| What are physical findings in dx of fibromyalgia? | There are 18 tender points that may be very painful, somewhat painful or mildly irritating.
sensitive and specific locations, control locations are over the thumb, mid forearm, and forehead.
Palpation force is 4 kg/equal to force needed to blanch the thumbnail |
| What are lab tests in FM? | Other conditions (DD), CBC, ESR, CRP, TSH, CPK, VitD, Ca, ANA |
| What is fibromyalgia? | Common cause of chronic widespread musculoskeletal pain, fatigue, cognitive disturbance, psychiatric symptoms and multiple somatic symptoms.
Unknown etiology, no evidence of tissue inflammation.
Pt look well, no abnormalities in PE other than tenderness and all labs are normal.
Some consider it a psychosomatic disorder, others suggest disorder of pain regulation (central sensitization)
associated with other conditions that may cause pain, disruption of sleep or psychiatric symptoms. |
| How is epidemiology of fibromyalgia? | Most common cause of generalized, musculoskeletal pain in women age 20-55 years, prevalence 2-3% and increases with age, women>men, children and adults.
Initially termed fibrositis, was thought as discrete syndrome, then dx criteria were put.
10% of general population have chronic widespread pain |
| How is pathophysiology of fibromyalgia? | Central sensitization
Genetic (familial, COMT polymorphism affects central pain)
Altered pain mechanism (noxious stimuli like heat, electric, pressure painful more than normal control, substance P increased in CSF)
Sleep disturbance (phasic alpha sleep activity characteristic FM, increase cyclic alternating pattern of sleep)
Neurohormonal perturbation (hyperactivity of stress response, altered HPA axis linked to childhood trauma, physical abuse, abnormal GH levels)
Autonomic nervous system dysfunction (low Dopa, serotonin, adrenaline) |
| What are the main clinical manifestations of fibromyalgia? | Widespread musculoskeletal pain (widespread in all the body, above and below waist, may initially be localized in neck/shoulder, feel hurt all over)
Fatigue (universal, arising from sleep and mid-afternoon, stiff in morning and feel unrefreshed even with adequate sleep, light sleep wake early morning)
Cognitive disturbances (fibrofog, attention problems and difficulty doing tasks requiring rapid thought change)
Psychiatric symptoms (depression/anxiety 30-50%, correlated with younger age, women, unmarried, food insecurity, chronic conditions, also we have mood disorders)
Headache (>50% include migraine, muscular (tension) types, common with episodic migraine)
Paresthesia (numbness, tingling, burning, creeping, crawling)
Other symptoms (abdominal pain, costochondritis, IBS symptoms, GERD, ocular dryness, allegies, palpitation and dyspnea, vulvodynia, weight fluctuation. |
| How is history of fibromyalgia pt taken? | Symptoms for at least 3 months, depression, anxiety, PTSD, CFS, OSA, restless leg syndrome, sleep disruption, Raynaud, autonomic dysfunction (orthostatic tachycardia), functional somatic syndromes (vulvodynia/temporomandibular syndrome)
Other conditions coexist/mimic FM (inflammatory rheumatic disorders (RA,SLE,SPA), non-inflammatory rheumatic diseases (osteoarthritis), localized pain syndrome, thyroid disease) |
| What are physical findings in dx of fibromyalgia? | There are 18 tender points that may be very painful, somewhat painful or mildly irritating.
sensitive and specific locations, control locations are over the thumb, mid forearm, and forehead.
Palpation force is 4 kg/equal to force needed to blanch the thumbnail |
| What are lab tests in FM? | Other conditions (DD), CBC, ESR, CRP, TSH, CPK, VitD, Ca, ANA |
| What are classification criteria of FM? | Three things must be present
At least 11 of 18 tender points (sensitivity 88%, specificity 81%)
Widespread pain index >7, symptoms severity scale >5 or WPI 3-6 with SS>9
No other disorder
pt can be no symptoms 0, few symptoms 1, moderate 2, great deal 3 |
