Objective. To compare the relative efficacy and tolerability of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia, and to identify predictors of response to amitriptyline and cyclobenzaprine.Methods, Two hundred eight patients who fulfilled the American College of Rheumatology criteria for the classification of fibromyalgia were entered into a 6‐month prospective, double‐blind, multicenter trial and were randomized to 1 of 3 treatment groups: amitriptyline, cyclobenzaprine, or placebo.Results. After 1 month, 21%, 12%, and 0% of the amitriptyline, cyclobenzaprine, and placebo patients, respectively, had significant clinical improvement (amitriptyline versus placebo P = 0.002, cyclobenzaprine versus placebo P = 0.02, amitriptyline versus cyclobenzaprine P not significant). These percentages increased to 36%, 33%, and 19%, respectively, at the 6‐month assessment (P not significant). The nature and frequency of side effects reported by patients treated with amitriptyline and those reported by patients treated with cyclobenzaprine were similar. A normal Minnesota Multiphasic Personality Inventory (MMPI) profile at baseline was predictive of clinical improvement at the 1‐month evaluation (odds ratio 3.3, 95% confidence interval 1.2—9.0). However, neither the MMPI profile nor any of the demographic, clinical, or functional parameters evaluated at baseline predicted long‐term response.Conclusion. Our data confirm the short‐term efficacy of amitriptyline and cyclobenzaprine in a small percentage of patients with fibromyalgia. Long‐term efficacy could not be demonstrated because of a higher‐than‐expected placebo response. Predictors of response to these drugs could not be determined.

ABT-263 blocks BCL-X _L to induce apoptosis in human dermal fibroblasts from patients with scleroderma and in myofibroblasts in mice, reversing dermal fibrosis.

Objective: A number of studies (all n <200) have assessed health‐related quality of life (HRQOL) in patients with systemic sclerosis (SSc), but no systematic review of the effect of SSc on HRQOL has been done. The objective of this study was to systematically review the literature on HRQOL in SSc measured using the Medical Outcomes Trust Short Form 36 (SF‐36).Methods: A comprehensive search was conducted in August 2007 using Medline, CINAHL, and EMBase to identify original research studies reporting SF‐36 scores of SSc patients. Selected studies were reviewed and characteristics of the study samples and SF‐36 data were extracted. Bayesian meta‐analysis and meta‐regression were performed to obtain pooled estimates of SF‐36 physical component summary (PCS) and mental component summary (MCS) scores for all patients as well as by limited and diffuse disease status.Results: Twelve data sets with a total of 1,127 SSc patients were included in the systematic review. HRQOL was impaired in patients with SSc, with pooled SF‐36 PCS scores being more than 1 SD below the general population (38.3; 95% credible interval [95% CI] 35.2, 41.5) and pooled SF‐36 MCS scores being ∼0.5 SDs below the general population (46.6; 95% CI 44.2, 49.1). SF‐36 PCS scores were 3.5 points (95% CI −1.0, 8.0) lower in patients with diffuse compared with limited disease.Conclusion: This study provides robust evidence of the presence and magnitude of impairment in HRQOL in patients with SSc. Although the impairment appears greater in physical health, mental health impairment is also reported.