Fibromyalgia / PMR / Chronic Fatigue Flashcards Preview

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Flashcards in Fibromyalgia / PMR / Chronic Fatigue Deck (14)
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1
Q

What are the symptoms of fibromyalgia

A

Widespread chronic pain >3 months
R+L side of body and above and below waist
Axial skeleton pain
Tender points >11/18

2
Q

What are other symptoms

A
Lethargy
Cognition
Headache 
Dizzy 
Morning stiff
Paraesthesia 
Sleep disturbance
Chronic fatigue
Depression 
IBS
3
Q

Who is at risk / associations

A
Women
Middle age
Low income
Divorced
Low education 
Chronic fatigue
IBS
Chronic headache
RA / AS / SLE
4
Q

What must you exclude before diagnosing

A
RA
PMR
Vasculitis
Hypothyroid
Myeloma as bone pan
5
Q

How do you Rx

A
Explanation
Aerobic exercise
CBT
Low dose pregabalin / amitryptilline
Address sleep issues
Physio
6
Q

What is Chronic fatigue / ME

A

Persistent disabling fatigue >6 months
Mental and physical function affected >50%
Absence of any disease that explains

7
Q

What 4+ other features needed for Dx

A
Myalgia 
Polyarthralgia
Poor memory 
Fatigue after mental or physical exertion
Persistent sore throat
Persistent headache
Tender cervical / axillary LN with no enlargement 
Malaise / dizzy / nausea
8
Q

What investigations

A

FBC, U+E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin
Coeliac screen
Urinanalysis

9
Q

How do you treat

A
Similar to fibromyalgia
Graded exercise
CBT
Low dose amitrpytilline for poor sleep
Pain clinic
10
Q

What is polymyalgia Rheumatica

A

Inflammatory condition of the elderly

11
Q

What are the symptoms

A
Sudden onset shoulder + pelvic girdle stiffness
Worse with movement
Interferes with sleep 
Rapid onset <1 month
ESR >45
Anaemia
Fatigue
Weight loss 
Anorexia
Low grade fever
Depression
Night sweats
Dyspnoea
Weak pulse
Mild polyarthralgia 
Carpal tunnel 
Weakness is NOT a feature
12
Q

How do you Dx

A
No test - Dx of exclusion 
Age + raised ESR + history (DDX could be statin induced myopathy but ESR would be normal) 
Raised ALP?
Do FBC, U+E, LFT, Ca, TFT
Myeloma screen
CK
RF ? 
Urine dip
13
Q

How do you Rx

A

Dramatic steroid response
Prednisolone for 18-24 months
Bone prophylaxis - bipshophonate, Ca, vit D + gastric protection = PPI
Urgent medical if GCA develops

14
Q

What are DDX

A
OA
RA
SLE
Cervical spondylosis
Adhesive capsulitis of both shoulders
Hyper or hypothyroid
Osteomalacia
Fibromyalgia