Fibromyalgia and Chronic Fatigue Syndrome

Question 1

what is fibromyalgia

Answer 1

syndrome of persistent widespread PAIN, FATIGUE, stiffness, disrupted/unrefreshing sleep, cognitive difficulties

often w/ other unexplained sx, anxiety/depression, impaired of ADL

Question 2

who does fibromyalgia usually present in

Answer 2

usually young/middle-aged women but can affect pt of either sex at any age

Question 3

aetiology of fibromyalgia?

Answer 3

complex, multifactorial - incl. env and genetics

Question 4

how is fibromyalgia classified?

Answer 4

central sensitivity syndrome (neurosensory disorder characterised in part by abnormalities in central pain professing)

Question 5

sx of fibromyalgia

Answer 5

PAIN THAT IS CHRONIC (>3MO) and WIDESPREAD in the absence of inflammation

morning stiffness (90%)
fatigue (90%) - often severe
poor conc
low mood
sleep disturbance

Question 6

typical presentation of fibromyalgia

Answer 6

PAIN THAT IS CHRONIC (>3MO) and WIDESPREAD in the absence of inflammation

tenderness in >11/18 tender points (L+R)

morning stiffness (90%)
fatigue (90%) - often severe
poor conc
low mood
sleep disturbance

Question 7

what are the 9 tender points

Answer 7

h&n
suboccipital muscle insertion
anterior inter-transverse spaces at C5-C7
midpoint of upper border of trapezius

thorax
origin of supraspinatus near medial border of scapular spine
costochondral junction of 2nd rib

upper limb
2cm distal to lateral humeral epicondyle

lower limb
upper outer gluteal quadrant
posterior greater trochanter
knee (medial fat pad near joint line)

Question 8

ix of fibromyalgia

Answer 8

are all normal
other causes need to be excluded (e.g. RA, PMR, vasculitis, hypothyroidism, myeloma)

Question 9

mx of fibromyalgia

Answer 9

conservative - crucial
- pt education, reassurance
- aerobic exercise
- cbt

medical
- unresponsive to nsaids, steroids as no underlying inflammation
- pregabalin, amitriptyline, duloxetine

Question 10

differences between fibromyalgia and pmr: age?

Answer 10

fm: middle-aged women
pmr: women > 50

Question 11

differences between fibromyalgia and pmr: location?

Answer 11

fm: various
pmr: shoulder, pelvic girdle

Question 12

differences between fibromyalgia and pmr: location?

Answer 12

fm: various
pmr: shoulder, pelvic girlde

Question 13

differences between fibromyalgia and pmr: esr?

Answer 13

fm: normal
pmr: raised markedly (>100mm/hr)

Question 14

differences between fibromyalgia and pmr: muscle biopsy?

Answer 14

both normal

Question 15

differences between fibromyalgia and pmr: classic findings?

Answer 15

fm: anxiety, stress, point tenderness, negative workup
pmr: temporal arteritis, responds to steroids

Question 16

differences between fibromyalgia and pmr: mx?

Answer 16

fm: antidepressants, NSAIDs, rest
pmr: low-dose prednisolone