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.

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).

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.

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.

 

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.

The patient presented diffused pain and very severe walking difficulties. Several seizures were recorded that are characteristic of non-epileptic seizures (see video 1)

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.

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.