Fibromyalgia

Question 1

Definition

Answer 1

Syndrome characterised by chronic widespread pain and hypersensitivity to pressure 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 sleep
Obesity
Smoking
Sedentary lifestyle

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

Question 5

Symptoms

Answer 5

Chronic pain
Allodynia
Fatigue
Sleep disturbances
Headaches
Difficulty concentrating

Question 6

Diagnosis

Answer 6

Clinical diagnosis
No serological markers
No ESR + CRP

Question 7

Treatment

Answer 7

FIRST LINE: Patient education and physiotherapy
SECOND LINE:
- CBT
- Antidepressant: SNRI = DULOXETINE, PREGABALIN, AMYTRIPTYLINE

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

Question 9

Diagnostic criteria

Answer 9

Patients are assessed by:
- A widespread pain index (WPI), which divides the body into 19 regions and patients report which ones are painful
- A symptoms severity score (SS), which assess fatigue, sleep and cognitive symptoms

A patient satisfies the diagnostic criteria for fibromyalgia if the following 3 conditions are met:
- Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3 - 6 and SS scale score ≥9
- Symptoms have been present at a similar level for at least 3 months
- The patient does not have a disorder that would otherwise explain the pain