Musco - Connective Tissue - Idiopathic Flashcards
1
Q
Fibromyalgia
A
A syndrome of widespread diffuse chronic pain of idiopathic etiology
AKA - Fibromyositis, Fibrositis, Idiopathic myalgia, Interstitial myofibrositis, Muscular rheumatism, musculorheumatism, myofibrositis, myogelosis, myositism, nodular rheumatism,nonarticular rheumatism
2
Q
Fibromyalgia - Epidemiology
A
- Chronic pain and fatigue are extremely prevalent in the general population, especially among women and persons of lower socioeconomic status
- Female to male ratio 9:1
- Prevalence in 1990 was 3.4% of women, and 0.5% of men
- Most prevalent in women 50 years of age or older.
3
Q
Fibromyalgia - Pathogenesis
A
- Possible sleep disturbance
- Possible disturbance of serotonin metabolism
- Possible disturbance in growth hormone production
- Possible disturbance in hypothalamic-pituitary-adrenal axis
- Possible dysregulation in the autonomic nervous system
- Possible over production of Substance P
- Possible dysregulation in the central pain modulation system
4
Q
Fibromyalgia - Presentation
A
- Generalized muscle pain
- Increased pain on exertion
- Pain described as burning or gnawing or as a sore, stiffness that is aching
- Perception of swollen joint, not present on physical examination
- Fatigue and exhaustion and complain of waking up tired
- Can be accomplished with cognitive impairment, difficulty thinking, loss of short-term memory
- Anxiety and depression
- Stress aggravates symptoms
5
Q
Fibromyalgia - Diagnostic Testing
A
- Widespread musculoskeletal pain of at least three months duration
- Significant pain or tenderness in 11 out of 18 tender points
- Normal neurologic exam
- No laboratory abnormalities suggestive of other rheumatologic diseases
6
Q
Fibromyalgia - Treatment
A
- Improve quality of sleep
- Exercise is critical; only consistently beneficial treatment to date
- Treat depression and anxiety if present
- Treat musculoskeletal issues involving somatic dysfunction (OMT)
- Maintain adequate circulation
*Acupuncture - Pharmacologic approach can include:
- low dose tricyclic antidepressants (amitriptyline)
- cyclobenzaprine (Flexeril)
- SSRIs
- Gabapentin
- Pregabalin (lyrica)
NSAIDs - Zolpidem (ambien)
- dextromethorphan
- capsaicin
- Guifenesin (no evidence of efficacy)
- melatonin
7
Q
Fibromyalgia - Management with complications
A
- Institute a program of low impact daily exercise when appropriate
- Stretching exercises
- Avoid all glucocorticoids and opiates based treatments
- Other therapies that can be helpful include:
- biofeedback
- Behavioral modification
- hypnotherapy
- stress management
8
Q
Fibromyalgia - Prevention and Health promotion
A
- Identification and alteration of stressful conditions in life
- Diet
- decrease caffeine intake
- increase tryptophan containing foods (turkey, bananas, skim milk, peanut butter)
- vitamin supplement, esp B6
- Group or individual therapy can be helpful
- Patient education and reassurance
9
Q
Polymyalgia Rheumatic
A
- Polymyalgia rheumatica is of idiopathi origin, possible related to an infection, and can feature pain and stiffness in the neck, shoulders, and pelvic region. PM is closely related to giant cell arteritis and could be a manifestation of the later disease.
10
Q
Polymyalgia Rheumatic - History
A
- One study revealed a prevalence of 1 in 200 people aged 50 years or older
- Can occur in isolation, but is comorbid in 40-50% of patients with giant cell arteritis
- PMR is not a life threatening disease, but it does require treatment for 2-4 years
- Mean age of onset is 70 years, range 50-90
11
Q
Polymyalgia Rheumatic - Presentation
A
- Onset can be abrupt or insidious
- Patient typically in good health before developing PM
- Low grade fever and weight loss present in over half the patients
- Arthralgias and myalgias
- Morning stiffness and getting up after inactivity are common complaints
- Malaise, fatigue, and depression
- Typically the shoulder girdle is the first area involved but hips or neck can also present initially
- Late stages can feature muscle atrophy
12
Q
Polymyalgia Rheumatic - Diagnostic Testing
A
- History and physical exam
- ESR greater than 50 mm/h
- Normochromic normocytic anemia in 50% of cases
- Normal creatinine kinase level
- Rheumatoid factor negative
- Negative muscle biopsy
13
Q
Sarcoidosis
A
- Chronic, multisystem granulomatous disorder of unclear etiology characterized pathologically by the accumulation of immune cells and the formation of noncaseating granulomas in effected tissue.
AKA - Lofgrens syndromeis an acute subgroup of sarcoidosis.
14
Q
Sarcoidosis - Epidemiology
A
- Incidence rnages from 5-40 per 100,000
- Incidence for whites is 11 per 100,000
- Incidence for african americans is 34 cases per 100,000
- Prevalence is 10 x greater for african americans than for whites
- More frequent in women than in men
- Most often presents between ages 20 to 40 but ranges from children to the elderly
15
Q
Sarcoidosis - Etiology
A
- Disordered immune regulation in the setting of a genetic background and an environmental trigger
