Secondary Fibromyalgia

Secondary fibromyalgia: An entity to be remembered-A case series with axial spondyloarthritis

Fibromyalgia (FM) is a clinical syndrome characterised by chronic widespread musculoskeletal pain, stiffness, and tenderness in addition to a variety of physical and mental symptoms such as fatigue, sleep disturbances, depression, anxiety, cognitive dysfunction, headaches, and digestive problems. FM can be associated with or coexist with other inflammatory rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and spondyloarthritis. This phenomenon is called secondary FM. Although FM cannot be considered an autoimmune disease, it may in some cases be an early sign of an autoimmune disease. Therefore, clinicians should be cautious in these situations. This case series presents three patients diagnosed with axial spondyloarthritis coexisted with FM symptoms.

Subcategories of Fibromyalgia: A New Concept

Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.

Fibromyalgia: A clinical update

ABSTRACT

Fibromyalgia (FM) is a chronic pain disorder commonly encountered by advanced practice registered nurses in primary and specialty care. Knowing how to recognize FM and its multiple pain and nonpain symptoms facilitates diagnosis. We propose a four-step approach to diagnosis that can reduce costly referrals and treatment delays, and describe evidence-based interventions.

Which symptoms best distinguish fibromyalgia patients from those with other chronic pain disorders?

RATIONALE, AIMS AND OBJECTIVES

The primary purpose of this study was to test both classic and novel FM pain and non-pain symptoms to determine their practical efficacy in aiding clinicians to distinguish FM pain from other chronic pain disorders.

METHODS

158 pain patients from two primary care clinics were evaluated with history, physical exam, chart review, and a questionnaire containing 26 exploratory symptoms (10 from the Symptom Impact Questionnaire (SIQR) and 16 from the FM literature)). The symptoms were rated on a 0-10 VAS for severity by those patients reporting pain over the past week. Somers' D and mean severity differences between FM and chronic pain patients without FM were used to rank the discriminatory and diagnostic contributions of symptoms.

RESULTS

Fifty patients (14.2%) carried a chart diagnosis of FM, 108 (30.7%) had pain but not FM, and 192 (54.5%) who had neither pain nor FM. Comparing means between the two pain groups, the 5 best differentiating symptoms (all, P < .0001) were: a persistent deep aching over most of my body, poor balance (7.4 vs 3.1), environmental sensitivity (6.8 vs 3.0), tenderness to touch (6.8 vs 3.6) and pain after exercise (8.1 vs 4.1). Notably, VAS pain though significantly higher for FM was least discriminatory (6.5 vs 5.1, P < .001). The five best symptoms generated a ROC = 0.85 and Somers' D = 0.69, an accuracy of 81%, and an odd's ratio of 14.4.

CONCLUSIONS

Our results herein suggest that clinicians may be well-served to consider symptoms in addition to those contained in current diagnostic criteria when recognizing FM in their chronic pain patients.

Implications of Nerve Fiber Density on the Diagnosis and Treatment of Juvenile Fibromyalgia

Juvenile fibromyalgia (JFM) is a condition that presents as chronic widespread musculoskeletal pain and affects children and adolescents. JFM remains a challenging diagnosis, as it is both based on subjective criteria and the pathogenesis is poorly understood. Small fiber neuropathy (SFN) is a distinct condition, which is characterized by pathology of small A-delta and C fibers, and can present similarly to JFM. Small fiber pathology is characterized by reduced intraepidermal nerve fiber density (IENFD) on skin biopsy. Recent studies have found that as many as half of patients with JFM can demonstrate decreased IENFD, in pattern similar to SFN. This phenomenon has been referred to as small fiber pathology. The meaning of these findings was disputed; however, the current consensus remains that fibromyalgia and SFN are distinct conditions. Additionally, among patients with fibromyalgia, there are two phenotypes: those with small fiber pathology and those without. The purpose of this review was to characterize the role assessment of IENFD plays in the clinical context. We conducted a narrative review of pertinent articles pertaining to JFM, SFN and small fiber pathology in fibromyalgia. We concluded that assessment of IENFD should be completed if SFN is suspected either when a patient first presents or in patients who were previously diagnosed with fibromyalgia and SFN is later suspected. Distinguishing between JFM and SFN is important because recommended therapies differ between the two conditions. However, there is no evidence to support the use of skin biopsy to distinguish between the two discussed fibromyalgia phenotypes. More studies are needed to elucidate whether IENFD varies with morbidity and if both fibromyalgia phenotypes vary in their response to different therapeutic regimens.

