musculoskeletal and connective tissue disorders
Fibromyalgia
Diagnosis of Fibromyalgia
Clinical criteria Usually testing and a detailed physical examination to exclude other disorders Fibromyalgia is suspected in patients with the following: Generalized pain and tenderness, especially if disproportionate to physical findings Negative laboratory results despite widespread symptoms Fatigue as a predominant symptom The diagnosis of fibromyalgia should be considered in people who have had widespread pain for at least 3 months, particularly when accompanied by various somatic symptoms. Pain is considered widespread when patients have pain in the left and right side of the body, above and below the waist, and in the axial skeleton (cervical spine, anterior chest or thoracic spine, or low back). The diagnosis is based on clinical criteria from the American College of Rheumatology ( Diagnosis reference ), which include a combination of joint and usually non-joint pain (sometimes including widespread body-wide pain) and the presence of various other cognitive and somatic symptoms, such as those listed above, which are graded in severity. Previous criteria relied on the presence of tenderness at some of 18 specified tender points. This criterion was eliminated because nonspecialists sometimes have difficulty evaluating tenderness consistently, the tender points may fluctuate in intensity, and it was thought advantageous to have criteria that are entirely symptom-based. However, tenderness is quite common, and some specialists continue to assess it systematically. of patient symptoms should include erythrocyte sedimentation rate (ESR) or C-reactive protein, creatine kinase (CK), and probably tests for Diagnosis and To avoid potential pitfalls, clinicians should consider the following: Fibromyalgia is often overlooked in men, children, and adolescents. Chronic Fatigue Syndrome (systemic exertion intolerance disease) can cause similar generalized myalgias and fatigue, and laboratory test results are typically normal. Polymyalgia Rheumatica causes more focused myalgias, particularly in older adults; it can be distinguished from fibromyalgia because it tends to affect proximal muscles selectively, is more symptomatic in the morning, and is usually accompanied by high ESR and C-reactive protein levels. In patients with systemic rheumatic disorders, diagnosing coexistent fibromyalgia may be more difficult, but it is quite common. For example, fibromyalgia may be misinterpreted as an exacerbation of Rheumatoid Arthritis (RA) or In patients with increased generalized stiffness and pain, consider fibromyalgia as well as an exacerbation of any known systemic rheumatic disorder such as Rheumatoid Arthritis (RA) or 1.Wolfe F, Clauw DJ, Fitzcharles MA, et al: 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria.Semin Arthritis Rheum46(3):319–329, 2016. doi: 10.1016/j.semarthrit.2016.08.012. 