| HOME > Library > Kwiatek radio interview |
Peter Grekko from Adelaide's Radio 5RPH interviewed Dr Richard Kwaitek for the "LeisureLink" program on 24 February 2001. Dr Kwiatek talked about the research he and his team from the Departments of Rheumatology and Nuclear Medicine at the Queen Elizabeth Hospital Adelaide have been doing into cerebral blood flow in fibromyalgia. The results of this research were published in Arthritis & Rheumatism in December 2000 (see article).
DJ (Peter Grekko): We're talking to Dr Richard Kwiatek who is a rheumatologist with the Queen Elizabeth Hospital, and he's at the forefront of some very exciting research. Dr Richard Kwiatek, thank you very much for your time.
Dr K: Thank you, and good afternoon.
DJ: Well, Doctor, tell us about the background behind this work into fibromyalgia. Obviously you saw a need for this sort of research?
Dr K: Yes indeed. As a rheumatologist that means I care for - or at least try to care for - people with musculoskeletal aches and pains (aches and pains in their joints and muscles). A significant proportion of the population have unexplained pain, as well as unexplained fatigue. We know that 1 percent of the population has Rheumatoid Arthritis, but it may well be that at least 2 percent of the population have variants of something which North American rheumatologists call fibromyalgia.
DJ: And up until now they've been fairly difficult to pin down as far as the diagnosis goes?
Dr K: Well precisely, yes. The issue is that it's due to so-called non-organic pain - that is, all blood tests and scans and so forth have been normal, and so the interpretation until perhaps more recently has been that it's primarily psychological. And it has this interesting and probably very important affiliation with chronic fatigue syndrome, in fact it's probably a variant of the chronic fatigue syndrome. Fibromyalgia is primarily a state of total body symptoms of pain both at rest and with exercise, associated with total body tenderness, whereas chronic fatigue syndrome is primarily a problem of severe fatigue for no obvious reason, and there probably is a spectrum of symptoms between the two. You can have people with both.
DJ: So your research - what did you set out to try and find out?
Dr K: We're very interested in trying to find out whether the primary problem here is actually something to do with how the brain works, unrelated to psychological status. We actually tried to confirm some initial work from five years ago, using SPECT scanning of the brain - that's a fairly sophisticated form of brain scan that measures the distribution of blood flow throughout the brain. This study was done in North America about five years ago, and we tried to repeat it, but this time with a larger group of people. We recruited 17 people with clear unequivocal fibromyalgia, and we compared the blood flow in their brains with 22 normal people - all of them being women, because the disorder tends to occur in a ratio of roughly 8 to 1 in favour of women.
And what we found was, that we actually confirmed the previous study which showed that the blood flow in a middle region of the brain called the thalamus was reduced. But we also discovered, completely to our surprise, that the blood flow is also reduced in a particular part of the brain stem. The brain stem is a part of the brain that connects the forebrain - the part that involves the intellect - with the spinal chord. It's a very primitive part of the brain, the so-called reptilian part of the brain. And why this is very intriguing to us, is that there are some preliminary brain studies from around the world showing that a similar, but not identical, deficit in blood flow occurs in people with the chronic fatigue syndrome.
And even more interesting is that the precise location of the blood flow deficit in the brainstem is not exactly in previously known areas of the brain which actually control the passage of pain signals to consciousness. So we may be looking at something which is unique to the fibromyalgia syndrome, or perhaps even unique for chronic fatigue syndrome.
DJ: So the discovery that you made is fairly significant, in that this hadn't been discovered as such before?
Dr K: Yes. Noone had actually bothered to look. But I need to emphasise that we have used very sophisticated analytical techniques. In fact because we had 22 normal women - being the largest number of normal women who have had SPECT scans [in a single study, anywhere] in the world - we have been able to improve the sensitivity of SPECT scanning significantly, and that actually enabled us to make this discovery. Without the selfless volunteering of these people we wouldn't have had the numbers to be able to improve the methodology, and so we wouldn't have discovered this.
DJ: So, this is pretty exciting, but what about from here - for example, with fibromyalgia or CFS, what sort of inspiration will you take from this sort of work?
Dr K: Well, the immediate inspiration is that, realistically, it is the strongest evidence that we have that there is something going wrong with the brain in these disorders, which is not psychologically mediated. Another implication of this finding is that now we're able to look at a new area of the brain, and that, I believe, is already starting to direct us to think of other medications that might work in this situation that we never thought of before, and we're starting to experiment with that. And finally, here in Adelaide, we're building up some affiliations with the chronic fatigue research group at Royal Adelaide Hospital, and we're hoping to either confirm or refute with our improved techniques what has been found internationally.
DJ: So would there be something that you could actually take to change the blood flow through the brain, or is that too simple?
