Rheumatology Book



Aka: Fibromyalgia, Fibrositis
  1. See Also
    1. ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
    2. Tender Points
    3. Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
    4. Myofascial Pain Syndrome
    5. Fibromyalgia Non-Pharmacologic Management
    6. Fibromyalgia Pharmacologic Management
  2. Epidemiology
    1. Women account for more than 75-85% of Fibromyalgia patients
    2. Peak Incidence: ages 20 to 60 years old
      1. Incidence increases with age
    3. Most common rheumatic cause of chronic diffuse pain
      1. Most common cause of Chronic Pain in women ages 20 to 55 years old
    4. Incidence
      1. Rheumatology patients: 15%
        1. Only Osteoarthritis is more common in rheumatology practice
      2. General medical patients: 5%
      3. General female population: 2-3%
  3. Pathophysiology
    1. Increased central sensitivity to peripheral Sensation (as with other functional pain syndromes)
    2. Pain system dysfunction related to abnormalities in the forebrain
  4. Risk Factors
    1. Post-Traumatic Stress Disorder (present in up to 45% of Fibromyalgia patients)
    2. Sexual abuse or rape
  5. Associated Conditions: Common Comorbid Chronic Conditions
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Lyme Disease
    4. Sleep Apnea
  6. Associated Conditions: Augmented pain and sensory processing disorders
    1. Chronic Fatigue Syndrome
    2. Tension Headache
    3. Migraine Headache
    4. Primary Dysmenorrhea
    5. Restless Legs Syndrome
    6. Periodic Limb Movement disorder
    7. Temporomandibular Joint pain
    8. Myofascial Pain Syndrome
    9. Interstitial Cystitis
    10. Irritable Bowel Syndrome
    11. Endometriosis
    12. Non-cardiac Chest Pain
    13. Chronic back pain
    14. Reduced functional ability
    15. Aerobic deconditioning
    16. Vulvodynia
    17. Post-Traumatic Stress Disorder
  7. Associated Conditions: Symptoms
    1. Severe Fatigue (81%)
    2. Morning stiffness longer than 15 minutes (77%)
    3. Sleep Disorder (75%)
      1. Non-restorative sleep (alpha-delta sleep)
      2. Sleep Apnea
      3. Nocturnal Myoclonus
      4. Restless Leg Syndrome
    4. Atypical Paresthesias (63%)
    5. Anxiety (48%)
    6. Dry Mouth (36%)
    7. Recurrent Headaches (53%)
    8. Dysmenorrhea (41%)
    9. Past History of Major Depression (31%)
    10. Irritable Bowel Syndrome (30-70%)
    11. Urinary urgency (26%)
    12. Cold sensitivity or Raynaud's Phenomenon (17%)
  8. Exacerbating Factors
    1. Post-exertional increase in Muscle pain
    2. Emotional Stress or Abuse
  9. Signs
    1. See Diagnosis below
  10. Differential diagnosis
    1. Other Myofascial Conditions
      1. See Associated Conditions listed above
      2. Myofascial Pain Syndrome
      3. Chronic Fatigue Syndrome
    2. Psychiatric Conditions
      1. Masked Major Depression
      2. Somatoform Disorder
    3. Rheumatic, Endocrine and Neurologic Conditions
      1. Systemic Lupus Erythematosus (SLE)
      2. Rheumatoid Arthritis
      3. Polymyalgia Rheumatica (esp. age >60 years old)
      4. Polymyositis
      5. Diabetes Mellitus
      6. Myopathy or Neuropathy
      7. Myotonic Dystrophy
      8. Multiple Sclerosis
      9. Hypothyroidism
      10. Hyperparathyroidism
      11. Ankylosing Spondylitis
      12. Disc Herniation with radiculopathy
      13. Paraneoplastic Neuropathy
      14. Parkinson's Disease
    4. Infectious Conditions
      1. Epstein-Barr Virus (Mononucleosis)
      2. Parvovirus
      3. Q Fever
      4. Lyme Disease
    5. Miscellaneous Conditions
      1. Vitamin D Deficiency
      2. Statin-Induced Myopathy
      3. Eosinophilia-Myalgia Syndrome (rare, likely toxin related, such as L-Tryptophan ingestion)
  11. Labs
    1. Labs are normal in isolated Fibromyalgia
    2. Standard Evaluation
      1. Complete Blood Count (CBC)
      2. Basic Metabolic Panel (e.g. Chem8)
      3. Thyroid Stimulating Hormone (TSH)
    3. Additional tests when indicated (non-specific tests, order judiciously)
      1. Erythrocyte Sedimentation Rate (ESR)
      2. C-Reactive Protein (C-RP)
      3. Antinuclear Antibody (ANA)
      4. Rheumatoid Factor (RF)
      5. Creatinine Phosphokinase (CPK)
  12. Diagnosis: General Criteria
    1. Fibromyalgia is a diagnosis of exclusion
    2. Widespread musculoskeletal pain ("I hurt all over")
    3. Regional: Each of 4 body quadrants involved
      1. Pain on left and right side of body
      2. Pain above and below waist
    4. Axial skeleton pain present
      1. Cervical Spine
      2. Anterior chest
      3. Thoracic Spine
      4. Low back
    5. Pain worse in the morning and at the end of the day
    6. Symptoms persist at least 3 months
  13. Diagnosis: Specific diagnostic tools
    1. New criteria (2010)
      1. See ACR Fibromyalgia Diagnostic Criteria (ACRFDC)
    2. Older criteria (1990)
      1. See Tender Points (11 of 18 present)
  14. Management
    1. See Fibromyalgia Non-Pharmacologic Management
    2. See Fibromyalgia Pharmacologic Management
    3. Fibromyalgia Impact Questionnaire
      1. Assess for associated functional Impairment
  15. Resources: Patients
    1. Fransen (1997) Fibromyalgia Help Book, Smith House
      1. Paid link to Amazon.com (ISBN 0961522143)
    2. Starlanyl (1996) Fibromyalgia and Myofascial Pain, NHP
      1. Paid link to Amazon.com (ISBN 1572240466)
  16. Resources: Organizations
    1. Arthritis Foundation
      1. http://www.arthritis.org
    2. National Fibromyalgia Research Association
      1. http://www.teleport.com/~nfra
    3. USA Fibromyalgia Association
      1. http://www.fibromyalgiaassnusa.org
    4. UK Fibromyalgia Association
      1. http://www.community-care.org.uk/charity/fmauk.html
  17. References
    1. Money and Glauser (2017) Crit Dec Emerg Med 31(1): 15-21
    2. Klippel (1997) Primer Rheumatic Diseases, p.124-7
    3. Yunus (1996) Consultant, p. 1260-74
    4. Yunus (1996) Consultant, p. 1279-85
    5. Berman (1999) J Fam Pract 48(3):213-18 [PubMed]
    6. Gremillion (1998) Phys Sportsmed, 26(4) 55-65 [PubMed]
    7. Hadler (1997) Postgrad Med 102(2):161-77 [PubMed]
    8. Kodner (2015) Am Fam Physician 91(7): 472-8 [PubMed]
    9. Reiffenberger (1996) Am Fam Physician 53(5):1698-1704 [PubMed]
    10. Wilke (1996) Postgrad Med 100(1):153-70 [PubMed]

