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Al Sharie S, Varga SJ, Al-Husinat L, Sarzi-Puttini P, Araydah M, Bal’awi BR, Varrassi G. Unraveling the Complex Web of Fibromyalgia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:272. [PMID: 38399559 PMCID: PMC10890445 DOI: 10.3390/medicina60020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence transcending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. This study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. This study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia management. Overall, this study provides a nuanced and up-to-date overview of the complexities surrounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.
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Affiliation(s)
- Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Scott J. Varga
- Department of Neurology, OhioHealth Mansfield General Hospital, Mansfield, OH 44903, USA;
| | - Lou’i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, University School of Medicine, 20157 Milan, Italy;
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman 11942, Jordan;
| | - Batool Riyad Bal’awi
- Department of Family Medicine, Jordan Royal Medical Services, Amman 11855, Jordan;
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Polat M, Kahveci A, Tecer D, Günendi Z, Göğüş F. The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia. Arch Rheumatol 2023; 38:174-182. [PMID: 37680511 PMCID: PMC10481687 DOI: 10.46497/archrheumatol.2023.9585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 09/09/2023] Open
Abstract
Objectives This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria. Patients and methods This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria. Results In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively). Conclusion Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.
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Affiliation(s)
- Musa Polat
- Department of Physical Medicine and Rehabilitation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
| | - Abdulvahap Kahveci
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Duygu Tecer
- Department of Rheumatology, Health Sciences University, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Feride Göğüş
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
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Silva MPS, Carvalho JF, Rodrigues CEM. Evaluation of Big Five personality factors in women with fibromyalgia: a cross-sectional study. Rheumatol Int 2021; 42:503-510. [PMID: 34255184 DOI: 10.1007/s00296-021-04936-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
Personality traits have been shown to contribute to the development and persistence of fibromyalgia (FM)-related symptoms. The aim of this study was to identify the most prevalent personality factor in Brazilian female FM patients, using the Factorial Personality Battery (FPB) and comparing patients to age-matched healthy controls. This was a cross-sectional study based on 40 FM patients and 40 age-matched controls. The FPB is a Brazilian self-reporting questionnaire based on the Big Five Inventory, containing 126 items and scored on a Likert scale. The study included 80 participants aged on the average 46.6 ± 6.7 years (FM) and 45.6 ± 13.8 years (controls) (p = 0.121). The groups differed significantly with regard to schooling (p = 0.013). Time of disease and time to diagnosis was 11.3 ± 7.3 and 6.6 ± 4.5 years, respectively. Fourteen patients (35%) had hypertension and 52% reported sedentary lifestyle. Many had generalized anxiety disorder (82.5%) and/or major depressive disorder (35%). Three facets of Neuroticism were highly significant: vulnerability (p = 0.008), emotional instability (p < 0.001), and depression (p < 0.001). A significant association was found between Openness and time to diagnosis (p < 0.033). Using multiple linear regression, we identified the independent associations Extraversion x systemic arterial hypertension (OR = - 0.65, p = - 0.013) and Openness x sedentary lifestyle (OR = - 0.48, p = 031). Neuroticism was the predominant factor, while Openness was found to be negatively correlated with time to diagnosis, suggesting personality assessments can help identify FM patterns used to tailor treatment and enhance compliance.
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Affiliation(s)
| | | | - Carlos Ewerton Maia Rodrigues
- Post‑Graduate Program in Medical Sciences, Medical School, University of Fortaleza (Unifor), Fortaleza, Brazil. .,Department of Internal Medicine, Federal University of Ceará, Rua Gontran Giffoni, 366 , ap. 301- Torre I- Patriolino Ribeiro, Cep: 60810-220, Fortaleza,, Ceará, Brazil.
