FIBROMYALGIA AND OTHER CHRONIC FATIGUE SYNDROMES

Abstract

T HE FIBROMYALGIA syndrome, also termed fibrositis, has been recently recognized as a common cause of chronic musculoskeleta1 pain and fatigue.‘” Specific diagnostic criteria have been proposed’*4*5 and fibromyalgia is now considered to be a discreet clinical syndrome.*v3 Fibromyalgia is the second or third most common diagnosis in ambulatory adult rheumatology, accounting for 4% to 20% of new patients’*4; conservative estimates of prevalence range from three to six million patients in the United States.3 There has recently been a dramatic increase in investigations of fibromyalgia. Although most reports have been clinical descriptions or therapeutic trials, investigators have recently evaluated possible etiologic and pathophysiologic pathways.6-‘4 One such pathway that we have been investigating concerns the possible role of chronic viral infection and fibromyalgia. poliomyelitis epidemic in Los Angeles. Two hundred ten cases, initially thought to be possible poliomyelitis, were eventually diagnosed as BME. Almost all of these cases occurred in hospital workers and 16% of the student nurses were affected. Unlike poliomyelitis, none of these patients developed muscle atrophy or progressive neurologic changes, although all had myalgias, paresthesias, headaches, and profound fatigue. None had temperatures above 37.8%. Loss of concentration, sleep disturbances, and emotional lability were prominent. The CSF and virologic studies were almost always normal. No patients died, but the majority experienced chronic symptoms and relapses. Seven years after the initial report, many of the patients were reevaluated and the fatigue, myalgias, and depression persisted in most patients.*’