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Review of Fibromyalgia on A4Medicine.

Fibromyalgia is a chronic pain syndrome 

ACR (American College of Rheumatology 1990 ) classification criteria states
presence of widespread pain in combination with 11 or more of 18 specific 
tender point sites. Widespread pain was defined as 3 out of 4 quadrant pain including left-and right and upper and lower segment pain and axial pain.

Better understanding of disease since initial ACR criteria ( 1990 ) Examination of tender point – found to be barrier in primary care Erroneous impression – that it is a peripheral musculoskeletal disease .Fibromyalgia usually diagnosed in primary care Diagnosis often not considered initially

Pain for at-least three months affecting both sides of the body , both above and below the waist Palpation of tender points not required Body divided into 19 regions and score how many regions are painful

Epidemiology-Common with a prevalence of 2 % Seen in all ethnic and socio-economic groups Prevalence ↑↑ in females Age of onset between 20-60 average age of 35 Diagnosis & management remains a challenge Often takes > 2 yrs to diagnose and an average 3.7 consultations with different physicians

Causes -Not known what exactly causes fibromyalgia – several mechanisms proposed
○ central sensitisation – maladaptive pain response
○ sleep cycle abnormalities
○ psychological and social factors
○ genetic-role of polymorphisms of genes
○ disturbances of serotonin , growth hormone , substance P & cortisol levels

Presentation-Varied and fluctuating symptoms
 Chronic widespread pain and tenderness
○ may have burning quality suggestive of neuropathic pain
○ not localised to any specific body tissue
○ tends to move from site to site
 Fatigue Unrefreshed sleep Cognitive dysfunction

Differential diagnosis -Inflammatory arthritis- including spondyloarthropathies Osteoarthritis Iron deficiency anaemia Hypermobility syndromes Chronic fatigue syndrome Polymyalgia rheumatica Polymyositis / dermatomyositis Thyroid dysfunction Multiple sclerosis Neuropathies Osteomalacia Drug related- eg statins

Investigations – ESR / CRP TFT FBC Iron studies Alkaline phosphatase Rheumatoid factor- if inflammatory cause suspected ( many false +ves ) Anti-CCP antibody – also many false + ves ANA -r/o SLE Vitamin D and B12

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