Opens in a new tab or window. Ten Ways to Prove ME/CFS is a Serious Illness, Fibromyalgia Central: Basic Introductions to FM, 10 Ways to Prove FM is a Real and Serious Disease, Small Fiber Neuropathy (SFN) Resource Center, Profound Immune Dysregulation and Inflammation Found in Long COVID but no Autoimmunity, The Coronavirus Vaccine Side Effects Poll, Prevalence of fibromyalgia 10 years after infection with. ICU, intensive care unit. Opens in a new tab or window, Visit us on LinkedIn. BMC Neurol. Online ahead of print. RA and Fibro Patient Experience with COVID-19 Vaccine Tiffani's Story Tiffani Weatherford, a health care worker and rheumatoid arthritis and fibromyalgia patient, shares her experiences preparing for and getting both doses of the COVID-19 vaccine. Disclaimer. The findings describe the relative symptom burden among these three groups using a cross-sectional descriptive survey investigating the . The need for COVID-19 vaccines has created quite a dilemma for these patients. amzn_assoc_default_search_key = "";
In 2007, someone had the presence of mind to gather together a large cohort of people with confirmed giardiasis and track them and an even larger control group of unexposed controls. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. Read our, ArtistGNDphotography / iStock / Getty Images. This effect may result in lung, cardiac, and central nervous system organ damage. 2021 Dec 13:1-16. doi: 10.1080/08870446.2021.2013484. K.K . Results from a web-based survey" RMD Open 2021; doi:10.1136/rmdopen-2021-001735. The American College of rheumatology 1990 criteria for the classification of fibromyalgia. The huge long COVID tracking efforts should tell us much about the manifold effects an infection can apparently have on the body even long after its been seemingly resolved. The Pfizer-BioNTech Covid-19 vaccine is associated with an increased risk of myocarditis, an inflammation of the heart muscle, a large new study from Israel confirms. Some researchers posited that many different pathways to ME/CFS exist all of which may end up in a common end state. Moldofsky H, Patcai J. Arthritis Care Res 2010;62:60010. Due to the fact that many occupational sectors, which . A review of early observations of COVID-19s impact on people with autoimmunity suggested that disease stressors (job loss, isolation, fear, less access to healthcare providers or medications) could lead to increases in fatigue, pain, and new cases of secondary fibromyalgia, which is especially common in autoimmune disease. 2022 Oct 14;23(20):12311. doi: 10.3390/ijms232012311. You likely know to expect a sore arm, or even a rash; a headache; fatigue; and maybe a fever and chills. , A review of the literature shows there has been But the vaccines themselves could drive the evolution of more mutants . Don't miss another one. Like the blog you're reading? Chronic fatigue syndrome. 8600 Rockville Pike Pauline, Annette, and Neil (MEA Chairman) have ME/CFS, but Caroline (MEA Magazine Editor)does not and yet she still experienced a bad reaction. There is no evidence to suggest that youre at risk for severe symptoms, either. One study found that over nearly. Of course, that doesn't make them any less uncomfortable. Did The ME/CFS Field Give Up Too Early on Enteroviruses? 2022;28(1):e289-e291. doi:10.1136/rmdopen-2021-001735. The https:// ensures that you are connecting to the A stressful situation, a minor injury, or a passing illness can all cause increased pain, fatigue, and fibro fog, or the feeling of being lost. Changes in the autonomic nervous system with the effect of SARS-CoV-2 may induce the emergence of FMS-related symptoms. "We completely understand the concerns of people with long-term conditions such as ME/CFS around vaccination. When you look at a COVID-19 symptom list and see fatigue, headaches, and sleep problems, you may think, I live with these symptoms every day. Treasure Island (FL): StatPearls Publishing; 2022 Jan. official website and that any information you provide is encrypted A Ministry of Health spokesperson said it was better for people with ME/CFS to get the vaccine than not get it. How clinicians can apply a more tailored approach to diagnosis and management. Chronic pain and COVID-19 hospitalisation and mortality: a UK Biobank cohort study [published online ahead of print, 2022 Apr 22]. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. We have answers Confused about Australia's vaccine rollout? 2022;9:865402. 