Week 1 Flashcards
What are some risk factors for fibromyalgia?
Female
Aged 20-60
RA
Family History
What is fibromyalgia?
Chronic pain disorder with an unknown cause and can’t be explained by any other diagnosis.
What are some differentials to consider when thinking about fibromyalgia?
Chronic fatigue syndrome
Hypothyroidism
PMR
Myopathies
Polymyositis
What investigations would you do in fibromyalgia?
Clinical diagnosis - diagnosis of exclusion
Widespread pain index can help aid diagnosis - 11 or point points, present for >3 months, no other diagnosis could explain the symptoms
Fibromyalgia impact questionnaire
Other investigations are to rule out other diagnosis:
Blood tests - ESR/CRP, TFTs, RF, ANA and FBC
What is chronic fatigue syndrome?
A severe, multi systemic and disabling condition characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise for at least 6 months (however, now recommended that after 3 months history to start treatment due to the negative impact of delaying tx).
What are the risk factors for Chronic Fatigue Syndrome?
Females
Covid 19
EBV in adolescence
Family history
What are the features seen in chronic fatigue syndrome?
Fatigue is the central feature, other recognised features include
sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
muscle and/or joint pains
headaches
painful lymph nodes without enlargement
sore throat
cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
physical or mental exertion makes symptoms worse
general malaise or ‘flu-like’ symptoms
dizziness
nausea
palpitations
What investigations are done in chronic fatigue syndrome?
NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis
DePaul Symptom Questionnaire
What is the management of chronic fatigue syndrome?
Management
Refer to a specialist CFS service if the diagnostic criteria are met and symptoms have persisted for 3 months
Energy management:
a self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional
Physical activity and exercise:
do not advise people with ME/CFS to undertake exercise that is not part of a programme overseen by an ME/CFS specialist team
should only be recommended if patients ‘feel ready to progress their physical activity beyond their current activities of daily living’
graded exercise therapy used to be recommended but is now specifically not recommended by NICE
Cognitive behavioural therapy:
NICE stress this is ‘supportive’ rather than curative for CFS
How is chronic fatigue syndrome diagnosed?
Diagnose ME/CFS in a child, young person or adult who has the symptoms that have persisted for 3 months and are not explained by another condition.
All of these symptoms should be present:
Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
Post-exertional malaise after activity in which the worsening of symptoms:
Is often delayed in onset by hours or days
Is disproportionate to the activity
Has a prolonged recovery time that may last hours, days, weeks or longer.
Unrefreshing sleep or sleep disturbance (or both), which may include:
Feeling exhausted, feeling flu-like and stiff on waking
Broken or shallow sleep, altered sleep pattern or hypersomnia.
Cognitive difficulties (sometimes described as ‘brain fog’).
What are medically unexplained symptoms?
This is when symptoms last for more than a few weeks but doctors can’t find a problem with the body that may be the cause. This doesn’t mean the symptoms are made up, they’re real and can affect the patients ability to function properly.
How should medically unexplained symptoms be managed?
Explanation of the symptoms and reassurance of the conditions that have been ruled out. Focus on the impact of the symptoms rather than the diagnosis.
Good communication and doctor/patient relationship
CBT
Exercise
SSRIs can help
Lifestyle changes can be useful
Regular follow up with GP
Managing stress
Name different conditions that cause unexplained symptoms without an organic cause:
Somatisation disorder
Illness anxiety disorder (hypochondriasis)
Functional neurological disorder (conversion disorder)
Dissociative disorder
Factitious disorder (also know as munchausen’s syndrome)
Factitious disorder by proxy
Malingering
What is malingering?
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
What is Factitious disorder and Factitious disorder by proxy?
The intentional production of physical or psychological symptoms
By proxy - when its done to another person, this is a form of abuse.