Dr K: I think it probably is too simple, although it just might be that simple. We are assuming that the blood flow is purely a reflection of the activity of nerve cells in the region, and that the blood flow changes as a secondary phenomenon. But it is still conceivable that it is the primary problem; the chronic fatigue people at the Royal Adelaide Hospital have some theories about that. Having said all that, I have to make it clear that our findings do not mean that we have found the fundamental cause or mechanism of the actual syndrome. We've found something which may be either primary or alternatively secondary - that is, it may be a reaction to having the syndrome. And clearly, further work needs to be done.
DJ: Now, people that have got fibromyalgia often pursue other areas trying to find relief or a cure, such as complementary or alternative medicine. As a rheumatologist, what's your view on that sort of thing?
Dr K: Well, not infrequently, people gain mild to moderate relief, but we do know that nothing is curative in the short term. It seems that to actually manage this group of disorders you need a package of techniques, most of which do not involve medicines. They involve self-management techniques. And organisations such as the Arthritis Foundation - which has a branch called Fibromyalgia SA - are well geared up to try and help people find techniques for helping themselves. Exercise seems to be important, but it's not the full answer. Surprisingly, believe it or not, there are people who we see with fibromyalgia - admittedly, milder forms of fibromyalgia - who are actually quite fit athletes. Previously, medical people thought that the only thing wrong with these people was that they were deconditioned, but that's not the case.
DJ: You mentioned they would be relieved at the fact that there is actually something physically wrong with them rather than it being "in the head" as in a psychological thing. That's pretty significant, is it? I mean, people with fibromyalgia or CFS, feel like they're - pardon the pun - banging their head against a brick wall when they don't get believed about their symptoms?
Dr K: Yes. Western medicine has had major problems trying to understand this, and as a result unfortunately the psychological label is too easily given to these people.
DJ: So what do you do from here, Richard?
Dr K: Our work currently is, firstly, to work collaboratively with the Royal Adelaide Hospital group with regards to chronic fatigue syndrome, this is obviously very important work. And our second area of concern is to actually look very meticulously at the actual structure of the brain stem - looking with MRI scans, which are different from SPECT scans, MRI measures the structure of the brain - to see whether there are actually subtle changes in the structure of the brain, that is, whether nerve cells have been killed. Superficially, on inspecting these people's brains with MRI scans, they look normal.
DJ: Richard, is it possible that someone would be born with their brain like this or is it something that develops in life?
Dr K: That raises a very interesting issue. It would seem that people need to be biologically predisposed to have this group of disorders. These disorders seem to be, in at least 50% of people, a response to some form of stress or multiple stresses. They could be psychological stresses, they could be physical stresses, they could be physical trauma, they could be infections. But it's not necessarily everyone who's like that. There are people who seem to slowly develop these syndromes over many years, if not decades. And there's also increasing evidence that these disorders tend to run in families - but not necessarily always. So there's a strong suggestion that part of the problem is a genetic predisposition.
DJ: Richard, are you looking for volunteers as far as the work with the RAH (Royal Adelaide Hospital) and CFS goes?
Dr K: I think that the RAH group will be making a call for volunteers fairly soon, not quite now, it's a little bit premature because ethics approval has to be sought from the two hospitals [Royal Adelaide Hospital and Queen Elizabeth Hospital]. We certainly will be looking for volunteers in the very near future.
DJ: And how excited are you about this, both from a professional point of view and also for those people that have CFS or fibromyalgia?
Dr K: Well, I'm very excited for South Australia, we've gained publication in the most prestigious journal in rheumatology, and the whole world is now fascinated by what we've done. And this actually means that rheumatology has expanded its field of interest beyond simple arthritis -- because I should also clearly state that fibromyalgia is NOT an arthritis, it's something outside of arthritis -- and that, of course, adds lots of interest to our profession. Finally, it's very reassuring and satisfying that we in Adelaide, a small team with minimal funds, has been able to improve on techniques which were developed during the 1990s which was the United Nations' decade of the brain, and we have been able to modify and improve those techniques and apply them to a major problem of the first ten years of the 21st century which is the United Nations' decade of the bone and joint.
DJ: So basically, for people that have got fibromyalgia or CFS now, there's a new approach being taken to what the possible treatment could be ?
Dr K: Yes, we don't have the final answers, but we have a very strong lead. By the way, may I mention to your listeners, if anyone [in South Australia] believes they have fibromyalgia and they would like some further information or help, as I said Fibromyalgia SA is part of the Arthritis Foundation and the number is 8379 5711.
DJ: Thanks, Richard.
Transcribed, and slightly edited, by Moira Smith
| HOME > Library > Kwiatek radio interview |
Webmaster
last revised 31 August 2002