2021;7(3):e001735. "Going to places that overstimulate my senses with noise, smells, lights, people, etc. Hemoglobin A1c is a simple blood test that measures what someone's blood sugar levels were during the past two or three months. Although, scientists are keeping a close eye on a variant first seen in South Africa. But managing fibromyalgia does have unique needs and concerns during the COVID-19 pandemic. Coronavirus vaccinations per country over time One model suggests that a combination of the slow vaccine rollout, the decrease in social distancing seen, and the spread of much more contagious forms of the virus could result in 300,000 more deaths in the U.S. over the next three months. 10.1186/s41927-020-00165-0 Multisystem inflammatory syndrome in U.S. children and adolescents. Savin E, Rosenn G, Tsur AM, Hen O, Ehrenberg S, Gendelman O, Buskila D, Halpert G, Amital D, Amital H. PLoS One. 1. 2022 May 19;23(1):471. doi: 10.1186/s12891-022-05436-0. Among the probable mechanisms are alterations in inflammatory and anti-inflammatory pathways. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). doi:10.1136/bjophthalmol-2020-316586. The pain may be worse in the morning and evening. 2022 Nov 8:101794. doi: 10.1016/j.berh.2022.101794. 2021 Jan-Dec;12: 21501327211030826. Sensory Overload. U.S. Centers for Disease Control and Prevention. A meta-analysis seeks to be the last word on the effectiveness of masks, but finding answers in science isn't that easy. Results: If you have fibromyalgia or chronic fatigue syndrome ( ME/CFS ), you may experience new or exacerbated body aches, weakness, dizziness, and other symptoms of your condition during or after a shower. In terms of long COVID patients, many factors can contribute to the risk of developing fibromyalgia. However, MIS may develop also in young adults. In December 2021, I was fully vaxxed and boosted against Covid and ready to fully enjoy the holidays for the first time since before the pandemic when I suddenly began feeling ill. Sore throat. Psychol Health. A total of 616 patients were included, with 189 diagnosed with fibromyalgia. Published 2022 Apr 22. doi:10.3389/fnut.2022.865402, Feldstein L, Rose EB, Horwitz SM, et al. This study clearly sets out what so many of us know but which has been documented in too few instances: that post-infectious illnesses can be severe and lasting. The American College of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Best Pract Res Clin Rheumatol. Since similar symptoms are present also in patients with fibromyalgia (FM), we decided to perform a web-based cross-sectional survey aimed at investigating the prevalence and predictors of FM in . There were no major demographic differences in the infected and non-infected patients. Mehrdad Matloubian, M.D., explains whether the COVID vaccines can cause an RA flare, how to safely take RA medications and get the COVID vaccine, and what is being done to study long-term effects . The symptoms healthcare providers are seeing in COVID long-haulers bear a striking resemblance to fibromyalgia symptoms. Long term complications and rehabilitation of COVID-19 patients, Immediate and long-term consequences of COVID-19 infections for the development of neurological disease, Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems networkUnited States, March-June 2020, People who have weakened immune systems, such as those who take immunosuppressive medications to treat autoimmune diseases like, Those who are physically inactive or have disabilities that make self-care or daily activities difficult. Is it safe for me to get the COVID-19 vaccine or will getting the vaccine make my tachycardia or other symptoms worse? Heneka MT, Golenbock D, Latz E, Morgan D, Brown R.Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. The experts said autoimmune diseases somewhat affect vaccine response, but not to the degree cancers that affect the blood, bone marrow, and lymph nodes, or solid-organ transplants do. The vast majority of patients with persistent musculoskeletal pain after SARS-CoV-2 will have no joint swelling or inflammation and the physical examination will typically be unrevealing. Water-based exercises might be particularly helpful. Sleep Quality Mediates the Effect of Sensitization-Associated Symptoms, Anxiety, and Depression on Quality of Life in Individuals with Post-COVID-19 Pain. By . It all came to pass in 2004 when a water reservoir for the city ofBergen, Norway became contaminated withGiardia lamblia. Pre-existing chronic pain may be a risk factor for long COVID. JAMA. Experts have also raised concerns about some other open issues regarding the vaccine, such as the duration of protection from antibody response and dosing beyond the two-dose schedule . Just how closely related all these diseases really are was the subject of a vigorous discussion at the recent Massachusetts ME/CFS and FM Association webinar. Although general expectations were negative, some FMS patients were able to manage the pandemic conditions and even turn them in their favor. BMC Neurol. Common side effects of Pfizer COVID vaccine The Therapeutic Goods Administration lists "very common side effects" of the Pfizer vaccine as: pain/swelling at injection site tiredness headache muscle pain chills fever joint pain Got questions about the COVID vaccines? 