Differentiating Fibromyalgia from other diseases: Difference between revisions
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==Differentiating Fibromyalgia from other Diseases== | ==Differentiating Fibromyalgia from other Diseases== | ||
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.<ref name="pmid15547167">{{cite journal |vauthors=Goldenberg DL, Burckhardt C, Crofford L |title=Management of fibromyalgia syndrome |journal=JAMA |volume=292 |issue=19 |pages=2388–95 |year=2004 |pmid=15547167 |doi=10.1001/jama.292.19.2388 |url=}}</ref><ref name="pmid24737367">{{cite journal |vauthors=Clauw DJ |title=Fibromyalgia: a clinical review |journal=JAMA |volume=311 |issue=15 |pages=1547–55 |year=2014 |pmid=24737367 |doi=10.1001/jama.2014.3266 |url=}}</ref><ref name="pmid26445775">{{cite journal |vauthors=Borchers AT, Gershwin ME |title=Fibromyalgia: A Critical and Comprehensive Review |journal=Clin Rev Allergy Immunol |volume=49 |issue=2 |pages=100–51 |year=2015 |pmid=26445775 |doi=10.1007/s12016-015-8509-4 |url=}}</ref><ref name="pmid23775553">{{cite journal |vauthors=Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P |title=[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines] |language=German |journal=Z Psychosom Med Psychother |volume=59 |issue=2 |pages=132–52 |year=2013 |pmid=23775553 |doi=10.13109/zptm.2013.59.2.132 |url=}}</ref><ref name="pmid19050952">{{cite journal |vauthors=Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P |title=[Definition, classification and diagnosis of fibromyalgia syndrome] |language=German |journal=Z Rheumatol |volume=67 |issue=8 |pages=665–6, 668–72, 674–6 |year=2008 |pmid=19050952 |doi=10.1007/s00393-008-0404-4 |url=}}</ref> | [[Fibromyalgia]] must be differentiated from other diseases that present with [[pain]], [[fatigue]] and [[Insomnia|sleep disturbance]], and symptoms of [[cognitive dysfunction]] and psychiatric disease such as [[rheumatoid arthritis]], [[SLE]], [[chronic fatigue syndrome]], [[spondyloarthritis]], [[polymyalgia rheumatica]].<ref name="pmid15547167">{{cite journal |vauthors=Goldenberg DL, Burckhardt C, Crofford L |title=Management of fibromyalgia syndrome |journal=JAMA |volume=292 |issue=19 |pages=2388–95 |year=2004 |pmid=15547167 |doi=10.1001/jama.292.19.2388 |url=}}</ref><ref name="pmid24737367">{{cite journal |vauthors=Clauw DJ |title=Fibromyalgia: a clinical review |journal=JAMA |volume=311 |issue=15 |pages=1547–55 |year=2014 |pmid=24737367 |doi=10.1001/jama.2014.3266 |url=}}</ref><ref name="pmid26445775">{{cite journal |vauthors=Borchers AT, Gershwin ME |title=Fibromyalgia: A Critical and Comprehensive Review |journal=Clin Rev Allergy Immunol |volume=49 |issue=2 |pages=100–51 |year=2015 |pmid=26445775 |doi=10.1007/s12016-015-8509-4 |url=}}</ref><ref name="pmid23775553">{{cite journal |vauthors=Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P |title=[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines] |language=German |journal=Z Psychosom Med Psychother |volume=59 |issue=2 |pages=132–52 |year=2013 |pmid=23775553 |doi=10.13109/zptm.2013.59.2.132 |url=}}</ref><ref name="pmid19050952">{{cite journal |vauthors=Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P |title=[Definition, classification and diagnosis of fibromyalgia syndrome] |language=German |journal=Z Rheumatol |volume=67 |issue=8 |pages=665–6, 668–72, 674–6 |year=2008 |pmid=19050952 |doi=10.1007/s00393-008-0404-4 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 14: | Line 14: | ||
!Differentiating labs | !Differentiating labs | ||
|- | |- | ||
|Rheumatoid arthritis | |[[Rheumatoid arthritis]] | ||
| | | | ||
* Multiple joint swelling | * Multiple joint swelling | ||
* Morning stiffness | * Morning stiffness | ||
* Rheumatoid nodules | * [[Rheumatoid nodules]] | ||
| | | | ||
* RF or anti-cyclic citrullinated protein (CCP) antibody is positive. | * [[Rheumatoid factor|RF]] or anti-cyclic citrullinated protein (CCP) antibody is positive. | ||
* Markers of systemic inflammation (ESR, CRP) are typically elevated. | * Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated. | ||
|- | |- | ||
|SLE | |[[SLE]] | ||
| | | | ||
* Maculopapular rash | * [[Maculopapular rash]] | ||
* Multi-system involvement | * Multi-system involvement | ||
| | | | ||
| Line 34: | Line 34: | ||
| | | | ||
*Fatigue plus 4 of the following symptoms | *Fatigue plus 4 of the following symptoms | ||
