Fibromyalgia causes, clinical picture, diagnosis and treatment

This article is to discuss Fibromyalgia (fibrositis) regarding its definition, causes, clinical picture (symptoms and signs), Diagnostic features and treatment approach . • Fibromyalgia (fibrositis) is a controversial diagnosis that is not universally accepted.

This article is to discuss Fibromyalgia (fibrositis) regarding its definition, causes, clinical picture (symptoms and signs), Diagnostic features and treatment approach .
• Fibromyalgia (fibrositis) is a controversial diagnosis that is not universally accepted.
 It is a useful diagnosis of exclusion.
• It is characterized by chronic diffuse pain with characteristic tender points. It is considered as a non-articular rheumatism.
• It affects about 2 % of all patients seen in general practice and 20 % of patients referred to rheumatologists
• All investigations are normal and the value is for exclusion.

Aetiology (Causes) :

The condition is poorly understood, two abnormalities have been reported: sleep abnormality and reduced threshold to pain at certain sites.

Clinical picture of Fibromyalgia

Diffuse muscle pain, stiffness and fatigue.
Focal tender points :
   - Occiput   : bilateral at suboccipital muscles insertions.
   - Low cervical   : bilateral at C 5 - 7 (interspinous ligaments).
   - Trapezius :  bilateral at mid point of the upper border.
   - Supraspinatus :  bilateral above the medial border of the scapular spine.
   - Second rib : bilateral at 2nd costochondral junctions.
   - Lateral epicondyle  : bilateral 2 cm distal to the epicondyles.
   - Gluteal : bilateral in upper outer quadrants.
   - Greater trochanter :  bilateral posterior to trochanteric prominence.
   - Knees :  bilateral at the medial fat pad proximal to the joint.
   - Other additional symptoms e.g tension headache, irritable bowel syndrome.
fibromyalgia-major-tender-sites


* Diagnosis requires at least 11/18 tender points .
* Palpation should be done with approximate force of 4 kg .

Treatment of Fibromyalgia 

• Reassurance
• Aerobic exercise
• Analgesics or NSAIDs may be helpful
• Low doses of sedative antidepressant e.g 10-25 mg amitriptyline (tryptizole) few hours before bed time.
• Selective seretonine reuptake inhibitora e.g fluoxetine 20mg/d may be of value.

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Med2Date: Fibromyalgia causes, clinical picture, diagnosis and treatment
Fibromyalgia causes, clinical picture, diagnosis and treatment
This article is to discuss Fibromyalgia (fibrositis) regarding its definition, causes, clinical picture (symptoms and signs), Diagnostic features and treatment approach . • Fibromyalgia (fibrositis) is a controversial diagnosis that is not universally accepted.
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