2021;60(SI):SI13-SI24. Gulf War Illness (GWI) is a case in point as it has near-identical symptoms to ME/CFS but two appear to have quite different immunological pathways. With the COVID-19 pandemic, there has been great uncertainty about whether the virus could exacerbate autoimmune diseases such as rheumatoid arthritis given that infection can lead to an overactivation of the immune system, which is thought to play a part in severe cases in the general population. Even so, immunosuppressants prescribed for other autoimmune disorders are ineffective for fibromyalgia, so healthcare providers don't generally prescribe them for fibromyalgia. See rights and permissions. Their recently published study Prevalence of fibromyalgia 10 years after infection withGiardia lamblia: a controlled prospective cohort study is one of the few to assess FM in the context of being a post-infectious disorder. Of course, it goes beyond the infection itself. BMC Musculoskelet Disord. One of the most mysterious and frightening consequences of COVID-19 is its impact on the brain. While it is a rare condition, it is still concerning because it is known . The use of etanercept/ mifepristone might via resets of the immune/endocrine systems be sufficient to boost both GWI and ME/CFS patients out of their illnesses. A lab conducting a COVID-19 study on patients with fibromyalgia says it's finding people who suffer from the condition are far less likely to have severe complications from COVID-19. One-hundred subjects with mild initial COVID completed questionnaires detailing persistent pain at an average of 47 weeks after a documented SARS-CoV-2 infection. In this cohort, 82% were women with a mean age of 45 years. Travel-related control measures to contain the COVID-19 pandemic: a rapid review. government site. Aside from the potentially lethal acute viral infection of SARS-CoV-2, a post-acute syndrome with myriad symptoms including not only pulmonary sequelae but also endocrine, cardiovascular, neuropsychiatric, and musculoskeletal manifestations is now widely recognized. On a positive note, Nancy Klimass modeling efforts suggest, interestingly enough, that whatever the origins of ME/CFS and GWI, that the same treatment approach might work in both diseases. One study evaluated the persistent symptoms at 6 months in 616 subjects with SARS-CoV-2, including 77% women, with only 11% hospitalized. One-third of these individuals met the American College of Rheumatology criteria for fibromyalgia at 6 months. Bileviciute-Ljungar I, Norrefalk J-R, Borg K. Pain burden in Post-COVID-19 syndrome following mild COVD-19 infection. In a similar study of 465 individuals with acute COVID, 42 (9%) had persistent symptoms suggestive of fibromyalgia and central sensitization at an average of 3 months after the initial infection. Two-thirds of these people were female and the mean age was 46 years. However, there has been no evidence that SARS-CoV-2 has caused any other unique, systemic immune disorder or musculoskeletal damage. According to the Centers for Disease Control and Prevention (CDC), 11.6% of those who got the first dose of the Moderna Covid-19 vaccine and 16.0% of those who got the second dose developed soon . Fibromyalgia is not on the list of pre-existing conditions that appear to make COVID-19 more severe. trigger a fibromyalgia flare-up.". This is the first study to show that infections can trigger a dramatic increase in the incidence of fibromyalgia putting FM solidly in the post-infectious disease category for the first time. Some people who get sick with COVID-19 experience symptoms that linger for months afterward. MMWR Morb Mortal Wkly Rep 2022;71:713717. Would you like email updates of new search results? Disclaimer. What does the COVID-19 pandemic mean for rheumatology patients? 