*(1) Short-term memory loss | *(1) Short-term [[memory loss]] | ||
*(2) Sore throat | *(2) [[Sore throat]] | ||
*(3) | *(3) Tender [[lymph nodes]] in the neck or armpit | ||
*(4) | *(4) Muscle pain | ||
*(5) | *(5) Joint pain without swelling or redness | ||
*(6) | *(6) [[Headaches]] | ||
*(7) | *(7) [[Insomnia]] | ||
*(8) | *(8) [[Malaise]] | ||
| | | | ||
*Diagnosis of exclusions | *Diagnosis of exclusions | ||
*Symptoms must present for more than 6 months | *Symptoms must present for more than 6 months | ||
|- | |- | ||
|Spondyloarthritis | |[[Spondyloarthritis]] | ||
| | | | ||
* Axial skeletal pain and stiffness | * Axial skeletal pain and stiffness | ||
* Restricted spinal motion | * Restricted spinal motion | ||
| | | | ||
* Elevated ESR or CRP | * Elevated [[ESR]] or [[CRP]] | ||
* Negative RF | * Negative [[RF]] | ||
* Bamboo spine on X-ray | * Bamboo spine on X-ray | ||
|- | |- | ||
|Polymyalgia rheumatica | |[[Polymyalgia rheumatica]] | ||
| | | | ||
* Older at onset | * Older at onset | ||
* Generalized stiffness | * Generalized stiffness | ||
| | | | ||
* An elevated erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP | * An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP | ||
* Response to corticosteroids | * Response to [[corticosteroids]] | ||
|- | |- | ||
| | |[[Osteoarthritis]] | ||
| | | | ||
* Localized joint pain | * Localized joint pain | ||
| Line 72: | Line 72: | ||
* Xray of the involved joints demonstrate degenerative changes | * Xray of the involved joints demonstrate degenerative changes | ||
|- | |- | ||
|Hypothyroidism | |[[Hypothyroidism]] | ||
| | | | ||
*Systemic symptoms such as weight gain, constipation, dry skin | *Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]] | ||
*Muscular aching and prominent fatigue that improves on replacement of thyroid hormone. | *Muscular aching and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]]. | ||
| | | | ||
*TSH is elevated and free T4 is low. | *[[TSH]] is elevated and free [[T4]] is low. | ||
|- | |- | ||
|Myopathaies(polymyositis and dermatomyositis) | |[[Myopathaies]](polymyositis and dermatomyositis) | ||
| | | | ||
*Pelvic and shoulder girdle muscle weakness | *Pelvic and shoulder girdle [[muscle weakness]] | ||
*Rash | *[[Rash]] | ||
| | | | ||
*Muscle biopsy confirms the diagnosis | *Muscle biopsy confirms the diagnosis | ||
*Elevated CPK enzyme | *Elevated [[CPK enzyme]] | ||
|- | |- | ||
|Neuropathy | |[[Neuropathy]] | ||
| | | | ||
*Numbness and tingling | *[[Numbness]] and [[tingling]] | ||
*Paresthesia | *[[Paresthesia]] | ||
| | | | ||
*Abnormal EMG | *Abnormal [[EMG]] | ||
|} | |} | ||
Revision as of 14:24, 19 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.[1][2][3][4][5]
Differentiating Fibromyalgia from other Diseases
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease such as rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, polymyalgia rheumatica.[1][2][3][4][5]
| Disease | Differentiating signs and symptoms | Differentiating labs |
|---|---|---|
| Rheumatoid arthritis |
|
|
| SLE |
|
|
| Chronic fatigue syndrome |
|
|
| Spondyloarthritis |
|
|
| Polymyalgia rheumatica |
|
|
| Osteoarthritis |
|
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| Hypothyroidism |
|
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| Myopathaies(polymyositis and dermatomyositis) |
|
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| Neuropathy |
|
References
- ↑ 1.0 1.1 Goldenberg DL, Burckhardt C, Crofford L (2004). "Management of fibromyalgia syndrome". JAMA. 292 (19): 2388–95. doi:10.1001/jama.292.19.2388. PMID 15547167.
- ↑ 2.0 2.1 Clauw DJ (2014). "Fibromyalgia: a clinical review". JAMA. 311 (15): 1547–55. doi:10.1001/jama.2014.3266. PMID 24737367.
- ↑ 3.0 3.1 Borchers AT, Gershwin ME (2015). "Fibromyalgia: A Critical and Comprehensive Review". Clin Rev Allergy Immunol. 49 (2): 100–51. doi:10.1007/s12016-015-8509-4. PMID 26445775.
- ↑ 4.0 4.1 Häuser W, Burgmer M, Köllner V, Schaefert R, Eich W, Hausteiner-Wiehle C, Henningsen P (2013). "[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines]". Z Psychosom Med Psychother (in German). 59 (2): 132–52. doi:10.13109/zptm.2013.59.2.132. PMID 23775553.
- ↑ 5.0 5.1 Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P (2008). "[Definition, classification and diagnosis of fibromyalgia syndrome]". Z Rheumatol (in German). 67 (8): 665–6, 668–72, 674–6. doi:10.1007/s00393-008-0404-4. PMID 19050952.