Rheumatology Book

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Fibromyalgia

Aka: Fibromyalgia, Fibrositis
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  1. See Also
    1. ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
    2. Tender Points
  2. Epidemiology
    1. Women account for 75% of Fibromyalgia patients
    2. Peak Incidence: ages 20 to 60 years old
    3. Most common rheumatic cause of chronic diffuse pain
    4. Incidence
      1. Rheumatology patients: 15%
      2. General medical patients: 5%
      3. General population: 2%
  3. Associated Conditions: Common Comorbid Chronic Conditions
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Lyme Disease
    4. Sleep Apnea
  4. Associated Conditions: General
    1. Chronic Fatigue Syndrome
    2. Irritable Bowel Syndrome
    3. Tension Headache
    4. Migraine Headache
    5. Primary Dysmenorrhea
    6. Restless legs syndrome
    7. Periodic limb Movement Disorder
    8. Temporomandibular Joint pain
    9. Myofascial Pain Syndrome
  5. Associated Conditions: Miscellaneous Symptoms
    1. Severe Fatigue (81%)
    2. Morning stiffness longer than 15 minutes (77%)
    3. Sleep Disorder (75%)
      1. Non-restorative sleep (alpha-delta sleep)
      2. Sleep Apnea
      3. Nocturnal Myoclonus
      4. Restless Leg Syndrome
    4. Atypical Paresthesias (63%)
    5. Anxiety (48%)
    6. Dry Mouth (36%)
    7. Recurrent Headaches (53%)
    8. Dysmenorrhea (41%)
    9. Past History of Major Depression (31%)
    10. Irritable Bowel Syndrome (30%)
    11. Urinary urgency (26%)
    12. Cold sensitivity or Raynaud's Phenomenon (17%)
    13. Reduced functional ability
    14. Aerobic deconditioning
  6. Exacerbating Factors
    1. Post-exertional increase in muscle pain
    2. Stress or Abuse
  7. Signs
    1. See Diagnosis below
  8. Differential diagnosis
    1. Other Myofascial Conditions
      1. Myofascial Pain Syndrome
      2. Chronic Fatigue Syndrome
    2. Psychiatric Conditions
      1. Masked Major Depression
      2. Somatoform Disorder
    3. Rheumatic, Endocrine and Neurologic Conditions
      1. Systemic Lupus Erythematosus (SLE)
      2. Rheumatoid Arthritis
      3. Polymyalgia Rheumatica
      4. Diabetes Mellitus
      5. Myopathy or Neuropathy
      6. Hypothyroidism
      7. Ankylosing Spondylitis
      8. Disc Herniation
      9. Paraneoplastic Neuropathy
      10. Parkinson's Disease
  9. Labs (Should be Normal)
    1. Standard Evaluation
      1. Complete Blood Count (CBC)
      2. Erythrocyte Sedimentation Rate (ESR)
      3. Chemistry Panel (Chem7)
      4. Thyroid Stimulating Hormone (TSH)
      5. Creatinine Phosphokinase (CPK)
    2. Additional tests when indicated
      1. Antinuclear Antibody (ANA)
      2. Rheumatoid Factor (RF)
  10. Diagnosis: General Criteria
    1. Fibromyalgia is a diagnosis of exclusion
    2. Widespread musculoskeletal pain ("I hurt all over")
    3. Regional: Each of 4 body quadrants involved
      1. Pain on left and right side of body
      2. Pain above and below waist
    4. Axial skeleton pain present
      1. Cervical spine
      2. Anterior chest
      3. Thoracic Spine
      4. Low back
    5. Pain worse in the morning and at the end of the day
    6. Symptoms persist at least 3 months
  11. Diagnosis
    1. New criteria (2010)
      1. See ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
    2. Older criteria (1990)
      1. See Tender Points (11 of 18 present)
  12. Management
    1. See Fibromyalgia Non-Pharmacologic Management
    2. See Fibromyalgia Pharmacologic Management
    3. Fibromyalgia Impact Questionnaire
      1. http://www.myalgia.com/FIQ/fiq.pdf
      2. Assess for associated functional Impairment
  13. Resources: Patients
    1. Fransen (1997) Fibromyalgia Help Book, Smith House
      1. Paid link to Amazon.com (ISBN 0961522143)
    2. Starlanyl (1996) Fibromyalgia and Myofascial Pain, NHP
      1. Paid link to Amazon.com (ISBN 1572240466)
  14. Resources: Organizations
    1. Arthritis Foundation
      1. http://www.arthritis.org
    2. National Fibromyalgia Research Association
      1. http://www.teleport.com/~nfra
    3. USA Fibromyalgia Association
      1. http://www.fibromyalgiaassnusa.org
    4. UK Fibromyalgia Association
      1. http://www.community-care.org.uk/charity/fmauk.html
  15. References
    1. Berman (1999) J Fam Pract 48(3):213-18
    2. Gremillion (1998) Phys Sportsmed, 26(4) 55-65
    3. Hadler (1997) Postgrad Med 102(2):161-77
    4. Klippel (1997) Primer Rheumatic Diseases, p.124-7
    5. Reiffenberger (1996) Am Fam Physician 53(5):1698-1704
    6. Wilke (1996) Postgrad Med 100(1):153-70
    7. Yunus (1996) Consultant, p. 1260-74
    8. Yunus (1996) Consultant, p. 1279-85

