Widespread MSK pain

Question 1

What are the differentials for widespread MSK pain?

Answer 1

• inflammatory arthritis
• fibromyalgia
• systemic lupus erthythematosus (SLE)
• myositis
• polymyalgia rheumatica (bilateral shoulders/neck and pelvic girdle)
• metabolic bone disease (osteomalacia, Paget disease)
• paraneoplastic rheumatic syndrome
• widespread skeletal metastases
• vitamin deficiency: B12/folate
• hypothyroidism

Question 2

What does widespread MSK pain with associated symptoms of rashes, mouth ulcers, and Raynaud phenomenon suggest?

Answer 2

• possibility of SLE

Question 3

What does widespread MSK pain with associated symptoms of anxiety and depression suggest?

Answer 3

• fibromyalgia

Question 4

What are the symptoms of fibromyalgia?

Answer 4

• fatigue, depression, anxiety, sleep disturbance, altered bowel habits
• accompanied with widespread MSK pain with a number of localised trigger points

Question 5

What is the management of fibromyalgia?

Answer 5

• Education, physio/exercise, CBT
  (note: emphasise that exercise will not make worse)
• Medications: antidepressants (amitriptyline), anticonvulsants (gabapentin, pregabalin), tramadol
  -(note: NSAIDs have no role in treatment)

Question 6

What is paraneoplastic rheumatic syndrome? (and what primary tumours commonly metastasise to bone?)

Answer 6

• Widespread bony metastases can present with widespread pain (very rare)
• note: primary tumours that commonly metastasise to bone are: breast, lung, prostate, kidney, and thyroid cancers