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