Diagnosis Of Fibromyalgia

The diagnosis is made clinically by the history and certain physical findings as mentioned above. At the same time it is done by exclusion of other rheumatological conditions that may produce symptoms very similar to fibromyalgia as mentioned above in the introduction. Most often it is a young or middle-aged woman who is first diagnosed with this condition.

In older women it often is associated with a minor osteoarthritic condition, which is not associated with the fibromyalgia, but which in some way seems to contribute or worsen the fibromyalgia. In men fibromyalgia often follows a work related injury or a sports injury and may develop out of a "myofascial pain syndrome" in association with such an event (Ref.3, p. 481).

The various reference materials seem to agree that there is no single cause for fibromyalgia. Instead it likely will ultimately be found that it is a multifactorial, but very real entity. One contributing factor can be a physician with a closed mind who makes a statement to a patient with fibromyalgia like "it is all in your head". Such a physician would do better referring the patient to a rheumatologist. What this uncaring statement really is communicating is the frustration that the physician feels: the aching muscles and other persistent symptoms did not respond to the usual anti-inflammatory interventions that, for instance, arthritis cases respond to. However, fibromyalgia is a condition that is known not to be due to inflammation, therefore anti-inflammatories will not tend to help that much.

A fibromyalgia patient with a lot of sleep disturbance should be send to a sleep laboratory, which likely will document a certain type of sleep disorder that can be treated accordingly. A number of blood tests should be ordered to rule out hypothyroidsm (TSH level), rheumatoid arthritis(RA titre) and lupus (ANA titre). A blood sugar or a hemoglobin A1C level would be useful to rule out diabetes. Depending on what the physician detects during the physical examination other tests may also be done. A study where people with acute chest pain were examined with coronary artery angiograms (Xrays of the coronary arteries) showed that less than 30% of the patients had actual narrowed coronary arteries (actual angina chest pain). In the patients with normal coronary arteries there were 30% with fibromyalgia and 10% with costochondritis (an inflammatory disease of the junction between a rib and the chestbone). The group with coronary artery disease had only 2.5% of fibromyalgia and no costochondritis( Ref.5). The authors concluded that patients with chest pain and normal coronary arteries often have a number of rheumatological diseases with the most common one being fibromyalgia.

An important aspect that comes from the anti-aging medicine approach is to do a saliva hormone panel as often the hormone levels of progesterone, testosterone or DHEAS are low with fibromyalgia patients (Ref. 8)

*Factors found in fibromyalgia*
*Factors:*	*Comments:*
muscles, ligaments and tendons ache	12 out of 18 fibromyalgia tender spots or more are positive
sleep disturbance	can be verified by sleep laboratory study if necessary
mild to moderate depression	often present, may point to a change in serotonin metabolism
rule out other medical and rheumatological diseases	blood tests help in that regard (RA, ANA titres normal; TSH and Hgb A1C normal)
precipitating factors often present	trauma, degenerative arthritis, emotional stress
patients with atypical chest pain	if coronary arteries normal and other diseases excluded, fibromyalgia frequently found
hormonal dysbalance	saliva hormone tests may show low progesterone, testosterone, DHEAS, cortisol; blood tests may show low IGF-1, indicating low human growth hormone

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. G.Littlejohn Aust Fam Physician 2001 Apr;30(4):327-333.

2. LS Brecher et al. J Am Osteopath Assoc 2001 Apr;101(4 Suppl Pt 2):S12-17.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 59.

4. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 6. Fibromyalgia Syndrome.

5. B Mukerji et al. Angiology 1995 May;46(5):425-430.

Last Modified: May 27, 2010