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Fibromyalgia- diagnosis

How is fibromyalgia diagnosed?

There are no blood tests or imaging studies specifically for fibromyalgia diagnosis. Fibromyalgia is diagnosed after a thorough history, a complete physical exam, and labs to rule out other diseases.

 

Classification criteria

There are 2 classification criteria developed by the American College of Rheumatology (ACR), that rheumatologist often use to help the diagnosis.

 

The 1990 ACR criteria established fibromyalgia as “widespread musculoskeletal pain” plus tenderness at 11 or more of the 18 fibromyalgia tender points (see figure). The tender points are mostly either bursae or sites of tendon insertion. Tenderness at 11 or more of the tender points, specially when there is involvement of all 4 quadrants (ie. upper and lower body, right and left sides), is fairly sensitive for fibromyalgia.

 

Fibromyalgia tender points
Fibromyalgia tender points

 

The 2010 ACR criteria are significantly more complicated (see table below). According to these criteria, tenderness in specific areas PLUS some of the symptoms are required to be classified as fibromyalgia.

 

2010 ACR Fibromyalgia diagnostic criteria

fm dx driteria

 

Stated more simply, according to this criteria, fibromyalgia diagnosis is made when there is widespread pain (shoulder, upper arm, lower arm, hip, etc) AND there is significant fatigue, waking unrefreshed, cognitive symptoms, and somatic symptoms. Cognitive symtp0ms refer to difficulty with thinking and concentration. Somatic symptoms are what is experienced by the body, including headaches, irritable bowel syndrome, numbness/tingling, dry mouth, painful urination, bladder spasm, to name a few.

 

It is important to  note that other medical conditions may have similar symptoms as fibromyalgia. For example, low thyroid levels can cause fatigue, body aches, and sleep disturbances. Some autoimmune diseases may present with joint and muscle pain, fatigue, and a variety of somatic symptoms. Therefore, before fibromyalgia is diagnosed, it is important that other medical conditions are rule out.

 

Also read:

What is fibromyalgia?

The essentials of fibromyalgia treatment

 

Reference:

American College of Rheumatology http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp

Arthritis foundation  http://www.arthritis.org/

Uptodate http://www.uptodate.com/contents/fibromyalgia-beyond-the-basics?source=search_result&search=fibromyalgia+patient&selectedTitle=1%7E150

F Wolfe, DJ Clauw, MA Fitzcharles, DL Goldenberg, RS Katz, P Mease, AS Russell, J Russell, JB Winfield, MB Yunus. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research,Vol. 62, No. 5, May 2010, pp 600–610

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What is fibromyalgia?

What is fibromyalgia?

Fibromyalgia is a chronic condition that causes pain all over the body. It can be associated with pain in multiple joints and muscles, and fatigue. It affects between 4-8% of people, and is more common in women than in men. People with a rheumatic disease such as lupus or rheumatoid arthritis are at an increased risk for developing fibromyalgia.

 

Fibromyalgia symptoms

Symptoms associated with fibromyalgia can include:

Pain

This is a diffuse, chronic and persistent pain all over, including the muscles, joints, and tendons. The pain is often described as burning, aching, stiffness, or soreness. It can vary with times of the day, weather, sleep patterns, and amount of stress. People with fibromyalgia often feel like they constantly have the flu.

Fatigue

 Fatigue is one of the hallmarks of fibromyalgia syndrome and can be severe in some people. There may be a close relationship between fibromyalgia and chronic fatigue syndrome (CFS).

Poor sleep

Most people with fibromyalgia complain of poor sleep- either difficulty falling asleep, staying asleep, or both. Poor sleep is known to aggravate fibromyalgia, so improvement of sleep quality is one of the treatments of fibromyalgia.

Mood changes

Anxiety and depression are common in people with fibromyalgia.

Abdominal pain, diarrhea, constipation

Many people with fibromyalgia also have a diagnosis of irritable bowel syndrome or spastic colon.

Bladder pain, frequent need to urinate

Interstitial cystitis is a common diagnosis in people with fibromyalgia

Headaches (tension or migraine headaches)

Memory problems

Jaw pain, temporomandibular joint (TMJ) syndrome

Tendonitis

Numbness and tingling in hands and feet

 

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. Although the pain experienced by people with fibromyalgia is very real, no abnormalities may be found on exam or lab tests. It is thought that the cause of fibromyalgia is “multi-factorial”, meaning that various physical and emotional factors (like infections, physical or emotional trauma, genetic factors, etc.) may play a role in development of fibromyalgia. Studies have pointed to a central process in fibromyalgia, which means something in the brain and the nervous system may be responsible. It is thought that people with fibromyalgia may have an impaired pain perception, and a decreased ability to lower pain. This means that the nervous system interprets a stimulus to be much more painful than it really is. For example, while a person without fibromyalgia will perceive a hug as mild pressure on their muscles, the nerves of the person with fibromyalgia may perceive a hug as a painful stimulus and will send signals to the body that will experience pain.

See next:

 

Fibromyalgia- diagnosis

 

The essentials of fibromyalgia treatment

 

 

Reference:

American College of Rheumatology http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp

Arthritis foundation  http://www.arthritis.org/

Uptodate http://www.uptodate.com/contents/fibromyalgia-beyond-the-basics?source=search_result&search=fibromyalgia+patient&selectedTitle=1%7E150

F Wolfe, DJ Clauw, MA Fitzcharles, DL Goldenberg, RS Katz, P Mease, AS Russell, J Russell, JB Winfield, MB Yunus. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research,Vol. 62, No. 5, May 2010, pp 600–610

Categories: