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.
 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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