Differentiating Fibromyalgia from other diseases: Difference between revisions

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__NOTOC__
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{{Fibromyalgia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Fibromyalgia]]
{{CMG}}
{{CMG}}; {{AE}} {{ADG}}


==Overview==
==Overview==
Fibromyalgia must be differentiated from other diseases that present with [[pain]], [[fatigue]] and [[Insomnia|sleep disturbance]], and symptoms of cognitive dysfunction and [[psychiatric disease]] such as [[rheumatoid arthritis]], [[SLE]], [[chronic fatigue syndrome]], [[spondyloarthritis]], and [[polymyalgia rheumatica]].<ref name="pmid15547167">{{cite journal |vauthors=Goldenberg DL, Burckhardt C, Crofford L |title=Management of fibromyalgia syndrome |journal=JAMA |volume=292 |issue=19 |pages=2388–95 |year=2004 |pmid=15547167 |doi=10.1001/jama.292.19.2388 |url=}}</ref><ref name="pmid24737367">{{cite journal |vauthors=Clauw DJ |title=Fibromyalgia: a clinical review |journal=JAMA |volume=311 |issue=15 |pages=1547–55 |year=2014 |pmid=24737367 |doi=10.1001/jama.2014.3266 |url=}}</ref><ref name="pmid26445775">{{cite journal |vauthors=Borchers AT, Gershwin ME |title=Fibromyalgia: A Critical and Comprehensive Review |journal=Clin Rev Allergy Immunol |volume=49 |issue=2 |pages=100–51 |year=2015 |pmid=26445775 |doi=10.1007/s12016-015-8509-4 |url=}}</ref><ref name="pmid23775553">{{cite journal |vauthors=Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P |title=[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines] |language=German |journal=Z Psychosom Med Psychother |volume=59 |issue=2 |pages=132–52 |year=2013 |pmid=23775553 |doi=10.13109/zptm.2013.59.2.132 |url=}}</ref><ref name="pmid19050952">{{cite journal |vauthors=Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P |title=[Definition, classification and diagnosis of fibromyalgia syndrome] |language=German |journal=Z Rheumatol |volume=67 |issue=8 |pages=665–6, 668–72, 674–6 |year=2008 |pmid=19050952 |doi=10.1007/s00393-008-0404-4 |url=}}</ref>
==Differentiating Fibromyalgia from other Diseases==
==Differentiating Fibromyalgia from other Diseases==
A number of other disorders can produce similar symptoms to fibromyalgia:
[[Fibromyalgia]] must be differentiated from other diseases that present with [[pain]], [[fatigue]] and [[Insomnia|sleep disturbance]], and symptoms of cognitive dysfunction and [[psychiatric disease]] such as [[rheumatoid arthritis]], [[SLE]], [[chronic fatigue syndrome]], [[spondyloarthritis]], and [[polymyalgia rheumatica]].<ref name="pmid15547167">{{cite journal |vauthors=Goldenberg DL, Burckhardt C, Crofford L |title=Management of fibromyalgia syndrome |journal=JAMA |volume=292 |issue=19 |pages=2388–95 |year=2004 |pmid=15547167 |doi=10.1001/jama.292.19.2388 |url=}}</ref><ref name="pmid24737367">{{cite journal |vauthors=Clauw DJ |title=Fibromyalgia: a clinical review |journal=JAMA |volume=311 |issue=15 |pages=1547–55 |year=2014 |pmid=24737367 |doi=10.1001/jama.2014.3266 |url=}}</ref><ref name="pmid26445775">{{cite journal |vauthors=Borchers AT, Gershwin ME |title=Fibromyalgia: A Critical and Comprehensive Review |journal=Clin Rev Allergy Immunol |volume=49 |issue=2 |pages=100–51 |year=2015 |pmid=26445775 |doi=10.1007/s12016-015-8509-4 |url=}}</ref><ref name="pmid23775553">{{cite journal |vauthors=Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P |title=[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines] |language=German |journal=Z Psychosom Med Psychother |volume=59 |issue=2 |pages=132–52 |year=2013 |pmid=23775553 |doi=10.13109/zptm.2013.59.2.132 |url=}}</ref><ref name="pmid19050952">{{cite journal |vauthors=Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P |title=[Definition, classification and diagnosis of fibromyalgia syndrome] |language=German |journal=Z Rheumatol |volume=67 |issue=8 |pages=665–6, 668–72, 674–6 |year=2008 |pmid=19050952 |doi=10.1007/s00393-008-0404-4 |url=}}</ref>
* [[Chronic fatigue syndrome]]
 
