Fibromyalgia Flashcards Preview

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Flashcards in Fibromyalgia Deck (14):
1

What should be asked when a patient presents with widespread pain and fatigue?

Exacerbating/relieving factors
Variability during day
Systemic features e.g. weight loss night sweats - malignancy
Weight gain, reduced appetite, hair loss - hypothyroidism
Sleep - unrefreshing sleep = fibromyalgia

2

What is needed for a diagnosis of fibromyalgia?

Chronic widespread pain (over 3 months), both sides of the body, above and below the waist and along the axial spine

Poor sleep
Poor concentration

3

What are the differentials for fibromyalgia?

Endocrine - Addison's, hypothyroid, vitamin D deficiency
Infection - Hep C, HIV
Rheum - RA, SLE, PR
Malignancy - lymphoma

4

What is needed on examination for a diagnosis of fibromyalgia?

11 or more tender points out of 18

5

Where are the 18 fibromyalgia tender points?

Occiput at nuchal ridge
Trapezius
Supraspinatus
Gluteal
Low cervical
Second rib
Lateral epicondyle
Greater trochanter
Medial knee

6

What can be used to score fibromyalgia?

Widespread pain index
Symptom severity score

7

What are the ACR criteria for diagnosing fibromyalgia?

WPI of 7 and SS score of 5
OR
WPI 3-6 and SS 9
Symptoms at same intensity for 3 months
No other disorder explains the pain

8

What investigations should be done for fibromyalgia?

TFTs
Vitamin D
Vitamin B12
Iron studies
Magnesium
ESR/CRP

9

How can fibromyalgia be explained to patients?

A pain condition, not due to inflammation, may be due to chemical changes in the body's pain pathways

10

What is the treatment for fibromyalgia?

Patient education
Exercise
Screen for anxiety and depression
Hydrotherapy, acupuncture

11

How is severe pain in fibromyalgia treated?

Duloxetine
Pregabalin
Tramadol

12

How is severe sleep disturbance in fibromyalgia treated?

Low dose amitriptyline
Cyclobenzapine
Pregabalin

13

What is prognosis in fibromyalgia based on?

Yellow flags - biopsychosocial indicators

14

What are the risk factors for fibromyalgia?

Low household income
Lack of further education
Female
FH
Traumatic events