W12 - Fibromyalgia Flashcards

1
Q

a) Define the term Rheumatic disease.

b) List the characteristic clinical manifestations of rheumatic conditions.

A

a) Rheumatic disease is an umbrella term for conditions causing chronic, often intermittent pain affecting the periarticular tissues.

b) Characteristic clinical manifestations:
- Achy pain (diffuse)
- Tenderness
- Stiffness (gelling of fluids within joints)
Locations: Muscles, tendon insertions and adjacent soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define the term fibromyalgia.

A

A non-articular rheumatologic condition characterised by spontaneous, widespread soft tissue pain, sleep disturbance, fatigue and extensively distributed areas of tenderness.

*PAIN is key clinical feature and this can be used to distinguish from Chronic Fatigue (where most significant clinical feature is fatigue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss the prevalence of fibromyalgia.

A
  • ~5% of all GP patients
  • 2-4% of the general population (ie 3.4% of females and 0.5% of males)
  • 2nd only to OA as most common diagnosis in patients seen by rheumatologists
  • Affects 2-5% of the population in developed countries (equates to 585,000-1,175,000 Australians)
  • Most commonly affects women (4-7x more common), 25-40 year age group
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the main clinical manifestations of fibromyalgia.

A
  • Muscular pain (achy) - 100%
  • Fatigue - 96%
  • Insomnia - 86%
  • Joint pains - 72%
  • Headaches - 60%
  • Restless legs - 56%
  • Paraesthesia - 52%
  • Leg cramps - 42%
  • Cognitive or mental changes (impaired memory and concentration, nervousness and depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name four (4) areas of the body that are frequently affected by fibromyalgia.

A

Any 4 of the following:

  • Occiput
  • Neck
  • Shoulders
  • Thorax
  • Lower back
  • Thighs
  • Often occurs in in areas called “tender points (TPs)” – Usually found in same place on repeated examination, actual nodules may be palpated in the TPs 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Write brief notes on tender-spots.

A

Paired regions of the body that may or may not have nodules that are tender (pressure just enough to make nail beds turn white = ~1kg of pressure)
Often occurs in in areas called “tender points (TPs)”
– Usually found in same place on repeated examination
- actual nodules may be palpated in the TPs

Locations:

  • Low Cx (2) – At anterior aspects of intertransverse spaces at C5-C7
  • 2nd rib (2) – Upper lateral to second costochondral junction
  • Lateral epicondyle (2) – 2cm distal to the epicondyles
  • Knee (2) – At the medial fat pad proximal to the joint line
  • Occiput (2) – at midpoint of upper border
  • Supraspinatus (2) – At origins, above the scapula spine or near the medial border
  • Gluteal (2) – In upper outer quadrants of buttocks in anterior fold of muscle
  • Greater trochanter (2) – Posterior to the trochanteric prominence

*Diagnosis of fibromyalgia no longer made based on presence of TPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which factors are known to exacerbate the manifestations of fibromyalgia?

A
  • More frequent and prominent in morning or evening
  • Changes in the weather
  • Aching increased by inactivity
  • Pain aggravated by straining and overuse
  • Stress
  • Insensitive treatment by health practitioners
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which factors are known to alleviate the manifestations of fibromyalgia?

A
  • Aching relieved by moderate physical activity
  • Better in the middle part of the day – suggest doing physical activity in middle of day
  • More relaxed mental state – empathy and advice about stress-inducing factors
  • Stretching and breathing exercises – prescribe
  • Heat and massage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List four (4) non-rheumatic/non-articular symptoms of fibromyalgia.

A
  • Headaches
  • Insomnia
  • Exhaustion/Fatigue
  • Irritable Bowel Syndrome (IBS) – Maybe because demograph is young, stressed women
?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which female personality type is characteristic of fibromyalgia?

A
  • Healthy, young female
  • Self-driven, striving
  • Intense, anxious, compulsive, tense
  • Fervently involved in numerous activity
  • Very sensitive and responsive to external stimuli such as: cold, heat, humidity, noise
  • +/- a degree of depression 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Discuss the diagnosis of fibromyalgia

A
  • Typical for FM patients to see many doctors over 5 years before being correctly diagnosed
  • > 50% of patients are misdiagnosed and undergo unnecessary treatments including surgery
  • Diagnosed by considering all the patients relevant symptoms
  • Diagnosis is no longer based just on the number of tender points a patient has

American College of Rheumatology (ACR) criteria for diagnosing FM:

Criterion #1

  • Widespread Pain Index (WPI) >7 and Symptom Severity (SS) scale score >5 OR WPI 3-6 & SS >9
  • SS = Sum of severity of following 3 symptoms: Fatigue, waking unrefreshed, cognitive symptoms (rated 0-3). Plus severity of the somatic symptoms in general. Final score between 0-12
  • WPI = practitioner notes number of areas in which pt. has had pain over the last week (19 regions examined). WPI score between 0-19

Criterion #2 – Symptoms have been present at a similar level for at least 3 months

Criterion #3
– Patient does not have a disorder that would otherwise explain the pain (use diagnostic investigations to exclude)
- DD may include myofascial pain syndrome

Diagnostic investigations:

  • Complete blood count
  • Basal metabolic panel and urinalysis
  • TSH
  • Vit D & B12
  • Iron studies
  • Magnesium levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Discuss the prognosis of fibromyalgia.

A
  • Not life-threatening, deforming or progressive
  • Ssx are variable
  • Without proper diagnosis and treatment, patient may have the illusion of disease progression because of sleep deprivation and physical deconditioning
  • ~1/3 of patients need to modify their work to keep their jobs (eg shortened workdays or weeks, change to jobs that are less physically and mentally taxing)
  • Inability to advance in careers or education leading to decreased income and increased
  • A significant negative impact on the quality of social functions
  • > 15% of FM sufferers receive disability benefits
  • With appropriate treatment and a caring, informed physician, FM patients should be able to improve their function and reduce their pain 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly