Fibromyalgia

Question 1

Fibromyalgia

Answer 1

 Single syndrome or included in multiple syndrome category, such as Functional Somatic Syndromes(FSS)?

 Chronic Fatigue Syndrome
 Irritable Bowel Syndrome
 Headache Syndromes
 Multiple Chemical Sensitivities

Question 2

Fibromyalgia

Answer 2

Originally thought to be 9:1 ratio of females to men in diagnosis, now may be lower with only slightly higher dx in women
Prevalence 1-4%

Question 3

Fibromyalgia

Etiology/Pathophysiology

 Genetics ( low gene expression of
proinflammatory cytokines)

Answer 3

 Psychosocial
 Sleep Disturbances?
 Neuroendocrine dysfunction/dysregulation
 Abnormal Pain Processing
 Reduced pain tolerance
 Perceive pain as more intense and longer
 Decreased Pain Inhibition  Low levels of Serotonin

Question 4

Fibromyalgia

Clinical Symptoms

Answer 4

 Most Common complaint- Generalized pain/
“Pain all over”
 Tender points
 Sleep problems
 Fatigue/tiredness
 Muscle Pain
 Muscle Weakness
 Parasthesias
 Cognitive problems ( memory)
 Headache
 Irritable bowel syndrome
 Depression/Anxiety
 Raynaud’s syndrome

Question 5

Fibromyalgia

Tender points- all bilateral

Answer 5

Tender points- all bilateral
 Occiput
 Low Cervical (C5-C7)
 Trapezius
 Supraspinatus
 Second Rib
 Lateral Epicondyle
 Gluteal
 Greater Trochanter
 Knee (medial fat pad)

Question 6

Fibromyalgia

How do we diagnosis?

Answer 6

 Two criteria systems still used
 Both the 1990 diagnostic criteria by American
College of Rheumatology and the revised 2010 diagnostic criteria by ACR
 Exclude all other differentials

Question 7

Differential Diagnoses

Answer 7

 Rheumatoid Arthritis
 SLE
 Sjogren’s Syndrome
 Chronic Fatigue Syndrome  Irritable Bowel Syndrome
 Myofascial Pain Syndrome  Hypothyroidism
 Multiple Sclerosis
 Peripheral Neuropathies
 Myasthenia Gravis

Question 8

Labs/Diagnostics

Answer 8

 Basic Metabolic Panel  CBC with Diff
 Thyroid function panel
 Radiographs ?

 Usually all normal in Fibromyalgia
 May need other lab work to exclude differential diagnoses

Question 9

Treatment

Answer 9

 Consult/Referral to Rheumatologist and possibly
Neurologist
 Education
 Exercise
 Cognitive Behavioral Therapy
 NSAIDs and Analgesics ( not well studied)
 Psychotropic Agents
 Hypnosis
 Chiropractic manipulation
 Injections
 Combination Therapy

Question 10

Fibromyalgia

Answer 10

 A complex disorder with multiple components
Mixed results with treatment

Question 11

Fibromyalgia

What is it?

Answer 11

 “A clinical syndrome defined by the presence
of generalized pain, fatigue, unrefreshed sleep, multiple somatic symptoms, cognitive problems, and other symptoms, often including depression.” Kelley’s Textbook of Rheumatology, 2013.