Fibromyalgia (C0016053)

Definition (MEDLINEPLUS)

Fibromyalgia is a disorder that causes muscle pain and fatigue. People with fibromyalgia have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.

People with fibromyalgia may also have other symptoms, such as

  • Trouble sleeping
  • Morning stiffness
  • Headaches
  • Painful menstrual periods
  • Tingling or numbness in hands and feet
  • Problems with thinking and memory (sometimes called "fibro fog")

No one knows what causes fibromyalgia. Anyone can get it, but it is most common in middle-aged women. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia. There is no cure for fibromyalgia, but medicine can help you manage your symptoms. Getting enough sleep, exercising, and eating well may also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Definition (NCI) Inflammation and fibrous degeneration of a muscle.
Definition (NCI) A chronic disorder of unknown etiology characterized by pain, stiffness, and tenderness in the muscles of neck, shoulders, back, hips, arms, and legs. Other signs and symptoms include headaches, fatigue, sleep disturbances, and painful menstruation.
Definition (NCI_FDA) Inflammation and fibrous degeneration of a muscle.
Definition (MSH) A common nonarticular rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure to cold. This condition is often associated with general symptoms, such as sleep disturbances, fatigue, stiffness, HEADACHES, and occasionally DEPRESSION. There is significant overlap between fibromyalgia and the chronic fatigue syndrome (FATIGUE SYNDROME, CHRONIC). Fibromyalgia may arise as a primary or secondary disease process. It is most frequent in females aged 20 to 50 years. (From Adams et al., Principles of Neurology, 6th ed, p1494-95)
Definition (PSY) A common nonarticular rheumatic condition that is characterized by muscle pain, tenderness, and stiffness.
Definition (CSP) an acute, subacute, or chronic painful state of muscles, subcutaneous tissues, ligaments, tendons, or fasciae caused by a number of agents such as trauma, strain, occupation, exposure, posture, infection, or arthritis.
Concepts Disease or Syndrome (T047)
MSH D005356
ICD10 M79.7, M79.1
SnomedCT 1304004, 203101004, 203082005, 203111006, 247365004, 13612005, 156727006, 268107007, 203138004, 24693007, 56557000, 203102006
English Fibromyalgias, Fibrositides, Fibrositis, Muscular Rheumatism, Rheumatism, Muscular, Diffuse myofascial pain synd, Fibrositis unspecified, MPDS-Myofac pain dysfunct syn, Myofac pain dysfunct syndrome, Myofascial pain dysfunct syn, Myofascial pain dysfunction syndrome, myofascial pain dysfunction syndrome, MPD syndrome, muscular rheumatism, fibrositis, fibromyalgia (diagnosis), fibromyalgia, fibrositis (diagnosis), Fibromyalgia syndrome, Diffuse Myofascial Pain Syndrome, Myofascial Pain Syndrome, Diffuse, Fibromyalgia Fibromyositis Syndrome, Fibromyalgia-Fibromyositis Syndrome, Fibromyalgia-Fibromyositis Syndromes, Fibromyositis Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndrome, Fibromyositis-Fibromyalgia