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Jiao J, Cheng Z, Wang W, Zhao Y, Jiang Q. Demographic Characteristics and Clinical Features of Fibromyalgia in China: A Cross-Sectional Study. Rheumatol Ther 2021; 8:817-831. [PMID: 33813715 PMCID: PMC8217401 DOI: 10.1007/s40744-021-00303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023] Open
Abstract
Objective The aim of this study is to characterize the demographics, fibromyalgia-related symptom severity and quality of life (QOL) among Chinese fibromyalgia patients. Methods A total of 124 patients who met the ACR 1990 criteria were recruited. Each subject completed a packet of questionnaires for collecting data on the demographics, medical history and severity of six major symptoms of fibromyalgia (i.e., pain, fatigue, sleep quality, depression, stress and QOL). Results The majority of the study subjects were women (86.3%), were married (78.2%) and had a mean age of 49.4 years and a median symptom duration of 24 months. Compared to their female counterparts, male patients were younger, were more likely to be employed, had a higher income and were more likely to be current smokers and alcohol drinkers (all p ≦ 0.027). Most patients experienced moderate to severe pain (69.4%), severe fatigue (70.2%) and moderate to severe depression (53.3%). A small percentage (19.4%) of the patients had very poor quality of sleep, and over one third (37.1%) suffered from moderate to severe stress. Less than one third (27.5%) patients’ health status was moderately or highly impacted by fibromyalgia. The mental health of men was affected significantly more than that of women, with lower SF-36 scores in the SF-36 mental component summary (p = 0.043) and role emotional (p = 0.006). Conclusion This study has revealed that Chinese fibromyalgia patients might share similar demographics but milder fibromyalgia-related symptoms and better mental QOL compared to patients of other races and ethnic groups. Some differences between male and female patients were found, too. Further cross-sectional studies with a larger sample size and nationwide study sites are needed to replicate those clinical findings.
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Affiliation(s)
- Juan Jiao
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China
| | - Zengyu Cheng
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China
| | - Wen Wang
- Rehabilitation Department, Shenzhen Hyzhen Hospital, Shenzhen, China
| | - Yayun Zhao
- Graduate School, Hebei University of Chinese Medicine, Hebei, China.,Rheumatology Department, Hebei Hospital of Traditional Chinese Medicine, Hebei, China
| | - Quan Jiang
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China.
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Diagnostic Accuracy of ACR 2010 Preliminary Diagnostic Criteria in the Diagnosis of Fibromyalgia Among Chronic Backache Patients. Indian J Orthop 2020; 54:150-157. [PMID: 32952923 PMCID: PMC7474007 DOI: 10.1007/s43465-020-00211-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic backache remains among common causes of attendance in orthopaedic, pain and neurology clinics and requires a detailed workup for the management of these patients. As per literature, fibromyalgia contributes to a significant number of chronic backache patients but in clinical practice, it remains a diagnosis of exclusion in the absence of definitive diagnostic workup. We need to evaluate the diagnostic accuracy of ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia among chronic backache patients for use in primary and speciality care. METHODS The patients with chronic backache (> 3 months) attending the orthopaedic OPD were screened by the principal investigator by ACR 1990 tender point and ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia. Symptoms severity assessment was done by the Fibromyalgia severity score by the principal investigator or resident doctors trained by the principal investigator. RESULTS Approximately 47% of patients didn't satisfy the American College of Rheumatology 1990 criteria but could be diagnosed as a case of fibromyalgia by ACR 2010 new case definition: (WPI ≥ 7 and SS ≥ 5) or (WPI ≥ 3-6 and SS ≥ 9). DISCUSSION The patients with chronic back pain along with marked symptoms variability need consideration of Fibromyalgia for possible diagnosis especially in the absence of secondary cause for these symptoms. ACR 2010 diagnostic criteria seem compelling and effective for the diagnosis of fibromyalgia among patients with chronic back pain.
