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MSK > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

What is fibromyalgia?

A

chronic widespread pain in the absence of inflammation

women are more affect than men (7:1)

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2
Q

Where are the ‘tender points’ located in fibromyalgia?

A

suboccipital muscle insertions
anterior aspects of the inter-transverse spaces at C5-7
anterior aspects of intertransverse spaces (C5-7)
midpoint of trapezius
origin of supraspinatus
costochrondral junction of the 2nd rib
2cm distal to the lateral humeral epicondyle
upper outer gluteal quadrant
posterior to the greater trochanter
posterior to the greater trochanter
knee at the medial fat pad proximal to the joint line

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3
Q

What is the diagnostic criteria for fibromyalgia?

A

presence of pain on palpation on at least 11/18 ‘tender points’ - left and right side
+ additional features

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4
Q

What are the additional features in fibromyalgia?

A 
Joint pain and morning stiffness (80-90%)
Fatigue (80-90%) often severe 
Poor concentration/cognitive problems 
Low mood 
Sleep disturbance 
Nausea 
Dysmenorrhoea
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5
Q

What investigations should be carried out to exclude other causes of pain and fatigue?

A 
Blood tests 
FBC 
ESR/CRP
TFTs
Calcium and ALP 
Anti-nuclear antibodies 
Rheumatoid factor 
Creatinine kinase
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6
Q

What is FBC used to exclude?

A

anaemia

lymphopenia of lupus

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7
Q

What is ESR/CRP used to exclude?

A

inflammatory disease

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8
Q

What is TFTs used to exclude?

A

hypothyroidism

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9
Q

What is calcium and ALP used to exclude?

A

hyperparathyroidism and osteomalacia

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10
Q

What are anti-nuclear antibodies tested to exclude?

A

lupus

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11
Q

What is rheumatoid factor tested to exclude?

A

various MSK conditions

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12
Q

What is creatinine kinase tested to exclude?

A

heart and muscle conditions

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13
Q

What is the major differential in fibromyalgia?

A

chronic fatigue syndrome

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14
Q

What is chronic fatigue syndrome?

A

defined as persistent disbling fatigue lasting >6months, affecting mental and physical function, present >50% of all time, plus more than 4 or more of: myalgia, polyarthralgia, reduced memory, unrefreshing sleep, fatigue after exertion >24 hours, persistent sore throat, tender cervical/axillary lymph nodes

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15
Q

How prevalent is fibromyalgia?

A

1-11%

mainly women aged 40-65 years

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16
Q

Which conditions are associated with fibromyalgia?

A 
chronic fatigue syndrome 
IBS
premenstrual syndrome 
tension headache 
anxiety and depression 
cold sensitivity 
also RA, AS, SLE
17
Q

What are the risk factors for developing fibromyalgia?

A 
female sex
middle age
low income household 
divorce
low educational status
18
Q

What are the two main hypotheses for the pathology of fibromyalgia?

A

aberrant pain processing

sleep hypothesis

19
Q

Describe the aberrhant pain processing pls

A

states that fibromyalgia is caused by aberrhant peripheral and central pain processing
two key features of the condition are allodynia (pain in response to a non-painful stimulus) and hyperaesthesia (exaggerated perception of pain in response to a mildly painful stimulus)

20
Q

Describe the sleep hypothesis pls

A

sleep disturbance may lead to abnormalities of serotonin, substance P and cortisol levels
Lack of restorative non-REM sleep
Leads to abnormal pain physiology

21
Q

How should fibromyalgia be managed?

A 
patient education 
developing coping strategies 
discuss psychosocial issues 
CBT 
Long term graded exercise programmes to improve function 
pharmacotherapy
22
Q

How could you explain fibromyalgia to a patient?

A

fibromyalgia is a relapsing and remitting condition with no easy cures and they will continue to have good and bad days
reassure them that there is no serious underlying pathology and that their joints are not being damaged and that further tests are not required

23
Q

What drugs can be used to treat fibromyalgia?

A

pain rarely responds to NSAIDs and steroids as there is no inflammation
Low dose TCAs and pregabalin may improve pain, sleep and morning stiffness

MSK (22 decks)

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