Fibromyalgia (C0016053)

Definition (NCI) Inflammation and fibrous degeneration of a muscle.
Definition (NCI) Inflammation and fibrous degeneration of a muscle.
Definition (MEDLINEPLUS)

Fibromyalgia makes you feel tired and causes muscle pain and "tender points." Tender points are places on the neck, shoulders, back, hips, arms or legs that hurt when touched. People with fibromyalgia may have other symptoms, such as trouble sleeping, morning stiffness, headaches, and problems with thinking and memory, sometimes called "fibro fog."

No one knows what causes fibromyalgia. Anyone can get it, but it is most common in middle-aged women. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia. There is no cure for fibromyalgia, but medicines can help you manage your symptoms. Getting enough sleep and exercising may also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Definition (NCI) A chronic disorder of unknown etiology characterized by pain, stiffness, and tenderness in the muscles of neck, shoulders, back, hips, arms, and legs. Other signs and symptoms include headaches, fatigue, sleep disturbances, and painful menstruation.
Definition (MSH) A common nonarticular rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure to cold. This condition is often associated with general symptoms, such as sleep disturbances, fatigue, stiffness, HEADACHES, and occasionally DEPRESSION. There is significant overlap between fibromyalgia and the chronic fatigue syndrome (FATIGUE SYNDROME, CHRONIC). Fibromyalgia may arise as a primary or secondary disease process. It is most frequent in females aged 20 to 50 years. (From Adams et al., Principles of Neurology, 6th ed, p1494-95)
Definition (PSY) A common nonarticular rheumatic condition that is characterized by muscle pain, tenderness, and stiffness.
Definition (CSP) an acute, subacute, or chronic painful state of muscles, subcutaneous tissues, ligaments, tendons, or fasciae caused by a number of agents such as trauma, strain, occupation, exposure, posture, infection, or arthritis.
Concepts Disease or Syndrome (T047)
MSH D005356
ICD10 M79.7, M79.1
SnomedCT 203138004, 203082005, 247365004, 156727006, 1304004, 203111006, 203101004, 24693007, 56557000, 203102006, 13612005, 268107007
English Fibromyalgias, Fibrositides, Fibrositis, Muscular Rheumatism, Rheumatism, Muscular, FIBROMYALGIA, FIBROSITIS, RHEUMATISM, TENSION, Fibromyositis, NOS, Fibrositis, NOS, Diffuse myofascial pain synd, Fibromyositis NOS, Fibromyalgia, NOS, Fibrositis unspecified, MPDS-Myofac pain dysfunct syn, Myofac pain dysfunct syndrome, Myofascial pain dysfunct syn, Myofascial pain dysfunction syndrome, myofascial pain dysfunction syndrome, MPD syndrome, muscular rheumatism, fibrositis, fibromyalgia (diagnosis), fibromyalgia, fibrositis (diagnosis), Fibromyalgia (disorder), Fibromyalgia (finding), FMS, Fibromyalgia syndrome, Diffuse Myofascial Pain Syndrome, Myofascial Pain Syndrome, Diffuse, Fibromyalgia Fibromyositis Syndrome, Fibromyalgia-Fibromyositis Syndrome, Fibromyalgia-Fibromyositis