Fibromyalgia vs. Polymyalgia Flashcards
(28 cards)
As what type of rheumatic disease is polymyalgia rheumatica (PMR) classified?
- subgroup of vasculitis
As what type of rheumatic disease is fibromyalgia classified?
- non-articular rheumatism (musculoskeletal aches and pains without arthritis).
What types of rheumatic conditions are primary care docs most likely to see?
- non-articular= fibromyalgia, bursitis, tendinitis, tenosynovitis, viral myalgia, RSD, PMR
A 35 y/o female complains of “pain all over.” Her multiple aches and pains have been present for at least 18 months and are associated with AM stiffness for at least 2 hrs. PE fails to reveal any true joint abnormality and labs are unremarkable. She has associated sleep disturbance and weather change aggravates her symptoms. What is her Dx?
- primary fibromyalgia syndrome= no inflammation, consistent symptom spectrum, no underlying cause.
*** What is fibromyalgia?
- non-articular rheumatism characterized by:
1. chronic musculoskeletal aches, pains, and stiffness (mostly in muscles, articular, and periarticular areas).
2. tender points and exaggerated tenderness in specific spots.
3. absence of articular pathology. - often associated with sleep disturbance.
What are the demographics of fibromyalgia?
- age 35-50, mainly women.
What diseases are often associated with fibromyalgia?
- SLE
- lyme disease
- IBD
- carpal tunnel syndrome
- tendonitis/bursitis
What are the aggravating factors of fibromyalgia?
- cold or humid weather
- non-restorative sleep
- physical/mental fatigue
- excess physical activity
- physical inactivity
- anxiety/stress
What are the relieving factors of fibromyalgia?
- warm/dry weather
- hot shower/bath
- restful sleep
- moderate activity
- stretching
- massage
What will you see on PE of a pt with fibromyalgia?
- multiple tender points
- mild soft tissue swelling (fingers)
- skin pinch tenderness
- hyperemia of skin
*** Will you see muscle weakness in fibromyalgia?
- NO
* neuro and joint exams will also be normal.
What are the criteria for fibromyalgia?
- widespread aching more than 3 months
- tenderness at 12 of 14 specified sites
- skin roll tenderness in upper scapular region
- disturbed sleep
- NORAML labs (CBC, ESR, CMP, serologies, EEG, EMG).
What is the ddx for fibromyalgia?
- psychogenic rheumatism
- RA
- palindromic rheumatism
- osteoarthritis
- polymyalgia rheumatica (PMR)
- hypothyroidism
Should you biopsy a pt with fibromyalgia to diagnose?
- NO. It is a clinical diagnosis.
*** How do we treat fibromyalgia?
- reassurance
- origin of pain
- relief of mechanical stresses (aquatic exercise)
- medical treatment: NSAIDs and ANTIDEPRESSANTS (TCAs= amitriptyline)
- heat, massage, OMT, relaxation, injections, acupuncture…
Should you use narcotics to treat fibromyalgia?
- NO!
Should you use steroids to treat fibromyalgia?
- NO
What are some additional medical therapies used to treat fibromyalgia?
- SSRIs
- tramadol
- duloxetine (SNRI)
- pregabalin
- combination is better than solo therapy.
A 63 y/o female presents to the office with the complaint of difficulty getting out of a chair. She also has vague symptoms such as fatigue and lack of energy in association with morning stiffness and aching in the proximal portions of her arms and legs. Lab data reveals a mild anemia, normal biochemistry profile, and a Westergren sedimentation rate of 75 mm/hr. PE is unremarkable. What is the Dx?
- Polymyalgia rheumatica (PMR)
*** What is the characteristic symptom of Polymalgia Rheumatica (PMR)?
- PROXIMAL girdle muscle STIFFNESS
* aka shoulders and hips
*** What is Polymalgia Rheumatica (PMR)?
- pain in neck, shoulders, and pelvic girdle for at least 1 month.
- morning stiffness and gelling without muscle atrophy or weakness.
- age greater than 50 and ESR greater than 50 (aka the 50/50 club)!
Will you see relief of symptoms within 4 days with a low dose (10-15 mg) of prednisone per day?
- YES
How long does polymyalgia rheumatica typically last?
- 2 years
* whereas fibromyalgia goes on forever.
What should be on your DDx for PMR?
- RA
- SLE
- viral myalgias
- polymyositis
- multiple myeloma
- osteoarthritis
- fibromyalgia
- occult cancer
- occult infection
- ENDOCRINE DISTURBANCE
