Fibromyalgia

Question 1

What types of rheumatological dzs cause widespread pain?

Answer 1

fibromyalgia, polymyalgia rheumatica, lupus, RA, and myositis.

Question 2

What sx would cue you in on fibromyalgia?

Answer 2

Young Age can rule out OA or polymyalgia rheumatica
A normal physical exam will rule our RA, and lupus
Tender points is unlikely in RA
Lack of muscle weakness rules out myositis

Question 3

What non-rheumatological condition must you always rule out first before diagnosing fibromyalgia?

Answer 3

Hypothyroidism

Question 4

What is the tenderpoint exam?

Answer 4

Patients need to show pain in 11/18 “tenderpoint” areas after application of pressure to be diagnosed with fibro

Question 5

What lab tests would you order in someone who you suspected of fibro?

Answer 5

CBC for anemia
ESR to rule out inflammatory disorder (polymyalgia rheumatica, RA, CT disease, malignancy, infection)
TSH

Question 6

Explain what we know about the pathogenesis of fibro

Answer 6

Biochemical abnormalities in neurotransmitters and hormones resulting in pain amplification syndrome/allodynia. Others think it is a somatiform disorder

Question 7

How do you treat fibromyalgia?

Answer 7

Daily low impact aerobic exercise at a gradual pace. Improve sleep with amitryptyline.
CBT to treat pts how to live life and cope with pain

Question 8

What other meds can help fibro?

Answer 8

Tramadol
Avoid narcotics
NSAIDs/acetaminophen limited benefit
Duloxetine (SNRI)
Gabapentin