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Çağlıyan Türk A. Old and New Criteria for the Diagnosis of Fibromyalgia: Comparison and Evaluation. ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.542154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lee HJ, Choi E, Nahm FS, Choi SS, Kim YH, Moon JY, Kim SH, Cho CW, Lee PB. Prevalence of fibromyalgia in fourteen Korean tertiary care university hospital pain clinics. J Pain Res 2018; 11:2417-2423. [PMID: 30425555 PMCID: PMC6200436 DOI: 10.2147/jpr.s172221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose We aimed to investigate the prevalence of fibromyalgia (FM) in patients who visited outpatient pain clinics in Korea, using the modified 2010 American College of Rheumatology (ACR) criteria and to evaluate comorbid conditions that may be associated with FM. Patients and methods Outpatients, aged ≥18 years, who first visited pain clinics at any of the 14 tertiary care university hospitals, were recruited for this study. Modified 2010 ACR criteria were used to diagnose FM. Participants’ demographic information and eleven comorbid measures (sleep disturbance, fatigue, irritable bowel syndrome, amnesia, hypothyroidism, headache, anxiety, depression, rheumatism, low back pain, and history of traffic accident) were also investigated via additional questionnaires. Results We recruited 1,233 outpatients (754 men and 479 women). Based on the modified 2010 ACR criteria, 13.38% (165/1,233 patients, 95% CI: 11.48–15.28) of patients had FM. As participants with a history of FM were excluded, the prevalence of FM was 11.0% (123/1,118 patients). Patients with FM were more likely to have one or more of the eleven predetermined comorbid conditions. Patients who were female and who had a previous history of FM, sleep disturbance, headache, or a history of traffic accident were more likely to have FM. Conclusion FM, according to the modified 2010 ACR criteria, appears to be a common disorder among chronic pain patients referred to tertiary care university hospital pain clinics. Therefore, physicians treating pain should consider this prevalence of FM among pain clinic patients.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Chan-Woo Cho
- Seoul Chan Pain Clinic, Seoul, Republic of Korea
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea, .,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea,
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Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46:319-329. [PMID: 27916278 DOI: 10.1016/j.semarthrit.2016.08.012] [Citation(s) in RCA: 1022] [Impact Index Per Article: 127.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/11/2016] [Accepted: 08/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The provisional criteria of the American College of Rheumatology (ACR) 2010 and the 2011 self-report modification for survey and clinical research are widely used for fibromyalgia diagnosis. To determine the validity, usefulness, potential problems, and modifications required for the criteria, we assessed multiple research reports published in 2010-2016 in order to provide a 2016 update to the criteria. METHODS We reviewed 14 validation studies that compared 2010/2011 criteria with ACR 1990 classification and clinical criteria, as well as epidemiology, clinical, and databank studies that addressed important criteria-level variables. Based on definitional differences between 1990 and 2010/2011 criteria, we interpreted 85% sensitivity and 90% specificity as excellent agreement. RESULTS Against 1990 and clinical criteria, the median sensitivity and specificity of the 2010/2011 criteria were 86% and 90%, respectively. The 2010/2011 criteria led to misclassification when applied to regional pain syndromes, but when a modified widespread pain criterion (the "generalized pain criterion") was added misclassification was eliminated. Based on the above data and clinic usage data, we developed a (2016) revision to the 2010/2011 fibromyalgia criteria. Fibromyalgia may now be diagnosed in adults when all of the following criteria are met: CONCLUSIONS: The fibromyalgia criteria have good sensitivity and specificity. This revision combines physician and questionnaire criteria, minimizes misclassification of regional pain disorders, and eliminates the previously confusing recommendation regarding diagnostic exclusions. The physician-based criteria are valid for individual patient diagnosis. The self-report version of the criteria is not valid for clinical diagnosis in individual patients but is valid for research studies. These changes allow the criteria to function as diagnostic criteria, while still being useful for classification.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases, 1035 N Emporia, Ste 288, Wichita, KS 67214; University of Kansas School of Medicine, Wichita, KS.
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, McGill University Health Center, Montreal, Quebec, Canada
| | - Don L Goldenberg
- Oregon Health Science University, Portland, OR; Tufts University School of Medicine, Boston, MA
| | - Winfried Häuser
- Department Internal Medicine 1, Saarbrücken, Germany; Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| | | | - Philip J Mease
- Swedish Medical Center, Seattle, WA; University of Washington, Seattle, WA
| | - Anthony S Russell
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brian Walitt
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Wolfe F, Egloff N, Häuser W. Widespread Pain and Low Widespread Pain Index Scores among Fibromyalgia-positive Cases Assessed with the 2010/2011 Fibromyalgia Criteria. J Rheumatol 2016; 43:1743-8. [DOI: 10.3899/jrheum.160153] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 12/29/2022]
Abstract
Objective.Widespread pain is no longer required for fibromyalgia (FM) diagnosis according to the American College of Rheumatology (ACR) 2010 preliminary diagnostic criteria and its 2011 modification, but its absence may be of concern. We investigated whether the widespread pain definition was satisfactory and the consequences of having a small number of painful regions or of not satisfying the widespread pain criterion.Methods.We studied 5011 patients who satisfied the 2011 criteria. FM was identified using the Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS): WPI ≥ 7 and SSS ≥ 5 or WPI 3–6 and SSS ≥ 9. Widespread pain was 4 quadrants plus axial pain, according to the 1990 ACR FM criteria.Results.There were 4700 patients (93.8%) who satisfied the ACR 1990 widespread pain criterion. Using a new strict definition for 5 pain regions based on the WPI sites, a modified widespread pain criterion requiring 4 of 5 regions identified 98.8% of criteria-positive patients. Patients without widespread pain or those in the low WPI/high SSS group had milder FM and no evidence of increased psychological or physical distress.Conclusion.In usual clinical and epidemiological studies, the 2011 and 2010 criteria work well, but are not as effective in patients with asymmetrical or regional pain who do not satisfy a widespread pain criterion. A ≥ 4-pain region widespread pain definition will eliminate regional pain false-positives and will identify 98.8% of current 2011 cases. Future revisions of the 2010/2011 criteria should consider incorporating the ≥ 4-region requirement to avoid misclassification.