Syndromes, Syndrome, Fibromyalgia-Fibromyositis, Syndrome, Fibromyositis-Fibromyalgia, Syndromes, Fibromyalgia-Fibromyositis, Syndromes, Fibromyositis-Fibromyalgia, Fibromyalgia [Disease/Finding], fibromyalgia (FM), fibromyalgia syndrome, pain syndrome myofascial, syndrome fibromyalgia, fibromyalgias, fms, mpd syndrome, fibromyalgia (FMS), Fibromyalgia Syndrome, fibromyositis fibromyalgia syndrome, FMS, Fibrositis unspecified (disorder), Fibromyalgia (finding), Fibromyalgia (disorder), Fibromyositis NOS (disorder), Fibrositis NOS, FIBROMYOSITIS, Fibromyositis, Diffuse myofascial pain syndrome, MPDS - Myofacial pain dysfunction syndrome, Myofacial pain dysfunction syndrome, Myofascial pain syndrome, Muscular rheumatism, Fibromyositis (disorder), Fibrositis (disorder), Muscular rheumatism (disorder), fibromyositis, Fibromyositis, NOS, Fibrositis, NOS, Fibromyalgia, NOS, Fibromyalgia -RETIRED-, Fibromyalgia [Ambiguous], Fibromyalgia, Fibromyositis NOS
Dutch fibrositis, fibromyalgiesyndroom, fibromyositis, spier reumatisme, fibromyalgie, Fibromyalgie, Fibrositis, Myofasciaal pijnsyndroom, Spierreuma, Wekedelenreuma
French Syndrome fibromyalgique, Fibrosite, Rhumatisme musculaire, Fibromyalgie, Fibro-myosite, Fibromyosite, Polyenthésopathie, Syndrome de la douleur chronique myofasciale, Syndrome polyalgique diffus
German Fibromyalgiesyndrom, Fibromyositis, Fibromyalgie, Fibrositis, Diffuses myofasziales Schmerzsyndrom, Muskelrheumatismus, Rheumatismus, muskulärer
Italian Fibromiosite, Sindrome fibromialgica, Fibrosite, Reumatismo muscolare, Sindrome dolorosa miofasciale diffusa, Fibromialgia
Portuguese Síndrome de fibromialgia, Reumatismo muscular, Fibromiosite, Síndrome da Dor Miofascial Difusa, Fibromialgia, Fibrosite, Reumatismo Muscular
Spanish Fibromiositis, Reumatismo muscular, Síndrome de fibromialgia, Síndrome de Dolor Miofascial Difuso, fibromiositis, SAI, fibromiositis, SAI (trastorno), fibrositis, no especificada (trastorno), fibromialgia - RETIRADO - (concepto no activo), fibrositis, no especificada, fibromialgia - RETIRADO -, fibromialgia, no especificada (trastorno), fibromialgia, no especificada, fibromialgia, fibromiositis (trastorno), fibromiositis, fibrositis (trastorno), fibrositis, reumatismo muscular (trastorno), reumatismo muscular, síndrome de dolor miofascial, Fibromialgia, Fibrositis, Reumatismo Muscular
Japanese 線維筋炎, 線維筋痛, 線維筋痛症候群, 結合織炎, センイキンツウショウコウグン, センイキンツウ, ケツゴウシキエン, センイキンエン, キンニクリウマチ, 筋肉リウマチ, 線維筋痛症, 筋リウマチ, 結合組織炎, リウマチ-筋肉
Swedish Fibromyalgi
Czech fibromyalgie, Fibrozitida, Fibromyalgie, Svalový revmatismus, Syndrom fibromyalgie, Fibromyozitida, fibrositis, fibromyalgický syndrom, svalový revmatismus, fibrozitida, myofasciální bolestivý dysfunkční syndrom
Finnish Fibromyalgia
Korean 섬유근육통
Polish Zapalenie tkanki łącznej włóknistej, Fibromialgia, Reumatyzm mięśniowy
Hungarian Fibromyalgia syndroma, Fibromyositis, Fibrositis, Muscularis rheumatismus, Fibromyalgia
Norwegian Fibromyalgi, Kronisk muskelsmerte syndrom, Fibrositt, Myofascielle smerter, Myofibrositt, Fibromyositt
Derived from the NIH UMLS (Unified Medical Language System)

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