Fibromyalgia Flashcards
What is fibromyalgia?
chronic widespread pain in the absence of inflammation
women are more affect than men (7:1)
Where are the ‘tender points’ located in fibromyalgia?
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
What is the diagnostic criteria for fibromyalgia?
presence of pain on palpation on at least 11/18 ‘tender points’ - left and right side
+ additional features
What are the additional features in fibromyalgia?
Joint pain and morning stiffness (80-90%) Fatigue (80-90%) often severe Poor concentration/cognitive problems Low mood Sleep disturbance Nausea Dysmenorrhoea
What investigations should be carried out to exclude other causes of pain and fatigue?
Blood tests FBC ESR/CRP TFTs Calcium and ALP Anti-nuclear antibodies Rheumatoid factor Creatinine kinase
What is FBC used to exclude?
anaemia
lymphopenia of lupus
What is ESR/CRP used to exclude?
inflammatory disease
What is TFTs used to exclude?
hypothyroidism
What is calcium and ALP used to exclude?
hyperparathyroidism and osteomalacia
What are anti-nuclear antibodies tested to exclude?
lupus
What is rheumatoid factor tested to exclude?
various MSK conditions
What is creatinine kinase tested to exclude?
heart and muscle conditions
What is the major differential in fibromyalgia?
chronic fatigue syndrome
What is chronic fatigue syndrome?
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
How prevalent is fibromyalgia?
1-11%
mainly women aged 40-65 years
Which conditions are associated with fibromyalgia?
chronic fatigue syndrome IBS premenstrual syndrome tension headache anxiety and depression cold sensitivity also RA, AS, SLE
What are the risk factors for developing fibromyalgia?
female sex middle age low income household divorce low educational status
What are the two main hypotheses for the pathology of fibromyalgia?
aberrant pain processing
sleep hypothesis
Describe the aberrhant pain processing pls
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)
Describe the sleep hypothesis pls
sleep disturbance may lead to abnormalities of serotonin, substance P and cortisol levels
Lack of restorative non-REM sleep
Leads to abnormal pain physiology
How should fibromyalgia be managed?
patient education developing coping strategies discuss psychosocial issues CBT Long term graded exercise programmes to improve function pharmacotherapy
How could you explain fibromyalgia to a patient?
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
What drugs can be used to treat fibromyalgia?
pain rarely responds to NSAIDs and steroids as there is no inflammation
Low dose TCAs and pregabalin may improve pain, sleep and morning stiffness