2. They used the Norwegian version of the 2016 modified Fibromyalgia Survey Questionnaire (FSQ) which they reported was a validated tool that could accurately assess fibromyalgia outside of a doctors visit. Over 80 percent of hospitalized COVID-19 patients have neurological symptoms, a Northwestern Medicine health system study found. Fact: The mRNA vaccines cannot give you COVID-19. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). G. lamblia is a protozoan that often causes intestinal distress, but, at least in the scientific literature was not known to cause post-infectious illnesses until the Norwegian group published their findings. Rheumatol Int 35:159166. He created the first and only blood test to diagnose fibromyalgia eight years ago. The study also suggested that post-infectious fibromyalgia may be worse than fibromyalgia which was triggered in other ways. 2021 May-Jun;39 Suppl 130(3):72-77. doi: 10.55563/clinexprheumatol/dnxtch. Covid vaxx/booster conundrum. The mRNA vaccines cannot cause disease because they do not contain a live virus. An acute myositis and rhabdomyolysis have occurred rarely in patients with severe COVID-19 infection. In these few cases, there has been the expected marked elevation of serum muscle enzymes, and muscle biopsies demonstrated necrotizing myositis. A few cases of a possible reactive arthritis have been reported, but any association with SARS-CoV-2 has not been established. -, Nalbandian A, Sehgal K, Gupta A, et al. This site needs JavaScript to work properly. About 2,500 of the almost 50,000 people of Bergen were subsequently treated for giardiasis. There was initial concern that MIS was the first of unique, systemic, immune diseases that would be precipitated by SARS-CoV-2. In the subjects with fibromyalgia features, muscle pain was the most prominent symptom, present in 90%, followed by fatigue (74%), dyspnea (43%), and orthostatic intolerance (38%). Pre-existing chronic pain conditions such as fibromyalgia and rheumatoid arthritis may be risk factors for long COVID. . Like most vaccines, the COVID-19 vaccine is injected into the deltoid muscle on the side of the arm. Median duration of acute COVID-19 was 13 days, and 10.7% were hospitalized. Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) Are They The Same? "Notably, both male gender and obesity have been consistently associated with a more severe clinical course in patients with COVID-19, including a significantly increased mortality rate.". This article explains which conditions appear to make COVID-19 more severe, and fibromyalgia isn't one of them. Twenty-six percent had chronic fatigue (compared to 10.5% of the controls). Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. Among the symptoms reported during the acute viral illness. Several studies over the years have confirmed the association between exposure to Giardia and the subsequent development of chronic fatigue syndrome (ME/CFS) and irritable bowel syndrome (IBS). and transmitted securely. 2021;39 Suppl 130(3):72-77. doi:10.55563/clinexprheumatol/dnxtch, Rivera J, Rodrguez T, Pallars M, et al. Therefore, to investigate the prevalence of fibromyalgia following acute COVID-19, the researchers conducted a cross-sectional survey during April 2021, in which participants completed a survey that included information on demographics, symptoms and duration of COVID-19, and comorbidities. 2017 Dec;20(12):1922-1926. doi: 10.1111/1756-185X.12678. Can COVID-19 Cause Chronic Fatigue Syndrome? Re-use permitted under CC BY-NC. Multisystem inflammatory syndrome is an example of SARS-CoV-2 triggering a severe immune, systemic disease. At the time of this writing, the only subacute, immune disease that has been definitively linked to SARS-CoV-2 is multisystem inflammatory syndrome (MIS). They also assessed the presence of IBS using the Rome III diagnostic criteria, and fatigue using the Chalder Fatigue Scale. 3. amzn_assoc_link_id = "YV25CNBNF26YD2J5";
J Clin Rheumatol. Medpage Today is among the federally registered trademarks of MedPage Today, LLC and may not be used by third parties without explicit permission. Ten years after the outbreak, no less than 43.1% of those Giardia exposed had irritable bowel syndrome (compared to 13.7% of controls). (The FSQ consists of a Widespread Pain Index (WPI) which assesses the number of painful body areas, and the Symptom Severity Scale (SSS) which assesses symptom severity.) Enteroviruses ubiquitous pathogens often associated with the common cold were one possible culprit. Hospital admission rate was significantly higher in men (15.8% vs 9.2%, p=0.001) and obese (19.2 vs 10.8%, p=0.016) respondents. Conservatively, long COVID has occurred in 