Differentiating Fibromyalgia from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Fibromyalgia from other Diseases

Fibromyalgia must be differentiated from other diseases that present with musculoskeletal pain

Disease Differentiating signs and symptoms Differentiating labs
Rheumatoid arthritis
  • Multiple joint swelling
  • Morning stiffness
  • Rheumatoid nodules
  • RF or anti-cyclic citrullinated protein (CCP) antibody is positive.
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
  • Maculopapular rash
  • Multi-system involvement
  • Positive anti-Smith antibodies
Chronic fatigue syndrome
  • Fatigue plus 4 of the following symptoms
  • (1) Short-term memory loss
  • (2) Sore throat
  • (3) tender lymph nodes in the neck or armpit
  • (4) muscle pain
  • (5) joint pain without swelling or redness
  • (6) headaches
  • (7) unrefreshing sleep
  • (8) malaise
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
  • Axial skeletal pain and stiffness
  • Restricted spinal motion
  • Elevated ESR or CRP
  • Negative RF
  • Bamboo spine on X-ray
Polymyalgia rheumatica
  • Older at onset 
  • Generalized stiffness
  • An elevated erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP
  • Response to corticosteroids
Osteoarthritis 
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • Xray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • Systemic symptoms such as weight gain, constipation, dry skin
  • Muscular aching and prominent fatigue that improves on replacement of thyroid hormone.
  • TSH is elevated and free T4 is low.
Myopathaies(polymyositis and dermatomyositis)
  • Pelvic and shoulder girdle muscle weakness
  • Rash
  • Muscle biopsy confirms the diagnosis
  • Elevated CPK enzyme
Neuropathy
  • Numbness and tingling
  • Paresthesia
  • Abnormal EMG

References

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