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Ting TV, Barnett K, Lynch-Jordan A, Whitacre C, Henrickson M, Kashikar-Zuck S. 2010 American College of Rheumatology Adult Fibromyalgia Criteria for Use in an Adolescent Female Population with Juvenile Fibromyalgia. J Pediatr 2016; 169:181-7.e1. [PMID: 26545727 PMCID: PMC7675923 DOI: 10.1016/j.jpeds.2015.10.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/27/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the utility of the 2010 American College of Rheumatology (ACR) adult fibromyalgia criteria for use in adolescents with juvenile fibromyalgia (JFM). STUDY DESIGN Participants included 47 adolescent girls diagnosed with JFM (mean age = 15.3 years) and 48 age- and sex-matched adolescents (mean age = 15.0 years) with localized chronic pain (eg, headaches or abdominal pain). A trained examiner administered the Widespread Pain Index and Symptom Severity measures and also completed a manual tender point exam. Clinicians completed a form indicating the presence of active JFM per Yunus and Masi (1985) criteria, the only available and most commonly used measure for JFM. Criterion validity analysis was performed as well as t tests comparing symptoms between JFM and controls. RESULTS With the Yunus and Masi criteria used as the gold standard, the 2010 ACR fibromyalgia criteria showed a sensitivity of 89.4% and specificity of 87.5%. CONCLUSION The 2010 ACR measure appears to be a valuable tool for the identification of JFM. However, a slight modification to the 2010 ACR measure and inclusion of a clinical exam is recommended.
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Affiliation(s)
- Tracy V. Ting
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Anne Lynch-Jordan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH;,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Catharine Whitacre
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Henrickson
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH;,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Sen M, Kilic MO, Cemeroglu O, Icen D. Can mastalgia be another somatic symptom in fibromyalgia syndrome? Clinics (Sao Paulo) 2015; 70:733-7. [PMID: 26602519 PMCID: PMC4642489 DOI: 10.6061/clinics/2015(11)03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/19/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.
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Affiliation(s)
- Meral Sen
- Turgut Ozal University, Department of General Surgery, School of Medicine, Ankara, Turkey
- Corresponding author: E-mail:
| | - Murat Ozgur Kilic
- Turgut Ozal University, Department of General Surgery, School of Medicine, Ankara, Turkey
| | - Ozlem Cemeroglu
- Turgut Ozal University, Department of Physical Therapy, School of Medicine, Ankara, Turkey
| | - Duygu Icen
- Hacettepe University, Department of Statistics, Ankara, Turkey
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Kianmehr N, Haghighi A, Bidari A, Sharafian Ardekani Y, Karimi MA. Are general practitioners well informed about fibromyalgia? Int J Rheum Dis 2015. [PMID: 26200844 DOI: 10.1111/1756-185x.12716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Fibromyalgia syndrome (FMS) is a common rheumatologic disorder characterized by easy fatigability, widespread musculoskeletal pain and sleep disorder. In spite of its high prevalence, general practitioners, as primary care providers, seem to have inadequate knowledge about FMS. This study aimed to assess Iranian general practitioners' knowledge about FMS and its treatment. METHOD A detailed questionnaire (including items on signs and symptoms, diagnostic criteria and treatment) was completed by 190 general practitioners (54.7% male; mean age: 41 years). Data analysis was performed with SPSS for Windows 15.0 and awareness about all aspects of FMS was reported as percentages. RESULTS About one-third (30%) of the participants had seen at least one case of FMS during their practice. Most subjects (62.7%) claimed to know 1-6 tender points. Only 3.2% knew 16-18 points. The common proposed symptoms of FMS were widespread pain (72.6%), excessive fatigue (72.6%), weakness (60.5%), sleep disorder (36.3%), anxiety (34.7%) and depression (34.2%). Wrong symptoms including elevated erythrocyte sedimentation rate and C-reactive protein, arthritis, joint swelling, weight loss and abnormal radiologic findings were selected by 27.9%, 18.9%, 14.7%, 12.6% and 2.1% of the physicians, respectively. Moreover, selective serotonin reuptake inhibitors, tricyclic antidepressant and pregabalin were identified as treatment options for FMS by, respectively, 45.8%, 22.1% and 15.3% of the participants. Finally, 52.1% and 23.7% of the subjects incorrectly considered nonsteroidal anti-inflammatory drugs and corticosteroids as treatment modalities for FMS. CONCLUSION Iranian general practitioners are not well informed about FMS. Therefore, FMS should be specifically integrated in continuing medical education programs and undergraduate medical training curriculum.
