Hypermobility and Fibromyalgia Flashcards
what is the diagnostic criteria for fibromyalgia
Widespread pain for at least 3 months
Widespread pain index ≥7 and
Symptom severity scale ≥5 OR
WPI 4-6 and SSS score ≥9
Generalised pain, defined as pain in at least 4 of 5 regions
Symptoms have been present at a similar level for the 3 months
All on a background of normal laboratory tests
what is the widespread pain index
19 areas in which a patient may feel pain
Measured over the last week, with a score given if pain was felt in that area for
An alternative to this is the 18 tender point scale, where a 4kg weight is pressed at the 18 tender points and the patient is asked if they feel pain
what is the symptom of severity scale score
Fatigue
Waking unrefreshed
Cognitive symptoms
For each of the 3 symptoms a score out of 3 is given
0 = no problem
1 = slight, mild, intermitten issues
2 = moderate, considerable problems, often present at a moderate level
3 = severe, pervasive, continueous life-disturbing problems
what is a highly sensitive history point to ask patients with suspected fibromyalgia
sleep pattern - <6 hours of uninterrupted sleep = high liklihood for fibromyalgia
what are the common comorbid conditions with fibromyalgia
IBS
Chronic fatigue syndrome
Tension headaches
Migraines
Temporomandibular disorder
Major depressive disorder
what are some differentials for fibromyalgia + what are some features of each
Myofascial pain syndrome
Typically in axial (trunk and head) muscles
Therefore it contrasts with the widespread pain of fibromyalgia
Chronic fatigue syndrome
Whilst this has fatigue and chronic pain, this is the result of subclinical inflammation causing lymph node enlargment, low grade fever and acute onset of illness
Hypothyroidism
Symptoms mimic fibromyalgia but this should be ruled out with a blood test
Polymyalgia rheumatica
Inflammatory myopathies
Especially in patients taking statins
what are common treatments of fibromyalgia
Education and advice
Sleep hygiene
CBT
Exercise
Amitriptyline (low dose)
what is hypermobility
Musculoskeletal condition without rheumatological disease giving them ligament laxity allowing a greater degree of movement of their joints
how do you diagnose hypermobility syndromes
beighton score
>4/9 = significant, 6+ = hypermobility
what are the movements involved in the beighton score and what is considered abnormal
little finger extension, >90 degrees is abnormal, 1 point for each side
bringing thumb towards forearm whilst in wrist flexion, bringing thumb onto the forearm is abnormal, 1 point for each side
elbow extension, hyperextension of the elbow is abnormal, 1 point for each side
knee extension whilst supine, if lower part of leg comes off the bed with knee straight that is abnormal, 1 point for each side
touching toes, touching palms with straight legs onto the floor is abnormal and scores 1 point – you should ask if they’ve even been able to do that as people get stiffer in old age
what is an alternative diagnostic score for hypermobility
brighton score
what are the major and minor criteria for the Brighton score for hypermobility
Major Criteria
Beighton score >4/9
arthralgia for >3 months in 4 or more joints
Minor Criteria
Beighton score of 1-3/9 (0-3 if 50+)
Arthralgia >3 months in 1-3 joints OR 3 months of back pain, spondylosis, spondylosis
Dislocation/subluxation in more than one joint, or in one joint on more than one occasion
Soft tissue rheumatism
Marfinoid Habitus
abnormal skin
eye signs
systemic skin involvement
requires: 2 major, 1 major 2 minor, 4 minor
what are features of marfinoid habitus
Tall
Slim
Span:height >1.03
Upper segment:lower segment 0.89
Arachnodactyly
what abnormal skin features are associated with hypermobility syndromes
Striae
Hyperextensibility
Thin skin
Papyraceous scarring
what eye signs are associated with hypermobility syndromes
Drooping eyelids
Myopia
Antimongoloid slant