5% to 15% of these individuals, and as many as 7 million Americans meet current criteria for long COVID. Many previous reports on long COVID symptoms have not differentiated myalgias from arthralgias, and very few reports have characterized symptom severity or comorbid symptoms. This survey compares the burden of illness for individuals with a history of Lyme disease (HLD) with individuals with a HLD who have either contracted COVID-19 or who have taken the COVID-19 vaccine. The majority of these individuals were female and had not been hospitalized with COVID infection. This is thought to be due to this patient group having established strategies to cope with stress in the pre-pandemic period, and they had sufficient ability to adapt to changing situations. Effect of COVID-19 pandemic lockdown on fibromyalgia symptoms. Published by BMJ. While scientists know that people with autoimmune disorders have a greater risk of infection stemming from bacteria (think, a bout of pneumonia after the flu), little research has been done looking. Clin Rheumatol 40:38533858. Keywords: Aloush V, Gurfinkel A, Shachar N, Ablin JN, Elkana O. A level of 5.7% to 6.4% is considered pre-diabetes, according to the . On univariate analysis, factors associated with fibromyalgia included age, male sex, cough, dyspnea, hypertension, obesity, and treatment with antibiotics, low molecular weight heparin, or oxygen. Please enable it to take advantage of the complete set of features! Medicine (Baltimore). -, Wolfe F, Clauw DJ, Fitzcharles M-A, et al. Laboratory testing should be kept to a minimum, possibly just an ESR or CRP, which will usually be normal. And keep up your prevention efforts by wearing a mask, washing your hands frequently, and social distancing. Just about any assault on the system of someone with fibromyalgia can lead to a flare. Another infectious event an outbreak of giardiasis infection in Norway about 15 years ago presented a similar opportunity. Health experts widely believe. Before The most painful sites were the head/face, chest, and lower extremities. How good to see then, some dogged Norwegian researchers add FM to the list of conditions theyre tracking in people exposed to an infectious outbreak that occurred in Bergen, Norway back in 2004. Similarly, severe acute respiratory syndrome (SARS), which is also caused by a coronavirus, led to long-term post-viral illness that, according to a 2011 study, overlaps with the clinical and sleep features of [fibromyalgia] and chronic fatigue syndrome.. Were no major demographic differences in the infected and non-infected patients alterations in inflammatory anti-inflammatory... Non-Infected patients ahead of print, 2022 Apr 22 ] severe symptoms, either some posited... 616 patients were included, with 189 diagnosed with fibromyalgia can lead to a flare are alterations in inflammatory anti-inflammatory. # x27 ; s vaccine rollout any association with SARS-CoV-2 has caused any other,... Findings describe the relative symptom burden among these three groups using a cross-sectional descriptive survey the! Unique, systemic immune disorder or musculoskeletal damage and non-infected patients scientists are keeping a eye. Presented a similar opportunity because they do not contain a live virus beyond the infection itself majority of individuals... `` YV25CNBNF26YD2J5 '' ; J Clin Rheumatol MIS may develop also in young adults 47 weeks after a documented infection... Web-Based survey '' RMD Open 2021 ; 39 Suppl 130 ( 3 ):72-77.:. Other unique, systemic, immune diseases that would be precipitated by SARS-CoV-2 the evolution of mutants. 2022 may 19 ; 23 ( 1 ):471. doi: 10.1111/1756-185X.12678 systemic immune disorder or musculoskeletal damage more to! In U.S. children and adolescents make my tachycardia or other symptoms worse musculoskeletal damage and... 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A total of 616 patients were able to manage the pandemic conditions and even turn them in their favor online., cardiac, and lower extremities expected marked elevation of serum muscle enzymes, and social.... Fibromyalgia can lead to a flare the presence of IBS using the fatigue..., Visit us on LinkedIn tachycardia or other symptoms worse hospitalisation and mortality: a rapid.! For fibromyalgia, so healthcare providers do n't generally prescribe them for fibromyalgia and rheumatoid arthritis be! Factors can contribute to the are ineffective for fibromyalgia and measurement of symptom.! Mild initial COVID completed questionnaires detailing persistent pain at an average of 47 weeks after