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RH28 Rheumatology
Non-Articular Rheumatism Toronto Notes 2019 Fibromyalgia
Definition
• chronic(>3mo),widespread(axial,left-andright-sided,upperandlowersegment),non-articularpain with characteristic tender points
Diagnosis
Table 32. 2010 ACR Preliminary Diagnostic Criteria for Fibromyalgia
Criteria
Widespread Pain Index = number of areas in which the patient had pain over the last week (max score = 19):
L and R: shoulder girdle, upper arm, lower arm, hip, upper leg, lower leg, jaw
One Area: chest, abdomen, upper back, lower back, neck
Symptom Severity Score = sum of:
a) severity of fatigue
b) waking unrefreshed
c) cognitive symptoms over the past week
d) extent of somatic symptoms (IBS, H/A, abdominal pain/
cramps, dry mouth, fever, hives, ringing in ears, vomiting, heartburn, dry eyes, SOB, loss of appetite, rash, hair loss, easy bruising, etc.)
all (a-d) rated on 0-3 scale: 0 = no problem, 1 = mild, 2 = moderate, 3 = severe
Arthritis Care and Research 2010;62(5):600-610
Epidemiology
Comments
A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
1. Widespread Pain Index (WPI) ≥7 and Symptom Severity (SS)
scale score ≥5 or WPI 3–6 and SS scale score ≥9
2. Symptoms have been present at a similar level for at least
3 mo
3. The patient does not have a disorder that would otherwise
explain the pain
• F:M=3:1
• primarilyages25-45yr,someadolescents
• prevalenceof2-5%ingeneralpopulation
• overlapswithchronicfatiguesyndromeandmyofascialpainsyndrome • strongassociationwithpsychiatricillness
Signs and Symptoms
• widespreadaching,stiffness
• easyfatigability
• sleepdisturbance:non-restorativesleep,difficultyfallingasleep,andfrequentwakening
• symptomsaggravatedbyphysicalactivity,poorsleep,emotionalstress
• patientfeelsthatjointsarediffuselyswollenalthoughjointexaminationisnormal
• neurologicsymptomsofhyperalgesia,paresthesias,allodynia
• associatedwithirritablebowelorbladdersyndrome,migraines,tensionH/As,restlesslegsyndrome,
obesity, depression, and anxiety
• physicalexamshouldrevealonlytendernesswithpalpationofsofttissues,withnospecificityfor
trigger/tender points
Investigations
• bloodwork:includesTSHandESR;alltypicallynormalunlessunrelated,underlyingillnesspresent • serology:donotorderANAorRFunlessthereisclinicalsuspicionforaconnectivetissuedisease
• laboratorysleepassessment