ABC of rheumatology. Fibromyalgia syndrome.

Abstract

Fibromyalgia is common in hospital practice. It is rarely reported in children, and most patients are in their 40s or 50s. In all settings there is a strong female preponderance (about 90%). It is well reported in the United States, Canada, and Europe, but racial and social predisposition have not been adequately addressed. Symptoms are variable. Pain and fatiguability are usually prominent and associated with considerable disability and handicap. Although patients can usually dress and wash independently, they cannot cope with a job or ordinary household activities. Pain is predominently axial and diffuse but can affect any region and may at times be felt all over. Characteristically, analgesics, non-steroidal anti-inflammatory drugs, and local physical treatments are ineffective and may even worsen symptoms. Patients often have a poor sleep pattern with considerable latency and frequent arousal. Typically they awake exhausted and feel more tired in the morning than later in the day. Unexplained headache, urinary frequency, and abdominal symptoms are common and may have been extensively investigated with no cause found. Patients usually score highly on measures of anxiety and depression. Although the term fibromyalgia syndrome is not ideal, it does not imply causation and describes the commonest symptom. Idiopathic diffuse pain syndrome, generalised rheumatism, and non-restorative sleep disorder are terms that are increasingly preferred by some. Typical hyperalgesic withdrawal response by patient with fibromyalgia. (Picture reproduced with patient's permission.) View this table: Prevalence of fibromyalgia Principal symptoms of fibromyalgia Pain Predominantly axial (neck and back), but may be all over Often aggravated by stress, cold, and activity Often associated with generalised morning stiffness Often with subjective swelling of extremities Paraesthesiae and dysaesthesiae of hands and feet Fatiguability Often extreme, occurring after minimal exertion Non-restorative sleep Waking unrefreshed Poor concentration and forgetfulness Low affect, irritable, and weepy Headache …