Fibromyalgia

Question 1

Definition

Answer 1

Syndrome characterised by chronic widespread pain and tender points at specific anatomical sites for more than 3 months with all other causes redundant
- Often accompanied by depression, fatigue and sleep disturbance

Question 2

Epidemiology

Answer 2

Females
Family history
30-60

Question 3

Risk factors

Answer 3

Depression
Stress
Poor

Question 4

Signs

Answer 4

Specific tender points throughout the body are suggestive of fibromyalgia:
- Occiput
- Low cervical region
- Trapezius
- Supraspinatus
- Second rib
- Lateral epicondyle
- Gluteal region
- Greater trochanter
- Knees
Tenderness to these areas bilaterally were previously used as a diagnostic criteria for fibromyalgia.

Question 5

Symptoms

Answer 5

Chronic pain
Fatigue
Sleep disturbances
Headaches
Difficulty concentrating

Question 6

Diagnosis

Answer 6

Clinical diagnosis
No serological markers
No ESR + CRP
Pain in 11+ out of the 18 regions palpable

Question 7

Treatment

Answer 7

FIRST LINE: Patient education and physiotherapy
SECOND LINE: Antidepressants (e.g. TCA - Amitriptyline) + CBT

Question 8

Differential diagnosis

Answer 8

Polymyalgia Rheumatica
- Chronic inflammatory rheumatic condition similar to large cell vasculitis presenting as chronic pain syndrome = affecting muscles and joints
Epidemiology = female, 50+, white
Risk factors = Giant cell arteritis
Signs = Bilateral arm tenderness, peripheral MSK signs: pitting peripheral oedema, carpel tunnel syndrome, asymmetric peripheral arthritis
Symptoms = Bilateral shoulder +/or pelvic girdle pain, stiffness >45 mins after waking or resting, systematic symptoms= low grade fever, anorexia, fatigue, depression
Diagnosis = Elevated ESR + CRP
Treatment = Prednisolone