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Fibromyalgia

Fibromyalgia. R. John Looney, MD University of Rochester. Fibromyalgia vs. Other Patients. 1990 Criteria for Fibromyalgia. Widespread pain 11 of 18 tender points. 2010 Diagnostic Criteria. Widespread pain index (19 areas) Fatigue, waking unrefreshed, cognitive symptoms

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Fibromyalgia

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  1. Fibromyalgia R. John Looney, MD University of Rochester

  2. Fibromyalgia vs. Other Patients

  3. 1990 Criteria for Fibromyalgia • Widespread pain • 11 of 18 tender points

  4. 2010 Diagnostic Criteria • Widespread pain index (19 areas) • Fatigue, waking unrefreshed, cognitive symptoms • Present at similar level for 3 months • Not otherwise explained

  5. Differential • Degenerative disease: osteoarthritis, tendonitis, localized myofacial pain • Inflammatory-immune disease: RA, SLE, Sjögren’s, Mixed Connective Tissue Disease. Scleroderma, Myositis, Undifferentiated Connective Tissue Disease, Vasculitis, Polymyalgia, • Metabolic disease: hypo-/hyper-thyroid, high or low calcium, high or low potassium, liver disease, kidney disease • Other: anemia, infection malignancy

  6. Myth – SLE Causes Pain “The most frequent cause of positive ANA and chronic pain is fibromyalgia! The failure to recognize that pain is NOT because of active SLE leads to much unnecessary glucocorticoid use and even inappropriate use of narcotics.” “Estimates for the prevalence of fibromyalgia among patients with SLE range from 10 to 30%.” A Clinician’s Pearls and Myths in Rheumatolody. Ed. John H.Stone

  7. Myth – Fatigue is a sign of active SLE “Fatigue is a major cause of reduced quality of life reported by SLE patients and is a significant contributor to disability. Acute fatigue often accompanies SLE flare , but this usually resolves along with the other features of active disease. However, for many patients with lupus, fatigue is a chronic symptom this is unresponsive to NSAIDs, glucocorticoids, and immunosuppressive medications. In these SLE patients, chronic fatigue is probably due to fibromyalgia.”

  8. SLE Flare - BILAG • General • Mucocutaneous • Musculoskeletal • Neurological • Cardiovascular and respiratory • Renal • Vascular • Hematologic

  9. Mild to Moderate Flare • Mucocutaneous – discoid, photosensitive, profundus, cutaneous vasculitis, bullup lupus, nasopharyngeal ulcers • Cardio/respiratory – pleurisy, pericarditis • Musculoskeletal – arthritis • General – fever

  10. Severe Flare • Central nervous system lupus • Vasculitis • Nephritis • Myositis • Plt < 60,000 • Hemolytic anemia Hgb < 7

  11. Flare of SLE vs. Flare of FM • Pain in joints vs. tender points • Evidence of inflammation • Involvement of other systems • Laboratory abnormalities • Response to glucocorticoids, hydroxychloroquine, mycophenolate

  12. SLE Flare - BILAG • General • Mucocutaneous • Musculoskeletal • Neurological • Cardiovascular and respiratory • Renal • Vascular • Hematologic

  13. Fibromyalgia = Central Sensitization

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