fibromyalgia

Question 1

definition of fibromyalgia

Answer 1

Fibromyalgia is a chronic pain syndrome diagnosed by the presence of widespread body pain (front and back, right and left, both sides of the diaphragm) for at least 3 months in addition to tenderness (digital palpation at an approximate force of 4 kg) of at least 11 out of 18 designated tender point sites as defined by the American College of Rheumatology 1990 classification criteria.
Criteria have been established that do not require performing a tender point count.[2] These criteria comprise adding up the number of body sites of pain, as well as the presence and severity of frequent comorbid symptoms such as fatigue, memory problems, and sleep disturbances. Although there is not likely to be any single cause, substantial evidence suggests that this is in part a central nervous system-driven pain amplification syndrome.

Question 2

risk factors

Answer 2

• family history of fibromyalgia
• rheumatological conditions (autoimmune conditions like RA, SLE or chronic pain conditions likes osteoarthritis)
• 20-60 y/o
• female (? may be problem with old diagnosis method)
• presence of associated conditions (e.g. IBD, tension headache)

Question 3

symptoms

Answer 3

• chronic pain
• significant fatigue
• sleep disturbance
• mood disturbance
• cognitive dysfunction

Question 4

signs

Answer 4

diffuse tenderness on examination

Question 5

investigations

Answer 5

1st: clinical diagnosis

• ESR, CRP (rule out inflammatory causes)
• TFT (rule out hypothyroid)
• FBC (rule out anemia as cause for pain and fatigue)
• rheumatoid factor (rule out RA)
• anti-CCP antibody (rule out RA)
• ANA (rule out SLE)
• vit D (vit D deficiency can cause widespread muscular pain)