Please enable JavaScript.
Coggle requires JavaScript to display documents.
Fibromyalgia (Diagnosis (ESR & CRP (to exclude PMR), ANA's and…
Fibromyalgia
Diagnosis
ESR & CRP (to exclude PMR)
ANA's and DsDNA (to exclude SLE)
Ca2+ and electrolytes (to exclude high calcium)
Vit D (to exclude low vitamin D)
Thyroid function test (to exclude hypothyroidism)
Examine patient and CRP (to exclude inflammatory arthritis)
Pain at 11 of 18 tender point sites on digital palpitation
Risk Factors & Aetiology
Low household income
Divorced
Middle age
Low educational status
Female
Associations
Depression, chronic headache, IBS, chronic fatigue syndrome and myofascial pain syndrome
Differential Diagnosis
Polymyalgia rheumatics (PMR)
High calcium
SLE
Low vitamin D
Hypothyroidism
Inflammatory arthritis
Key Facts
Fibro = soft tissue & myalgia = muscle pain
Fibromyalgia is characterised by CENTRAL (NON-NOCICEPTIVE) PAIN:
Due to a central disturbance in pain processing
Bipsychosocial factors are important
Definition
Symptoms present for at least 3 months and other causes have been excluded
Pain at 11 of 18 tender point sites on digital palpitation (with enough pressure that the thumb blanches)
Widespread musculoskeletal pain AFTER other diseases have been excluded
Not easily diagnosed as no specific pathology is pinpointed
Is also known as chronic persistent pain (CWP)
Clinical Presentation
Fatigue is often extreme and occurring after minimal exertion
Non-restorative sleep
Poor concentration and forgetfulness
Low mood, irritable and weepy
Waking unrefreshed
Lack of non-REM (rapid eye movement) sleep causes functional pain
Frequent waking during the night
Pain
Associated with generalised morning stiffness
Parasthesiae of hands and feet
Areas that pain focuses on: Lowe neck in front, base of skull, upper edge of breast, neck and shoulder, upper inner shoulder, below side bone at allow, upper outer buttock, hip bone, just above knee on inside
Aggravated by stress, cold and activity
Predominantly neck and back but may be all over
Patient is often anxious and angry since cannot find reason for pain
Chronic pain (more than 3 months) that is widespread
Treatment
Reset pain thermostat
Correct non-restorative sleep
Improv aerobic fitness - to tire them so sleeping will be easier
Low-dose antidepressants and anticonvulsants
Tricyclic antidepressant e.g. ORAL AMITRIPTYLINE
Anticonvulsant e.g. ORAL PREGABALIN
Induce muscle relaxation and make normal sleeping patterns
Avoid unnecessary investigations
NSAIDs and steroids rarely work in fibromyalgia
Educate patient & family - explain that they have real symptoms but pain doesn't always mean damage - can be explained as a migraine of the joints
Epidemiology
More common in FEMALES than males
12% of those with RA have fibromyalgia
Can develop at any age but often over 60 years