Rheumatology Book

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FibromyalgiaAka: Fibrositis

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  1. 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%
  2. Associated Conditions: Common Comorbid Chronic Conditions
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Lyme Disease
    4. Sleep Apnea
  3. 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
  4. 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
  5. Exacerbating Factors
    1. Post-exertional increase in muscle pain
    2. Stress or Abuse
  6. Signs
    1. See Diagnosis below
  7. 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
  8. 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)
  9. 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
  10. Diagnosis: Tender Points (11 of 18 present)
    1. See Tender Points
  11. 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
  12. 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)
  13. 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
  14. References
    1. Berman (1999) J Fam Pract 48(3):213
    2. Gremillion (1998) Phys Sportsmed :
    3. Hadler (1997) Postgrad Med 102(2):161
    4. Klippel (1997) Primer Rheumatic Diseases, p.124-7
    5. Reiffenberger (1996) Am Fam Physician 53(5):1698
    6. Wilke (1996) Postgrad Med 100(1):153
    7. Yunus (1996) Consultant, p. 1260-74
    8. Yunus (1996) Consultant, p. 1279-85

Fibromyalgia (C0016053)

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 (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.
ConceptsDisease or Syndrome (T047)
ICD9729.1
MSHD005356
EnglishDiffuse Myofascial Pain Syndrome, Fibromyalgia, Fibromyalgia -RETIRED-, Fibromyalgia Fibromyositis Syndrome, Fibromyalgia Syndrome, Fibromyalgia-Fibromyositis Syndrome, Fibromyalgia-Fibromyositis Syndromes, Fibromyalgias, FIBROMYOSITIS, Fibromyositis Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndromes, Fibrositides, FIBROSITIS, Fibrositis unspecified, MPD syndrome, MPDS - Myofacial pain dysfunction syndrome, Muscular rheumatism, Myofacial pain dysfunction syndrome, myofascial pain dysfunction syndrome, Myofascial pain syndrome
Spanishfibromialgia, fibromialgia - RETIRADO -, fibromiositis, fibrositis, reumatismo muscular, sindrome de dolor miofascial
Parent ConceptsMyalgias/Myopathy (C0221570), Myopathy (C0026848), Rheumatism (C0035435), Myalgia and myositis unspecified (C0026893), Myositis (C0027121), Primary fibromyalgia syndrome (C0521517), Reason not stated concept (C1276325), Disorder characterized by pain (C1300028), Disorder of skeletal muscle (C1533847), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAIR, COSTAR, CSP, DXP, MEDLINEPLUS, MSH, MTH, MTHICD9, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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