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==
Fibromyalgia must be differentiated from other diseases that present with musculoskeletal pain such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, 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>
[[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>


{| class="wikitable"
{| class="wikitable"
!Disease
!Disease
!Differentiating signs and symptoms
!Differentiating signs and symptoms
!Differentiating labs
!Diagnostic findings
!
|-
|[[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]]
|
*All lab tests are normal
|-
|-
|Rheumatoid arthritis
|[[Rheumatoid arthritis]]
|
|
* Multiple joint swelling
* Multiple [[joint swelling]]
* Morning stiffness
* Morning [[stiffness]]
* Rheumatoid nodules
* [[Rheumatoid nodules]]
|
|
* RF or anti-cyclic citrullinated protein (CCP) antibody is positive.
* [[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]]
|
|
* Maculopapular rash
* [[Maculopapular rash]]
* Multi-system involvement
* Multi-system involvement
|
|
*Positive anti-Smith antibodies
*Positive anti-Smith [[antibodies]]
|
|-
|-
|[[Chronic fatigue syndrome]]
|[[Chronic fatigue syndrome]]
|
|Fatigue plus 4 of the following symptoms:
*Fatigue plus 4 of the following symptoms
*Short-term [[memory loss]]
*(1) Short-term memory loss  
*[[Sore throat]]
*(2) Sore throat
*Tender [[lymph nodes]] in the neck or armpit
*(3) tender lymph nodes in the neck or armpit
*[[Muscle pain]]
*(4) muscle pain
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]]
*(5) joint pain without swelling or redness
*[[Headaches]]
*(6) headaches
*[[Insomnia]]
*(7) unrefreshing sleep
*[[Malaise]]
*(8) malaise
|
|
*Diagnosis of exclusions  
*Diagnosis of exclusions  
*Symptoms must present for more than 6 months
*Symptoms must present for more than 6 months
|
|-
|-
|Spondyloarthritis
|[[Spondyloarthritis]]
|
|
* Axial skeletal pain and stiffness
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
* Restricted spinal motion
* Restricted spinal motion
|
|
* Elevated ESR or CRP
* Elevated [[ESR]] or [[CRP]]
* Negative RF
* Negative [[RF]]


* Bamboo spine on X-ray
* [[Bamboo spine]] on [[x-ray]]
|
|-
|-
|Polymyalgia rheumatica
|[[Polymyalgia rheumatica]]
|
* Older at onset 
* Generalized stiffness
|
|
* An elevated erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP
* Older at onset
* Response to corticosteroids
* Generalized [[stiffness]]
|
|
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
* Response to [[corticosteroids]]
|-
|-
|Osteoarthritis 
|[[Osteoarthritis]]
|
|
* Localized joint pain  
* Localized [[joint pain]]
* Restricted to affect joints
* Restricted to affect joints
* Older at onset
* Older at onset
|
|
* Xray of the involved joints demonstrate degenerative changes
* [[X-ray]] of the involved joints demonstrate degenerative changes
|
|-
|-
|Hypothyroidism
|[[Hypothyroidism]]
|
|
*Systemic symptoms such as weight gain, constipation, dry skin  
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
*Muscular aching and prominent fatigue that improves on replacement of thyroid hormone.
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
|
*TSH is elevated and free T4 is low.
|
|
*[[TSH]] is elevated and free [[T4]] is low.
|-
|-
|Myopathaies(polymyositis and dermatomyositis)
|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
|
*Pelvic and shoulder girdle muscle weakness
*Rash
|
|
*Muscle biopsy confirms the diagnosis
*Pelvic and shoulder girdle [[muscle weakness]]
*Elevated CPK enzyme
*[[Rash]]
|
|
*[[Muscle biopsy]] confirms the diagnosis
*Elevated [[CPK|CPK enzyme]]
|-
|-
|Neuropathy
|[[Neuropathy]]
|
|
*Numbness and tingling
*[[Numbness]] and [[tingling]]
*Paresthesia
*[[Paresthesia]]
|
|
*Abnormal EMG
*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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