Differentiating Fibromyalgia from other diseases

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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 Diagnostic findings
Rheumatoid arthritis
  • RF or anti-cyclic citrullinated protein (CCP) antibody is positive.
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
  • Positive anti-Smith antibodies
Chronic fatigue syndrome
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
  • Axial skeletal pain and stiffness
  • Restricted spinal motion
  • Bamboo spine on X-ray
Polymyalgia rheumatica
  • Older at onset 
  • Generalized stiffness
Osteoarthritis
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • Xray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • TSH is elevated and free T4 is low.
Myopathaies(polymyositis and dermatomyositis)
  • Muscle biopsy confirms the diagnosis
  • Elevated CPK enzyme
Neuropathy

References

  1. 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. 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. 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. 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. 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.

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