clinical)]TJ
2.175 -1.25 Td
[(trials of anti-tumor necrosis factor)19.7 (-alpha in rheumatoid arthritis.)]TJ
0 -1.25 TD
(Arthritis Rheum 2003;48:313-8.)Tj
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