Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Fibromyalgia 569

■Symptoms that mimic inflammatory disorders, including

Raynaud’s-like symptoms, livedo reticularis, malar flushing,

morning stiffness, subjective swelling of hands & feet, may con-

found diagnosis

■Symptoms often begin or worsen after exposure to a “stressor” such

as trauma, infection, emotional stress

Signs & Symptoms

■Normal except for findings of tenderness present anywhere in body,

not just confined to areas of typical “tender points”

■Formal American College of Rheumatology criteria require 11 of 18

tender points present, but in clinical practice at least half of pts w/

fibromyalgia will not have 11 of 18 tender points

tests

■Pts w/ acute or subacute symptoms may require an extensive

workup, whereas in those w/ chronic symptoms minimal workup

is necessary

Lab Tests

■Used to exclude other diseases

■CBC, routine chemistries, creatine kinase, TSH, urinalysis, ESR

should be normal

■Rheumatoid factor, antinuclear antibody should only be ordered if

there is high suspicion of autoimmune disorder (eg, abnormal phys-

ical exam or abnormal screening labs)

Imaging

■Not warranted unless dictated by history & physical findings

differential diagnosis

■Hypothyroidism (high TSH)

■Polymyalgia rheumatica (>50 yrs old, high ESR)

■Hepatitis C

■Drug-induced myopathies (esp. statin drugs)

■Chiari malformation or cervical spinal stenosis

■Early rheumatoid arthritis or SLE may simulate fibromyalgia

■Osteomalacia

management

What to Do First

■Educate pt