Fibromyalgia

Question 1

Define Fibromyalgia

Answer 1

Fibromyalgia is a chronic pain syndrome diagnosed by the presence of widespread body pain.

American College of Rheumatology criteria for the classification of fibromyalgia required that an individual:

• Has widespread pain for at least 3 months ​
  
  • front & back
  • right and left
  • both sides of the diaphragm
• Tenderness to digital palpation (of at least 11 out of 18 designated tender point sites)
• Fatigue, memory and sleep difficulties.

Question 2

Aetiology/Risk factors for Fibromyalgia

Answer 2

• Female sex
• Age 20-60
• FHx of Fibromyalgia
• Other rheumatological conditions:
  
  • Rheumatoid Arthritis
  • SLE
  • Osteoarthritis
• Associated conditions:
  
  • IBS
  • Tension headache
  • TMJ syndrome

Question 3

Epidemiology of Fibromyalgia

Answer 3

• Female 20-60

Question 4

Presenting Symptoms

Answer 4

• Chronic (>3 months) widespread pain
• Significant fatigue
• Sleep disturbance
• Mood disturbance
• Cognitive dysfunction (poor memory, difficulty concentrating)
• Paraesthesias (tingling)

Question 5

Signs on physical examination

Answer 5

• Widespread tenderness
• Normal examination
• No signs of inflammation (no swelling, deformity or erythema)

Question 6

Investigations for Fibromyalgia

Answer 6

• This is a clinical diagnosis using the American Rheumatology criteria
• If the patient does not meet clinical criteria for a diagnosis of fibromyalgia, then some tests should be performed to screen for alternative causes of symptoms including:
  
  • FBC
  • TFT (Hypothyroidism)
  • ESR & CRP
  • Vitamin D levels