a documented SARS-CoV-2 infection review! A flare the deltoid muscle on the system of someone with fibromyalgia more severe M-A, et al,! Usually be normal this cohort, 82 % were hospitalized email updates of new search results Department... A live virus like most vaccines, the COVID-19 vaccine is injected the... And non-infected patients themselves could drive the evolution of more mutants classification of fibromyalgia the mechanisms., people, etc not on the system of someone with fibromyalgia may be worse than fibromyalgia which triggered! Seeing in COVID long-haulers bear a striking resemblance to fibromyalgia symptoms people without fibromyalgia mRNA can! And adolescents by viral and non-viral pathogens: prospective cohort study [ published online ahead of print, 2022 22... Shachar N, Ablin JN, Elkana O FMS patients were included with. The American College of rheumatology 1990 criteria for fibromyalgia and measurement of symptom severity fibromyalgia may be worse in infected! 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Of these individuals met the American College of rheumatology criteria for fibromyalgia at 6 months, possibly an... Have unique needs and concerns during the COVID-19 pandemic the acute viral.... Disease and chronic fatigue syndrome ( ME/CFS ) are they the Same another infectious event an outbreak giardiasis... Disorders are ineffective for fibromyalgia 10.1186/s41927-020-00165-0 Multisystem inflammatory syndrome in U.S. children and adolescents came to pass in 2004 a! Nalbandian a, Shachar N, Ablin JN, Elkana O literature there! Advantage of the complete set of features hands frequently, and lower extremities a tailored. Became contaminated withGiardia lamblia association with SARS-CoV-2 has caused any other unique, systemic immune or. Artistgndphotography / iStock / Getty Images eye on a variant first seen in South Africa and.. Safe for me to get the COVID-19 pandemic: a UK Biobank cohort.... Among these three groups using a cross-sectional descriptive survey investigating the could the... Be worse in the autonomic nervous system with the common cold were one possible culprit 2021 May-Jun 39. Were the head/face, chest, and 10.7 % were women with a age!, but any association with SARS-CoV-2 has caused any other unique, systemic immune disorder or damage... To contain the COVID-19 pandemic fatigue Scale blood test to diagnose fibromyalgia eight ago! Diseases that would be precipitated by viral and non-viral pathogens: prospective cohort study [ published online of. Beyond the infection itself will getting the vaccine make my tachycardia or other symptoms?! Mean age of 45 years rheumatology patients Today is among the symptoms reported during the COVID-19 pandemic non-viral pathogens prospective... A rapid review ( HHS ) were no major demographic differences in autonomic. Came to pass in 2004 when a water reservoir for the classification of fibromyalgia your prevention efforts wearing... Efforts by wearing a mask, washing your hands frequently, and lower.. Borg K. pain burden in Post-COVID-19 syndrome following mild COVD-19 infection chronic fatigue ( to! Needs and concerns during the acute viral illness SARS-CoV-2 triggering a severe immune, systemic disease, chest and. Would you like email updates of new search results the deltoid muscle on the list pre-existing... Was initial concern that MIS was the first of unique, systemic disorder... Rose EB, Horwitz SM, et al during the acute viral.. Probable mechanisms are alterations in inflammatory and anti-inflammatory pathways % is considered,. The mean age of 45 years ( 1 ):471. doi: 10.1111/1756-185X.12678 like vaccines... Tachycardia or other symptoms worse such as fibromyalgia and measurement of symptom severity Aloush! Getting the vaccine make my tachycardia or other symptoms worse long-haulers bear a striking to! New tab or window, Visit us on LinkedIn the classification of fibromyalgia been reported, but any association SARS-CoV-2. 3. amzn_assoc_link_id = `` YV25CNBNF26YD2J5 '' ; J Clin Rheumatol conditions and even turn them in favor! Long-Term conditions such as fibromyalgia and measurement of symptom severity MIS may develop also in young.. Cause disease because they do not contain a live virus effect may result lung... Of a possible reactive arthritis have been reported, but any association SARS-CoV-2! Doesn & # x27 ; s vaccine rollout muscle biopsies demonstrated necrotizing myositis can covid vaccine make fibromyalgia worse fibromyalgia have! 130 ( 3 ):72-77. doi:10.55563/clinexprheumatol/dnxtch, Rivera J, Rodrguez t, Pallars,.