Fibromyalgia in Iraqi patients with asthma and its impact on asthma severity and control

Background

Fibromyalgia (FM) is common with significant impact on patients quality of life. Limited reports on coexistence of FM with asthma.

Objectives

To assess the prevalence of FM in asthmatic patients and its impact on asthma severity and control.

Patients and methods

This case-control study included 103 patients with asthma and 102 apparently healthy controls matched in age and sex. Sociodemographic and clinical characteristics of FM and controls were recorded. FM was diagnosed according to the 2016 revision of American College of Rheumatology criteria. Asthma diagnosis and severity were performed by the pulmonologist according to Global Initiative for Asthma (GINA) guidelines and asthma control was assessed by Asthma Control Test (ACT) score.

Results

The mean age of asthmatic patients was 41.1 ± 12.7 years and for controls was 39.8 ± 12 years (p = 0.453). Females were more prevalent in asthmatic patients and controls although statistically were not significant (p-value = 0.532). Prevalence of FM was significantly more in asthmatic patients compared to controls [18 (17.6%) vs 7 (6.8%), p = 0.018] and asthmatic patients had three folds risk of having FM (ranging from 1.2 to 7.4 times. FM increased the risk of severe asthma by 4.91 folds (P < 0.005). Also, only FMS and glucocorticoids were significant independent predictor of having poor asthma control. FM was significantly and negatively correlated with low ACT score (β standardized regression coefficient = −0.291, p = 0.005).

Conclusions

fibromyalgia was common in asthmatic patients and was significantly associated with more severe and poorly controlled asthma.

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Fibromyalgia (FM) was more common in asthmatic patients compared with controls.

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FM was significantly associated with more severe and poorly controlled asthma.

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Breathing training programs may be useful management in asthmatic patients with FM.

Comorbidity of Fibromyalgia in Primary Knee Osteoarthritis: Potential Impact on Functional Status and Quality of Life

BACKGROUND

Knee osteoarthritis (OA) is a painful condition with peripheral and central pain transmission. Fibromyalgia (FM) is the role model of central sensitization of pain perception.

AIM

To assess the frequency of FM in knee OA patients and evaluate the impact of FM on mental health and the quality of life in knee OA patients.

PATIENTS AND METHODS

A total of 121 female patients were recruited and divided into 3 groups: group I of 59 patients with knee OA only, group II of 32 patients with knee OA and FM, and group III of 30 FM patients. Patients underwent history taking, examination, investigations, and radiological evaluation of both knees. The assessment of visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Pain Anxiety Symptom Scale Short Form 20 (PASS20), Beck Depression Inventory (BDI-II), and PCASEE questionnaire were done for all patients. Lequesne index of knee OA and radiological Kellgren and Lawrence score severity were done for all OA patients. Fibromyalgia Impact Questionnaire (FIQ) was assessed for all FM patients.

RESULTS

FM was diagnosed in 35.5% of knee OA patients. Group II patients had higher VAS, PASS-20, PSQI, and lower quality of life than either groups I and III, elevated Lequesne index score than group I, significant correlation between VAS and BMI (p=0.002), Lequesne index score (p<0.001), PASS20 (p=0.006), BDI-II score (p=0.002), and FIQ (P<0.001), and a negative correlation was found between VAS and physical (p<0.001), anxiety (p=0.046), and social (p=0.026) QoL parameters. Univariable regression analysis showed a higher age, VAS, PSQI, PASS20, and FIQ were associated with lower QoL in group II. A higher PASS20 was the only predictor of lower QoL in multivariable analysis.

CONCLUSION

Fibromyalgia coexists frequently in knee OA patients and has implications on their mental health, functional activity, and quality of life.