* [[clinical depression|Depression]]
* [[Ehlers-Danlos syndrome]]
* [[Gulf War syndrome]]
* [[Influenza]]
* [[Lead poisoning]]
* [[Lupus erythematosus]]  
* [[Lyme disease]]
* [[Mercury poisoning]]
* [[Myofascial pain syndrome]]
*Sympathetic pain sydromes ([[RSD]], [[CRPS]])
* [[Tendinitis]]
* [[Thyroid disease]]
* [[Vitamin B12 deficiency]]
* [[Vitamin D]] deficiency
* [[Whiplash (medicine)|Whiplash-associated disorder]]
* [[Multiple chemical sensitivity]]
{| class="wikitable"
{| class="wikitable"
!Disease
!Disease
!Differentiating signs and symptoms
!Differentiating signs and symptoms
!Diifferentiating labs
!Diagnostic findings
!
|-
|-
|Rheumatoid arthritis
|[[Fibromyalgia]]
|
* Symptoms have been present at a similar level for at least 3 months.
* Chronic [[musculoskeletal pain]] with multiple tender points
* [[Stiffness]], [[numbness]], and [[fatigue]]
* [[Headaches]]
* [[Sleep disorder]]
|
|
* Multiple joint swelling
*All lab tests are normal
* Morning stiffness
|-
* Rheumatoid nodules
|[[Rheumatoid arthritis]]
|
|
* RF or anti-cyclic citrullinated protein (CCP) antibody is positive.
* Multiple [[joint swelling]]
* Morning [[stiffness]]
* [[Rheumatoid nodules]]
|
* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive.


* Markers of systemic inflammation (ESR, CRP) are typically elevated.
* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated.
|
|-
|-
|SLE
|[[SLE]]
|
* Maculo-papular rash
* Multi system involvement
|
|
* [[Maculopapular rash]]
* Multi-system involvement
|
|
*Positive anti-Smith [[antibodies]]
|-
|-
|[[Chronic fatigue syndrome]]
|[[Chronic fatigue syndrome]]
|Fatigue plus 4 of the following symptoms:
*Short-term [[memory loss]]
*[[Sore throat]]
*Tender [[lymph nodes]] in the neck or armpit
*[[Muscle pain]]
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]]
*[[Headaches]]
*[[Insomnia]]
*[[Malaise]]
|
|
*Diagnosis of exclusions
*Symptoms must present for more than 6 months
|-
|[[Spondyloarthritis]]
|
|
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
* Restricted spinal motion
|
|
* Elevated [[ESR]] or [[CRP]]
* Negative [[RF]]
* [[Bamboo spine]] on [[x-ray]]
|-
|-
|Spondyloarthritis
|[[Polymyalgia rheumatica]]
|
|
* Axial skeletal pain and stiffness
* Older at onset
* Restricted spinal motion
* Generalized [[stiffness]]
|
* Elevated ESR or CRP
* Negtive RF
|
|
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
* Response to [[corticosteroids]]
|-
|-
|[[Osteoarthritis]]
|
|
* Localized [[joint pain]]
* Restricted to affect joints
* Older at onset
|
|
* [[X-ray]] of the involved joints demonstrate degenerative changes
|-
|[[Hypothyroidism]]
|
|
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
|
|
*[[TSH]] is elevated and free [[T4]] is low.
|-
|-
|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
|
|
*Pelvic and shoulder girdle [[muscle weakness]]
*[[Rash]]
|
|
*[[Muscle biopsy]] confirms the diagnosis
*Elevated [[CPK|CPK enzyme]]
|-
|[[Neuropathy]]
|
|
*[[Numbness]] and [[tingling]]
*[[Paresthesia]]
|
|
*Abnormal [[EMG]]
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Rheumatology]]
[[Category:Diseases involving the fasciae]]
[[Category:Syndromes]]
[[Category:Ailments of unknown etiology]]

Latest revision as of 20:33, 20 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, and polymyalgia rheumatica.[1][2][3][4][5]

Differentiating Fibromyalgia from other Diseases

Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, and polymyalgia rheumatica.[1][2][3][4][5]

Disease Differentiating signs and symptoms Diagnostic findings
Fibromyalgia
  • All lab tests are normal
Rheumatoid arthritis
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
Chronic fatigue syndrome Fatigue plus 4 of the following symptoms:
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
Polymyalgia rheumatica
Osteoarthritis
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • X-ray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • TSH is elevated and free T4 is low.
Myopathaies (polymyositis and dermatomyositis)
Neuropathy

References

  1. ↑ 1.0 1.1 Goldenberg DL, Burckhardt C, Crofford L (2004). "Management of fibromyalgia syndrome". JAMA. 292 (19): 2388–95. doi:10.1001/jama.292.19.2388. PMID 15547167.
  2. ↑ 2.0 2.1 Clauw DJ (2014). "Fibromyalgia: a clinical review". JAMA. 311 (15): 1547–55. doi:10.1001/jama.2014.3266. PMID 24737367.
  3. ↑ 3.0 3.1 Borchers AT, Gershwin ME (2015). "Fibromyalgia: A Critical and Comprehensive Review". Clin Rev Allergy Immunol. 49 (2): 100–51. doi:10.1007/s12016-015-8509-4. PMID 26445775.
  4. ↑ 4.0 4.1 Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P (2013). "[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines]". Z Psychosom Med Psychother (in German). 59 (2): 132–52. doi:10.13109/zptm.2013.59.2.132. PMID 23775553.
  5. ↑ 5.0 5.1 Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P (2008). "[Definition, classification and diagnosis of fibromyalgia syndrome]". Z Rheumatol (in German). 67 (8): 665–6, 668–72, 674–6. doi:10.1007/s00393-008-0404-4. PMID 19050952.
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