Syndromes, Fibromyositis Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndromes, Syndrome, Fibromyalgia-Fibromyositis, Syndrome, Fibromyositis-Fibromyalgia, Syndromes, Fibromyalgia-Fibromyositis, Syndromes, Fibromyositis-Fibromyalgia, Fibromyositis NOS (disorder), Fibrositis unspecified (disorder), FIBROMYOSITIS, Fibromyalgia [Disease/Finding], fibromyalgia (FM), fibromyalgia syndrome, pain syndrome myofascial, syndrome fibromyalgia, fibromyalgias, fms, mpd syndrome, fibromyalgia (FMS), Fibromyalgia Syndrome, fibromyositis fibromyalgia syndrome, Fibromyositis, Diffuse myofascial pain syndrome, MPDS - Myofacial pain dysfunction syndrome, Myofacial pain dysfunction syndrome, Myofascial pain syndrome, Muscular rheumatism, Fibromyositis (disorder), Fibrositis (disorder), Muscular rheumatism (disorder), fibromyositis, Fibromyalgia -RETIRED-, Fibromyalgia [Ambiguous], Fibrositis NOS, Fibromyalgia
Dutch fibrositis, fibromyalgiesyndroom, fibromyositis, spier reumatisme, fibromyalgie, Fibromyalgie, Fibrositis, Myofasciaal pijnsyndroom, Spierreuma, Wekedelenreuma
French Syndrome fibromyalgique, Fibrosite, Rhumatisme musculaire, Fibromyalgie, Fibro-myosite, Fibromyosite, Polyenthésopathie, Syndrome de la douleur chronique myofasciale, Syndrome polyalgique diffus
German Fibromyalgiesyndrom, Fibromyositis, Fibromyalgie, Fibrositis, Diffuses myofasziales Schmerzsyndrom, Muskelrheumatismus, Rheumatismus, muskulärer
Italian Fibromiosite, Sindrome fibromialgica, Fibrosite, Reumatismo muscolare, Sindrome dolorosa miofasciale diffusa, Fibromialgia
Portuguese Síndrome de fibromialgia, Reumatismo muscular, Fibromiosite, Fibromialgia, Fibrosite, Reumatismo Muscular, Síndrome da Dor Miofacial Difusa
Spanish Fibromiositis, Reumatismo muscular, Síndrome de fibromialgia, Fibromyalgia, Fibromyalgia [Ambiguous], fibromialgia - RETIRADO - (concepto no activo), fibromialgia - RETIRADO -, fibromialgia, no especificada (trastorno), fibromialgia, no especificada, fibromialgia, fibromiositis (trastorno), fibromiositis, SAI (trastorno), fibromiositis, SAI, fibromiositis, fibrositis (trastorno), fibrositis, no especificada (trastorno), fibrositis, no especificada, fibrositis, reumatismo muscular (trastorno), reumatismo muscular, síndrome de dolor miofascial, Fibromialgia, Fibrositis, Reumatismo Muscular, Síndrome de Dolor Miofacial Difuso, Sindrome de Dolor Miofacial Difuso
Japanese 線維筋炎, 線維筋痛, 線維筋痛症候群, 結合織炎, ｾﾝｲｷﾝﾂｳｼｮｳｺｳｸﾞﾝ, ｾﾝｲｷﾝﾂｳ, ｹﾂｺﾞｳｼｷｴﾝ, ｾﾝｲｷﾝｴﾝ, ｷﾝﾆｸﾘｳﾏﾁ, 筋肉リウマチ, 線維筋痛症, 筋リウマチ, 結合組織炎, リウマチ-筋肉
Swedish Fibromyalgi
Czech fibromyalgie, Fibrozitida, Fibromyalgie, Svalový revmatismus, Syndrom fibromyalgie, Fibromyozitida
Finnish Fibromyalgia
Russian FIBROMIALGIIA, FIBROZIT, REVMATIZM MYSHECHNYI, РЕВМАТИЗМ МЫШЕЧНЫЙ, ФИБРОЗИТ, ФИБРОМИАЛГИЯ
Korean 섬유근육통
Croatian FIBROMIALGIJA
Polish Zapalenie tkanki łącznej włóknistej, Fibromialgia, Reumatyzm mięśniowy
Hungarian Fibromyalgia syndroma, Fibromyositis, Fibrositis, Muscularis rheumatismus, Fibromyalgia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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