It is a short and simple article that interestingly summarizes the main points of view around the 40s about the FIBROSITIS subject. He describes 3 schools.

 He insists that there is the presence of creatinuria in primary fibrositis.

 He gave a detailed explanation to differentiate “primary fibrositis” from psychogenic rheumatism (Personal note: It seems to me that psychogenic rheumatism is an American concept).

 He insisted that he managed to cure Dupuytren’s contracture through vitamin E treatment.

 He does not go deep to the physiopathological mechanism to explain the creatinuria in the patients with primary fibrositis.

 He thinks that not all the fibrositis cases can be explained by the herniation of subfascial fat.

 He insisted that the Dupuytren’s contracture could be treated by vitamin E supplement with an improvement even 4 weeks after the start. He has the theory that there is a kind of gastrointestinal disarrangement that does not lead to good vitamin absorption.

 He does not mention how he got his theory of the goodness of the vitamin E treatment either.

 Notes on the article:

Fibrositis (Muscular Rheumatism) Including Dupuytren’s Contracture: a New Method of Treatment

Charles Leroy Steinberg

Rochester, New York

Rochester General Hospital

The doctor starts like this:

“Present-day practice finds the surgeons busily occupied converting colons into semicolons; the physician occupied in extending the therapeutic uses of the antibiotics; and all of us excusing most people having “rheumatic pains” as suffering from hallucinations of pain.”

He mentions 3 schools regarding FIBROSITIS:

–The “liberal school”: It calls any recurrent ache or pain in soft tissue structure fibrositis. The corroborated evidence is the finding of a “bump” which is gleefully referred as a nodule. The extreme of this liberality was recently reached when Mylechreest labeled herniation of fat through a tear in the fascia of the back as fibrositis. Steinberg mentions that this finding brought more confusion, since the herniated mass became the nodule and the tear in the fascia became the pain.

–The “Nihilistic school”: It states that there is NO such thing as primary fibrositis.

–The “conservative school”: It states that primary fibrositis exists but that substantiating objective evidence is required.

History notes

Steinberg mentions Gowers (1904) as the one that coined the term fibrositis. It meant inflammation of the fibrous tissue.

Many rheumatologists then used the term FIBROSITIS as a synonym of any ache or pain in muscle, tendon, ligament, fascia, periostium, joint capsule, and nerve sheath.

Fibrositis associated to any systemic disease was then called secondary fibrositis.

Therefore, primary fibrositis is used when any of the structures above mentioned are inflamed but there is not an associated disease.

Steinberg recalls that a more fitting definition would be:

“Primary fibrositis is a rheumatoid disorder characterized as a metabolic disturbance affecting mesenchymal tissue”.

Incidence of primary fibrositis

Steinberg warns that the incidence of primary fibrositis varies considerably, and it depends on whether the writer is on the east shore or the west shore of the Atlantic Ocean.

The English writers have reported fibrositis in even 70 per cent of all rheumatic cases.

The American rheumatologists made the diagnosis less frequently.

Fibrositis usually appears in the latter part of the fourth decade of life and the peak incidence appears in the fifth decade. It is equally common in both sexes.

Patients can have fibrositis on and off for many years and have a good physical appearance of good health.

There is no muscular atrophy.

The disease is chronic with remissions and exacerbations. The attacks can last weeks rather than days.

The pain can vary in severity and can be localized or generalized. It can be a single painful nodule or even a tissue involving a group of muscles. The localized muscle areas can be indurated and UNDER SPASM. It usually causes generalized stiffness.

Draft and cold damp weather aggravate or initiate the attack.

Warm weather or application of local heat bring relief.

A slight degree of exercise limbers the patients, and excessive amount of exercise stiffens them.

Temporary deformities such as scoliosis or torticollis may result owing to marked SPASM.

There can be an associated Dupuytren’s contracture in the palm or fibrositis nodules that are firm, subcutaneous tender nodules.

General laboratory findings are normal: the white blood count, differential count and sedimentation rate.

There is the presence of CREATINURIA in primary fibrositis. Steinberg published previous work where he found up to 136mg in 24h in adults, but in primary fibrositis he observed up to 150 or more, usually 300-to 400mg.

This creatinuria responds to tocopherol therapy. He did not know the physiopathological explanation for that.

Steinberg ‘s patients mostly had normal vitamin E blood level except for patients that had other associated pathologies.

Steinberg has the theory that the patients with fibrositis had an alteration in the ABSORPTION of vitamin E from the gastrointestinal tract.

Steinberg states that on the muscular biopsy of one male case he could observe certain microscopic changes that improved after the treatment with vitamin E.

He also states that the Dupuytren’s contracture is a primary fibrositis expression.

Differential diagnosis

Steinberg says that primary fibrositis is difficult to differentiate from “psychogenic rheumatism”. He says that the phenobarbital test can be useful. The patient that suffers from the psychogenic rheumatism will improve with 16mg three times daily. The creatinuria is also normal. The symptoms are also different, the psychogenic rheumatism can give a precise location, “can’t quite describe it”, “has a misery all time”.

Treatment of Primary fibrositis

-Kursen had advised muscle massage with circular movement in order to “rub out the nodules”.

-Slocumb had used “fibrositic vaccine”.

–Pugh and Christie had advocated finding trigger points and injecting these with procaine solution with temporary to permanent relief in various cases. (Personal note: It seems he did not test it).

-Steinberg says that with up to 4 weeks with 300mg of vitamin E he had managed to resolve primary fibrositis of the Dupuytren’s contracture.

Published in April 2019 By Marta Cañis Parera   

Reference:

Steinberg C.L. Fibrositis (muscular rheumatism) including Dupuytren’s contracture: a new method of treatment. New York state journal of medicine. 47 (15) p1679-82. ISSN: 0028-7628.