Fibromyalgia

Question 1

1. a. Define the term Rheumatic disease.

b. List the characteristic clinical manifestations of rheumatic conditions

Answer 1

a. An umbrella term for conditions causing chronic, often intermittent pain affecting the joints and/or connective tissue.
b. Achy pain, tenderness, stiffness of
muscles, tendon insertions and adjacent soft tissues

Question 2

Define the term fibromyalgia

Answer 2

Fibromyalgia is a group of common, non articular rheumatic disorders characterised by:
Achy pain, tenderness, stiffness
Of
Muscles, Area of tendon insertions, Adjacent soft tissues.

Question 3

Discuss the prevalence of fibromyalgia.

Answer 3

2-4% of Pop Women
5% of all GP patients
15-20% of rheumatology patients
Top 5 rheumatic diseases, 2nd only to OA

The diagnosis is often not made because the criteria for diagnosis are inadequate.
The symptoms and signs are so vague that diagnosis is often missed.
FM most commonly presents in women 25 - 40 years that are otherwise healthy.
It is 5 times more in women than men.

Question 4

a. List the main clinical manifestations of fibromyalgia.

b. Name four areas of the body that are frequently affected fibromyalgia.

Answer 4

Rheumatic:
Diffuse aching
Tenderness / pain
Stiffness

Non Rheumatoidal
•	HA
•	Insomnia
•	Exhaustion/Fatigue
•	Anxiety/Depression
•	Irritable Bowel

Occiput, neck, shoulders, thorax, lower back thighs.

Question 5

Write brief notes on tender-spots.

Answer 5

• Found in the same place on repetitive examination (same spot on same patient) +- nodules
• Must have 11/18 possible tender spots to diagnose

Question 6

Which factors are known to exacerbate the manifestations of fibromyalgia?

Answer 6

Mornings & Evenings
Weather
Stress
Inactivity
Overuse/Straining
Insensitive Treatment by Health Pracs

Question 7

Which factors are known to alleviate the manifestations of fibromyalgia?

Answer 7

reassurance
 physical & mental relaxation
 stress management
 passive/active stretching
 regular moderate exercise
 local heat application
 osteopathy
 massage (deep and gentle)
 acupuncture
 counselling
 biofeedback
 NSAID’s
 medication for sleep problems
 tricyclic antidepressants
 injection of local anaesthetics

Question 8

Which female personality type is characteristic of fibromyalgia?

Answer 8

• Healthy young female
• Self driven
• Intense
• Anxious
• Compulsive
• Numerous activities
• Tense
• Sensitive to ext stimuli

Question 9

Discuss the diagnosis of fibromyalgia

Answer 9

Process of EXCLUSION (often >5yrs til diagnosis)
• Presenting ssx
• No longer solely based on tender spots
3 criteria
1. Widespread (diffuse) pain index >7/10 + ssx severity >5 (SS)
• WPI: Pain felt in any of 19 regions over 1 week
• SS: fatigue, waking unrefreshed & cognitive ssx – scored 0 – 3
2. SSX have been present and smilar >= 3/12
3. Patient does not have a disorder that would otherwise explain the pain

Investigations: used for exclusion
•	Radiography 
•	Blood cell count
•	Metabolic panel: urine analysis (TSH) 
•	VIt D levels
•	Vit B12
•	Iron Studies
•	Magnesium
•	ESR
•	ANtipolymer Ab (APA) assay (Controversial? may not be specific enough)
•	50% of patients have antipolymer abs

Question 10

Discuss the prognosis of fibromyalgia

Answer 10

The prognosis good i.e. FM is not a “serious” i.e. life-threatening disease.

2. Remission may occur in milder cases.
3. Usually observe recurrences at variable intervals
4. 1/3 of Patioents will need to modify their work to continue: reduced hours