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Affiliation(s)
- Nahid Kianmehr
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Anousheh Haghighi
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Bidari
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Sharafian Ardekani
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Karimi
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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14
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Ghavidel-Parsa B, Bidari A, Amir Maafi A, Ghalebaghi B. The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects. Korean J Pain 2015; 28:169-76. [PMID: 26175876 PMCID: PMC4500780 DOI: 10.3344/kjp.2015.28.3.169] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 12/02/2022] Open
Abstract
This review has focused on important but less visible aspects of fibromyalgia (FM) with respect to the high impact of this disorder on patients and societies. FM is a common but challengeable illness. It is characterized by chronic widespread pain, which can be accompanied by other symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. While our understanding of this debilitating disorder is limited, diagnosis and treatment of this condition is very difficult, even in the hands of experts. Due to the nature of disease, where patients experience invalidation by medical services, their families and societies regarding the recognition and management of disease, direct, indirect and immeasurable costs are considerable. These clinical and economic costs are comparable with other common diseases, such as diabetes, hypertension and osteoarthritis, but the latter usually receives much more attention from healthcare and non-healthcare resources. Present alarming data shows the grave and "iceberg-like" burden of FM despite the benign appearance of this disorder and highlights the urgent need both for greater awareness of the disease among medical services and societies, as well as for more research focused on easily used diagnostic methods and target specific treatment.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Amir Maafi
- Student Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Ghalebaghi
- Department of Allergy and Clinical Immunology, Iran University of Medical Sciences, Tehran, Iran
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15
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Egloff N, von Känel R, Müller V, Egle UT, Kokinogenis G, Lederbogen S, Durrer B, Stauber S. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 2015; 44:416-24. [DOI: 10.3109/03009742.2015.1010103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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16
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On AY, Aykanat D, Atamaz FC, Eyigor C, Kocanogullari H, Oksel F. Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain? Clin Rheumatol 2015; 34:1473-9. [PMID: 26006254 DOI: 10.1007/s10067-015-2975-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/25/2022]
Abstract
The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of whether they have accompanying painful disorders. Widespread pain index (WPI), symptom severity scale (SS), and fibromyalgia impact questionnaire (FIQ) scores were found to be significantly higher in the patients who satisfied the 1990 criteria than those who did not (P < 0.001). Tender point counts were found to be significantly correlated with WPI, SS, FIQ, and Beck depression inventory (BDI) scores (P < 0.001). The findings of the study support the suggestion that FMS is just a continuum of CWP, rather than a distinct diagnostic entity. As treatment of FMS is usually identical with that of CWP, strict diagnosis of FMS will provide little or no significance from the viewpoint of clinical practice. We suggest that future research should be directed toward classification of CWP to provide guidance to clinicians in selecting effective therapies.
