24 FIBROMYALGIA General Discussion The 1990 American College of Rheumatology classification criteria for fibromyalgia has two components: (1) the presence of widespread pain for more than 3 months and (2) the presence of 11 tender points among 18 specified sites as outlined below. Estimates of prevalence are 3.4% for women and 0.5% for men. The diagnosis of fibromyalgia can be made largely by pattern recognition. Fibromyalgia is a common clinical pain disorder in which the physical finding of palpable fibromyalgia tender points (FTPs) is associated with characteristic symptoms of generalized muscular aching, fatigue, stiffness, and nonrestorative sleep. Over three-quarters of individuals with fibromyalgia have these characteristic symptoms. Less common features that generally occur in 25–50% of cases of fibromyalgia include headache, irritable bowel syndrome, psychological distress, Raynaud’s phenomenon, subjective swelling, nondermatomal paresthesia, and marked functional disability. Other somatic complaints include palpitations, dyspareunia/pelvic pain, temporomandibular pain, chronic rhinitis or “allergies,” and cognitive difficulties such as memory impairment or concentration issues. The somatic complaints distinguish fibromyalgia from rheumatoid arthritis (RA). However, fibromyalgia frequently coexists with other rheumatic diseases, especially systemic lupus erythematosus and RA. The differential diagnosis of fibromyalgia includes hypothyroidism, arthritis, polymyalgia rheumatica, osteomalacia, myofascial pain syndrome, metabolic and inflammatory myopathies, spondyloarthropathy, radiculopathy, and cardiac or pleuritic pain. The major challenge for the clinician is to distinguish fibromyalgia from an inflammatory or metabolic myopathy. Muscular aching and stiffness in fibromyalgia are more proximal than distal, although the patient may complain of hurting all over. Palpation of an FTP causes pain localized to the area of palpation, and the pain does not radiate to adjacent areas and no pain is experienced at sites proximal or distal to the examining finger. No muscle induration is palpable. Medications Associated with Myalgias Clofibrate Colchicine Danazol Gemfibrozil Glucocorticoids Hydralazine Hydroxychloroquine Lovastatin Penicillamine Phenytoin Procainamide Rifampin Sulfonamides Valproic acid Vincristine Zidovudine Selected Causes of Myalgias Amyotrophic lateral sclerosis Collagen vascular disease Dermatomyositis Diabetes mellitus Drug-induced myopathic syndromes • Alcohol • Cocaine • Heroin • Ipecac • L-tryptophan • Medications listed above Familial periodic paralysis Fibromyalgia Guillain–Barré syndrome Hyperthyroidism Hypothyroidism Inclusion body myositis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on FIBROMYALGIA Full access? Get Clinical Tree
24 FIBROMYALGIA General Discussion The 1990 American College of Rheumatology classification criteria for fibromyalgia has two components: (1) the presence of widespread pain for more than 3 months and (2) the presence of 11 tender points among 18 specified sites as outlined below. Estimates of prevalence are 3.4% for women and 0.5% for men. The diagnosis of fibromyalgia can be made largely by pattern recognition. Fibromyalgia is a common clinical pain disorder in which the physical finding of palpable fibromyalgia tender points (FTPs) is associated with characteristic symptoms of generalized muscular aching, fatigue, stiffness, and nonrestorative sleep. Over three-quarters of individuals with fibromyalgia have these characteristic symptoms. Less common features that generally occur in 25–50% of cases of fibromyalgia include headache, irritable bowel syndrome, psychological distress, Raynaud’s phenomenon, subjective swelling, nondermatomal paresthesia, and marked functional disability. Other somatic complaints include palpitations, dyspareunia/pelvic pain, temporomandibular pain, chronic rhinitis or “allergies,” and cognitive difficulties such as memory impairment or concentration issues. The somatic complaints distinguish fibromyalgia from rheumatoid arthritis (RA). However, fibromyalgia frequently coexists with other rheumatic diseases, especially systemic lupus erythematosus and RA. The differential diagnosis of fibromyalgia includes hypothyroidism, arthritis, polymyalgia rheumatica, osteomalacia, myofascial pain syndrome, metabolic and inflammatory myopathies, spondyloarthropathy, radiculopathy, and cardiac or pleuritic pain. The major challenge for the clinician is to distinguish fibromyalgia from an inflammatory or metabolic myopathy. Muscular aching and stiffness in fibromyalgia are more proximal than distal, although the patient may complain of hurting all over. Palpation of an FTP causes pain localized to the area of palpation, and the pain does not radiate to adjacent areas and no pain is experienced at sites proximal or distal to the examining finger. No muscle induration is palpable. Medications Associated with Myalgias Clofibrate Colchicine Danazol Gemfibrozil Glucocorticoids Hydralazine Hydroxychloroquine Lovastatin Penicillamine Phenytoin Procainamide Rifampin Sulfonamides Valproic acid Vincristine Zidovudine Selected Causes of Myalgias Amyotrophic lateral sclerosis Collagen vascular disease Dermatomyositis Diabetes mellitus Drug-induced myopathic syndromes • Alcohol • Cocaine • Heroin • Ipecac • L-tryptophan • Medications listed above Familial periodic paralysis Fibromyalgia Guillain–Barré syndrome Hyperthyroidism Hypothyroidism Inclusion body myositis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on FIBROMYALGIA Full access? Get Clinical Tree
