Fibromyalgia / PMR / Chronic Fatigue

Question 1

What are the symptoms of fibromyalgia

Answer 1

Widespread chronic pain >3 months
R+L side of body and above and below waist
Axial skeleton pain
Tender points >11/18

Question 2

What are other symptoms

Answer 2

Lethargy
Cognition
Headache 
Dizzy 
Morning stiff
Paraesthesia 
Sleep disturbance
Chronic fatigue
Depression 
IBS

Question 3

Who is at risk / associations

Answer 3

Women
Middle age
Low income
Divorced
Low education 
Chronic fatigue
IBS
Chronic headache
RA / AS / SLE

Question 4

What must you exclude before diagnosing

Answer 4

RA
PMR
Vasculitis
Hypothyroid
Myeloma as bone pan

Question 5

How do you Rx

Answer 5

Explanation
Aerobic exercise
CBT
Low dose pregabalin / amitryptilline
Address sleep issues
Physio

Question 6

What is Chronic fatigue / ME

Answer 6

Persistent disabling fatigue >6 months
Mental and physical function affected >50%
Absence of any disease that explains

Question 7

What 4+ other features needed for Dx

Answer 7

Myalgia 
Polyarthralgia
Poor memory 
Fatigue after mental or physical exertion
Persistent sore throat
Persistent headache
Tender cervical / axillary LN with no enlargement 
Malaise / dizzy / nausea

Question 8

What investigations

Answer 8

FBC, U+E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin
Coeliac screen
Urinanalysis

Question 9

How do you treat

Answer 9

Similar to fibromyalgia
Graded exercise
CBT
Low dose amitrpytilline for poor sleep
Pain clinic

Question 10

What is polymyalgia Rheumatica

Answer 10

Inflammatory condition of the elderly

Question 11

What are the symptoms

Answer 11

Sudden onset shoulder + pelvic girdle stiffness
Worse with movement
Interferes with sleep 
Rapid onset <1 month
ESR >45
Anaemia
Fatigue
Weight loss 
Anorexia
Low grade fever
Depression
Night sweats
Dyspnoea
Weak pulse
Mild polyarthralgia 
Carpal tunnel 
Weakness is NOT a feature

Question 12

How do you Dx

Answer 12

No test - Dx of exclusion 
Age + raised ESR + history (DDX could be statin induced myopathy but ESR would be normal) 
Raised ALP?
Do FBC, U+E, LFT, Ca, TFT
Myeloma screen
CK
RF ? 
Urine dip

Question 13

How do you Rx

Answer 13

Dramatic steroid response
Prednisolone for 18-24 months
Bone prophylaxis - bipshophonate, Ca, vit D + gastric protection = PPI
Urgent medical if GCA develops

Question 14

What are DDX

Answer 14

OA
RA
SLE
Cervical spondylosis
Adhesive capsulitis of both shoulders
Hyper or hypothyroid
Osteomalacia
Fibromyalgia