Technical Information: Guidelines for the Diagnosis and Treatment of Fibromyalgia.

Approach to the patient with suspected fibromyalgi

How is fibromyalgia diagnosed?

Important features for history: Core symptoms

• Widespread pain for 3 months (refer to pain diagram)
• Exercise intolerance (Do you feel better or worse after more than usual activity?)
• Fatigue (Do you run out of energy during the day? If so what time?)
• Sleep disturbance (Do you awake rested or tired? Is regular sleep interrupted repeatedly? Disturbing nocturnal myoclonus or restless legs?)

Associated symptoms

• Headaches
• Bowel irritability (constipation alternating with diarrhea)
• Pelvic pain
• Low back pain
• Non-dermatomal parathesias (i.e. whole arm or leg tingles)

Query mood disorders

• Family history of mood disorders
• Personal history of anxiety/depression
• Current mood
• Childhood/adult history of abuse/neglect
• Current stressors

Mimics

• Hypothyroid ROS (i.e. cold intolerance, weight gain, skin dryness, etc…)
• Hypercalcemia (i.e. bones, stones, groans)
• Anemia (heavy periods, dietary habits, previous CBCs)
• Sleep apnea (AM headaches, sleep while at desk or chair during day, sleep partner report)
• Inflammatory arthritis (AM stiffness improves with exercise, joint swelling)

Examination

Focus on positives of history/ROS and possible medical mimics plus:

• Evaluate for joint swelling/ROM
• Muscle weakness (true weakness vs giveway)
• Tenderpoint examination

What tests may be used to diagnose fibromyalgia?

• CBC
• ESR
• Basic chemistry panel including calcium
• TSH
• +/-CPK
• +/- Hepatitis C

ESR can be mildly elevated in people who are heavy and remember that the upper limit of ESR is (age + 10)/2 for women and age / 2 for men.

DO NOT check rheumatoid factor or ANAs without a high degree of suspicion for an autoimmune illness, as the false positive rate is sufficiently high to forever label patients incorrectly. Remember that ANAs of titer 1:40 or 1:80 are rarely of any clinical significance.

Surgery for arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

How useful was this page or article? This article is rated out of 5 stars (250 ratings). Not useful at all Not very useful Useful Very useful Extremely useful