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