Fibromyalgia overview: Difference between revisions
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===Physical Examination=== | ===Physical Examination=== | ||
Physical examination helps not only to confirm the diagnosis of fibromyalgia but to rule out other systemic diseases. A careful physical examination also helps in identifying associated conditions. The tender-point examination is the most important aspect in the physical examination and other aspects of the examination are typically normal in fibromyalgia patients | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Revision as of 19:37, 15 June 2017
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Fibromyalgia Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Fibromyalgia (FM) is a disorder classified by the presence of chronic widespread pain and tactile allodynia.[1] While the criteria for such an entity have not yet been thoroughly developed, the recognition that fibromyalgia involves more than just pain has led to the frequent use of the term "fibromyalgia syndrome". It is not contagious, and recent studies suggest that some people with fibromyalgia may be genetically predisposed.[2] The disorder is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the disorder is generally perceived as non-progressive.
Historical Perspective
Classification
DSM 5 divides fibromyalgia into four groups based on the differences in psychological and autonomic nervous system profiles among affected individuals into extreme sensitivity to pain but no associated psychiatric conditions, fibromyalgia and comorbid, pain-related depression, depression with concomitant fibromyalgia syndrome, fibromyalgia due to somatization.[3][4][5]
Pathophysiology
The cause of fibromyalgia is unknown. In fact it is not be due to a singular factor at all but is due to a multiplicity of causes. Fibromyalgia does not, start as a result of some trauma such as a traffic accident, major surgery, or disease. Some evidence shows that Lyme Disease may be a trigger of fibromyalgia symptoms. Various hypothesis have been put through describing the pathogenesis of fibrommyalgia. Another study suggests that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression[6][7]
Causes
The cause is unknown. Possible causes or triggers of fibromyalgia are physical or emotional trauma, abnormal pain response - areas in the brain that are responsible for pain may react differently in fibromyalgia patients, sleep disturbances, infection, such as a virus, although none has been identified. [8][9]
Differentiating Fibromyalgia from other Diseases
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.[8][9][10][11][12]
Epidemiology and Demographics
The Prevalence of Fibromyalgia in the United States was reported to range from 500-5000 per 100,000 persons. Females are more commonly affected than males with a ratio of 9:1. 20-50 year age group is more commonly affected. Fibromyalgia has no racial predilection.[13]
Risk Factors
Common risk factors in the development of fibromyalgia are stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD), repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending, illness (such as viral infections), family history and obesity.[9]
Natural History, Complications and Prognosis
Fibromyalgia is a long-term disorder. If left untreated, chronic pain could cause permanent changes in how the body perceives pain. Complications that can develop as a result of Fibromyalgia are marked functional impairment, depression, anxiety, insomnia, obesity, allodynia. Factors associated with poor outcomes are female gender, low socioeconomic status, being unemployed. Even with appropriate treatment, symptoms of fibromyalgia improve other times, the pain may get worse and continue for months or years.[11]
Diagnosis
Diagnostic Criteria
The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:[14][15][16][17]
- 1) Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9.
- 2) Symptoms have been present at a similar level for at least 3 months.
- 3) The patient does not have a disorder that would otherwise explain the pain.
History and Symptoms
The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch.
Physical Examination
Physical examination helps not only to confirm the diagnosis of fibromyalgia but to rule out other systemic diseases. A careful physical examination also helps in identifying associated conditions. The tender-point examination is the most important aspect in the physical examination and other aspects of the examination are typically normal in fibromyalgia patients
Laboratory Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Psychotherapy
Future or Investigational Therap
References
- ↑ Wolfe, F (February 1990). "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee". Arthritis and Rheumatism. 33 (2): 160–172. PMID 2306288. Unknown parameter
|coauthors=ignored (help) - ↑ Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome
- ↑ Fitzcharles MA, Shir Y, Ablin JN, Buskila D, Amital H, Henningsen P, Häuser W (2013). "Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines". Evid Based Complement Alternat Med. 2013: 528952. doi:10.1155/2013/528952. PMC 3860136. PMID 24379886.
- ↑ Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990). "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee". Arthritis Rheum. 33 (2): 160–72. PMID 2306288.
- ↑ Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, Ko G, Moulin DE, Panopalis P, Proulx J, Shir Y (2013). "2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary". Pain Res Manag. 18 (3): 119–26. PMC 3673928. PMID 23748251.
- ↑ http://www.springerlink.com/content/1271314042w8405g/ Mueller W, et al. The classification of fibromyalgia syndrome. Rheumatol Int. 2007 Jul 25
- ↑ "Late and Chronic Lyme Disease: Symptom Overlap with Chronic Fatigue Syndrome & Fibromyalgia".
- ↑ 8.0 8.1 Goldenberg DL, Burckhardt C, Crofford L (2004). "Management of fibromyalgia syndrome". JAMA. 292 (19): 2388–95. doi:10.1001/jama.292.19.2388. PMID 15547167.
- ↑ 9.0 9.1 9.2 Clauw DJ (2014). "Fibromyalgia: a clinical review". JAMA. 311 (15): 1547–55. doi:10.1001/jama.2014.3266. PMID 24737367.
- ↑ Borchers AT, Gershwin ME (2015). "Fibromyalgia: A Critical and Comprehensive Review". Clin Rev Allergy Immunol. 49 (2): 100–51. doi:10.1007/s12016-015-8509-4. PMID 26445775.
- ↑ 11.0 11.1 Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P (2013). "[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines]". Z Psychosom Med Psychother (in German). 59 (2): 132–52. doi:10.13109/zptm.2013.59.2.132. PMID 23775553.
- ↑ Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P (2008). "[Definition, classification and diagnosis of fibromyalgia syndrome]". Z Rheumatol (in German). 67 (8): 665–6, 668–72, 674–6. doi:10.1007/s00393-008-0404-4. PMID 19050952.
- ↑ Vincent A, Lahr BD, Wolfe F, Clauw DJ, Whipple MO, Oh TH, Barton DL, St Sauver J (2013). "Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project". Arthritis Care Res (Hoboken). 65 (5): 786–92. doi:10.1002/acr.21896. PMC 3935235. PMID 23203795.
- ↑ Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU (2015). "Fibromyalgia diagnosis: a review of the past, present and future". Expert Rev Neurother. 15 (6): 667–79. doi:10.1586/14737175.2015.1046841. PMID 26035624.
- ↑ Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB (2011). "Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia". J. Rheumatol. 38 (6): 1113–22. doi:10.3899/jrheum.100594. PMID 21285161.
- ↑ Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P (2011). "Chronic widespread pain in the spectrum of rheumatological diseases". Best Pract Res Clin Rheumatol. 25 (2): 165–71. doi:10.1016/j.berh.2010.01.011. PMID 22094193.
- ↑ Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010). "The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity". Arthritis Care Res (Hoboken). 62 (5): 600–10. doi:10.1002/acr.20140. PMID 20461783.