Mimic Inflammatory Conditions Flashcards
What is fibromyalgia?
Centralised pain disorder characterised by severe pain and other somatic symptoms
Widespread pain in multiple regions of body for more than 3 months
What is the features of fibromyalgia?
Intrusive fatigue - physical, cognitive, and emotional
Increased sensitivity to sound, light, and fluctuations in temp.
Symptoms can fluctuate in severity and type over time
What are important conditions to think of when diagnosing fibromyalgia?
Malignancy, rheumatic conditions, polymyalgia rheumatica, endocrine disorders, drug induced conditions, sleep disorders, neurological disorders, functional neurological disorders and depression
What can help with general examination for fibromyalgia?
GALS screen
PIP tuck, thumb to little finer, wrist and fore/mid/hindfoot
Enthesitic points
Joint hypermobility
What is involved in joint examination for fibromyalgia?
Joint swelling
Bony/ firm
Soft tissue/ boggy/ spongy - synovitis (like a grape)
Dactylitis - think SpA
Pressure on palpation
What is the predisposition for fibromyalgia?
Common beliefs/ situations, usually coping strategies, coping skills not good, significant psychosocial stress, and physical illness now resolved (trigger)
Infections (viral), trauma, and prolonged stressful situations
What are the maintaining factors for fibromyalgia?
Fear of symptoms and consequences leads to activity avoidance, reduced external external stimulation, sleep problems leading to pain and fatigue
What are symptoms of fibromyalgia?
Widespread pain, intrusive fatigue, longevity of symptoms, feeling overwhelmed, poor concentration, poor refreshment from rest and ineffective treatments so far
What type of pain if fibromyalgia?
Nociplastic - caused by disturbance in peripheral and/ or central nervous system pain processing
Cant be alleviated from surgery
How is fibromyalgia diagnosed?
Symptoms present for more than 3 months
Use ACR criteria
Use symptom severity index
Use widespread pain index
What is the management for fibromyalgia syndrome (FMS)?
Pain related anxiety/ depression - CBT and SSRIs
Severe sleep disturbance - low dose amitriptyline and night time pregabalin
Severe pain - amitriptyline, gabapentin, pregabalin, duloxetine and tramadol
Physio
What can be a cause of MSK pain in children and adults?
Hypermobility
What are some features of hypermotility?
More females than males
Not every hypermobile person gets pain
Strongly genetically determined
Definitely a link with chronic pain
What is the difference between localised and widespread hypermotility (HM)?
Localised may be advantageous
Widespread may be disadvantageous
What is the spectrum of HM?
Wide - Ehler’s Danlos syndrome (EDS) - Marfan’s syndrome - Osteogenesis imperfecta
Hypermobility and pain - Hypermotility spectrum disorder (HSD) or hypermobile EDS (hEDS)
Pathophysiology - true connective tissue disorders
