Differentiating Fibromyalgia from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Fibromyalgia from other Diseases

Fibromyalgia must be differentiated from other diseases that present with musculoskeletal pain such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.

Disease	Differentiating signs and symptoms	Differentiating labs
Rheumatoid arthritis	Multiple joint swelling Morning stiffness Rheumatoid nodules	RF or anti-cyclic citrullinated protein (CCP) antibody is positive. Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE	Maculopapular rash Multi-system involvement	Positive anti-Smith antibodies
Chronic fatigue syndrome	Fatigue plus 4 of the following symptoms (1) Short-term memory loss (2) Sore throat (3) tender lymph nodes in the neck or armpit (4) muscle pain (5) joint pain without swelling or redness (6) headaches (7) unrefreshing sleep (8) malaise	Diagnosis of exclusions Symptoms must present for more than 6 months
Spondyloarthritis	Axial skeletal pain and stiffness Restricted spinal motion	Elevated ESR or CRP Negative RF Bamboo spine on X-ray
Polymyalgia rheumatica	Older at onset  Generalized stiffness	An elevated erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP Response to corticosteroids
Osteoarthritis	Localized joint pain Restricted to affect joints Older at onset	Xray of the involved joints demonstrate degenerative changes
Hypothyroidism	Systemic symptoms such as weight gain, constipation, dry skin Muscular aching and prominent fatigue that improves on replacement of thyroid hormone.	TSH is elevated and free T4 is low.
Myopathaies(polymyositis and dermatomyositis)	Pelvic and shoulder girdle muscle weakness Rash	Muscle biopsy confirms the diagnosis Elevated CPK enzyme
Neuropathy	Numbness and tingling Paresthesia	Abnormal EMG