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Affiliation(s)
- Arzu Yagiz On
- Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Izmir, Turkey
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17
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Wolfe F. Editorial: The Status of Fibromyalgia Criteria. Arthritis Rheumatol 2015; 67:330-3. [DOI: 10.1002/art.38908] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/02/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Frederick Wolfe
- Arthritis Research Center Foundation, National Data Bank for Rheumatic Diseases, and University of Kansas School of MedicineWichita
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18
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Carrillo-de-la-Peña MT, Triñanes Y, González-Villar A, Romero-Yuste S, Gómez-Perretta C, Arias M, Wolfe F. Convergence between the 1990 and 2010 ACR diagnostic criteria and validation of the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ). Rheumatol Int 2014; 35:141-51. [PMID: 24952419 DOI: 10.1007/s00296-014-3074-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/12/2014] [Indexed: 12/30/2022]
Abstract
(1) To assess the degree of convergence between the 1990 and 2010 American College of Rheumatology (ACR) diagnostic criteria; (2) To evaluate the validity and reliability of the 2010 ACR criteria; (3) To validate the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ); and (4) To assess the utility of the FSQ to differentiate fibromyalgia (FM) subgroups by disease severity. In the first study, agreement between the 1990 and 2010 ACR criteria for FM diagnosis was analyzed in a sample of 80 FM patients and 59 healthy controls. Algometry (mean threshold and tender points count) and the 2010 ACR indices [Symptom Severity Scale (SSS), Widespread Index (WPI) and Polysymptomatic Distress Scale (PSD)] were correlated with the key symptoms of FM and with indices of disease interference and quality of life. In a second study, we evaluated the validity and internal consistency of the Spanish version of the FSQ, as well as its ability to discriminate between groups of FM patients with low and high symptom severity. There is good agreement between the 1990 and 2010 ACR criteria for FM diagnosis. The 2010 ACR indices (SSS, WPI and PSD) demonstrated very adequate construct validity and appeared to be useful in the assessment of disease severity and global impact of FM. The FSQ had good internal consistency and validity and showed 100 % concordance with 2010 ACR criteria applied by a clinician. In addition, the FSQ proved to be useful in differentiating FM severity subgroups.
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Affiliation(s)
- M T Carrillo-de-la-Peña
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain,
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Nasser K, Kivitz AJ, Maricic MJ, Silver DS, Silverman SL. Twice daily versus once nightly dosing of pregabalin for fibromyalgia: a double-blind randomized clinical trial of efficacy and safety. Arthritis Care Res (Hoboken) 2014; 66:293-300. [PMID: 23983064 DOI: 10.1002/acr.22111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/06/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the efficacy, discontinuation rates, and safety of once nightly versus twice daily dosing of pregabalin in a community-based trial. METHODS This multicenter, double-blind, 8-week randomized clinical trial compared the effects of 300-mg daily doses of pregabalin given either twice daily or once nightly for the treatment of fibromyalgia in 177 patients. The primary outcome was the comparison of end point mean pain scores derived from a daily diary. RESULTS Both twice daily (88 patients randomized) and once nightly (89 patients) pregabalin significantly reduced the average severity of pain experienced by patients (P < 0.001 for both). Treatment-emergent adverse events were reported by significantly more patients in the twice daily group than those in the once nightly group (P = 0.023). There were no significant differences between the groups for the frequencies of individual adverse events (P > 0.05 for all). There was no significant difference in adverse events or efficacy in patients taking both pregabalin and a selective serotonin and norepinephrine reuptake inhibitor or selective serotonin uptake inhibitor. CONCLUSION While a nightly dosing schedule of pregabalin has been used by clinicians hoping to improve treatment, this study showed no significant difference (either beneficial or detrimental) between either treatment option. While there was a decrease in total patient-reported adverse events in the once nightly arm, the lack of specificity in relation to a particular adverse event suggested no real difference in adverse events.
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Affiliation(s)
- Keaton Nasser
- Osteoporosis Medical Center, Beverly Hills, California
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20
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Omar GM, Kamel SR, Abdel-Magied RA, Abel-Allah NM. Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.128133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Yun DJ, Choi HN, Oh GS. A case of postural orthostatic tachycardia syndrome associated with migraine and fibromyalgia. Korean J Pain 2013; 26:303-6. [PMID: 23862007 PMCID: PMC3710947 DOI: 10.3344/kjp.2013.26.3.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/05/2022] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance with a heart rate (HR) increment of 30 beats per minute (bpm) or an absolute HR of 120 bpm or more. There are sporadic reports of the autonomic nervous system dysfunction in migraine and fibromyalgia. We report a case of POTS associated with migraine and fibromyalgia. The patient was managed with multidisciplinary therapies involving medication, education, and exercise which resulted in symptomatic improvement. We also review the literature on the association between POTS, migraine, and fibromyalgia.
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Affiliation(s)
- Dong Joo Yun
- Department of Neurology, Eulji University School of Medicine, Daejeon, Korea
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