Fibromyalgia

Introduction to fibromyalgia Fibromyalgia syndrome (FS) is a non-articular rheumatism with clinical manifestations of multiple pains and stiffness in the musculoskeletal system and tender points in specific areas. Fibromyalgia syndrome can be secondary to trauma, various rheumatic diseases such as osteoarthritis, rheumatoid arthritis and various non-rheumatic diseases (such as hypothyroidism, malignant tumors). This type of fibromyalgia syndrome is called secondary fibromyalgia syndrome. If it is not accompanied by other diseases, it is called primary fibromyalgia syndrome. basic knowledge Sickness ratio: 2% Susceptible people: no specific population Mode of infection: non-infectious Complications: rheumatoid arthritis

Cause of fibromyalgia

The etiology of this disease is more complicated. From the pathological point of view, the disease lacks specific histological changes and inflammatory cell reactions, indicating that the use of fibromyalgia, such as "fibroitis" or "fibromyelitis", is more appropriate.

Systemic disease (45%):

The disease can be a systemic disease (sometimes secondary to other lesions), or it can be localized (such as myofascial pain syndrome often associated with strain or minor trauma). Primary fibromyalgia syndrome (PFS) It is a systemic idiopathic disease, especially in healthy young and middle-aged women. It has a tendency to be nervous, depressed, worried and struggling, but it can also occur in children (especially girls) or the elderly, often accompanied by mild Changes in vertebral osteoarthritis. Men are particularly prone to localized fibromyalgia caused by special occupational or recreational muscle strain.

Environmental and mental factors (30%):

Symptoms can be aggravated by the surrounding environment and mental stress, or because the doctor can't dispel the patient's worries very well, but simply dismissed as "all your mind is doing".

Psychology and physiology (15%):

A few cases may be associated with psychological and physiological abnormalities.

Fibromyalgia prevention

The prevention of this disease is mainly to actively treat the primary disease. For some patients with myogenic fibromyalgia syndrome, the patient's mood should be calmed first, and the release of nervousness can alleviate the symptoms of some light patients, followed by attention conditioning. Stretching exercises and other appropriate exercise methods to improve sleep, hyperthermia, gentle massage and warmth are beneficial to the patient.

Fibromyalgia complications Complications rheumatoid arthritis

The complications of this disease are mainly divided into two cases: primary fibromyalgia syndrome and secondary fibromyalgia syndrome:

(1) In patients with primary fibromyalgia syndrome, pain can spread throughout the body with common non-recovery sleep, anxiety, depression, fatigue and stressful bowel syndrome.

(2) patients with secondary fibromyalgia syndrome, the complications should be judged according to their primary disease, trauma, various rheumatism, such as osteoarthritis, rheumatoid arthritis and various non-rheumatic diseases (such as hypothyroidism, malignant tumors), etc. may cause the disease, the complications are diverse, clinically need to actively treat and prevent according to the diagnosis results.

Fibromyalgia Symptoms Common symptoms Myalgia Muscle tenderness Muscle spasm pain Tired muscle soreness Anxiety Insomnia

(1) Pain: Fibromyalgia syndrome is mainly characterized by extensive chronic pain throughout the body.

(2) tenderness: the body has a special tender point, and the vicinity of the tender point is normal.

(3) Fatigue and sleep disorders: About 90% of patients have obvious fatigue, and adequate rest can not be alleviated.

(4) Neurological and psychiatric symptoms: 35% to 62% of patients with anxiety, 58% to 86% of patients with depression, and 11% of patients with anxiety and depression.

(5) Joint symptoms: Some patients may also show joint pain with morning stiffness, but no objective signs such as joint redness and fever.

(6) Other symptoms: Some patients may have abdominal pain, loose stools, night sweats, dry mouth, dry eyes, frequent urination, dysuria and Raynaud's phenomenon.

Examination of fibromyalgia

(1) Laboratory examination: blood routine, blood biochemical examination, muscle enzyme, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, etc. are normal in patients with fibromyalgia syndrome unless other diseases are combined. Some patients have serum adrenocorticotropic hormone, gonadotropin-releasing hormone, growth hormone, insulin-like growth hormone-1, thyroxine and other hormone abnormalities, the concentration of substance P in cerebrospinal fluid can be increased, occasionally serum low titer anti-nuclear antibody Positive or mild complement C3 levels were reduced.

(2) Functional magnetic resonance imaging (fMRI): Functional magnetic resonance imaging (fMRI) is a sensitive and specific new technique to assist in the diagnosis of fibromyalgia syndrome. Patients with fibromyalgia syndrome may have frontal cortex, Abnormal activation reactions such as amygdala, hippocampus, and cingulate gyrus, and abnormal fiber contact with each other.

(3) Assessment scale: foreign studies showed fibromyalgia impact questionnaire (F1Q), pain visual analogue scale (vAS), Beck depression scale (BDI), McGiII pain questionnaire, Hamilton anxiety scale and Hamilton depression scale It is helpful to evaluate the condition of fibromyalgia syndrome.

Diagnosis and diagnosis of fibromyalgia

diagnosis

The diagnosis of primary fibromyalgia syndrome is through the identification of typical features of diffuse fibromyalgia and non-rheumatic symptoms (such as insomnia, anxiety, fatigue, intestinal allergy symptoms, etc.), excluding other systemic diseases (such as systemic Osteoarthritis, RA, polymyositis, rheumatic polymyalgia or other connective tissue diseases, etc.; exclude mental muscle pain and spasm (this is the most difficult). Fibromyalgia associated with the above diseases (coexistence) Or secondary) may have symptoms and signs of musculoskeletal, similar to primary fibromyalgia (except for cases of psychological rheumatism), which need to be differentiated to better treat potential diseases and fibromyalgia Intrinsic. For middle-aged female cases, potential rheumatic diseases and hypothyroidism must be excluded. Muscles may have non-specific and mild histopathological changes, and these changes may also occur in normal controls.

Differential diagnosis

1. Mental rheumatic pain: Fibromyalgia is easy to be confused with mental rheumatism, but there are significant differences between the two, mental rheumatism has emotional symptoms, such as the description of pain as a knife and inflammation , or described as numbness, tightness, needle-like or oppressive pain, these symptoms are often ambiguous, varied, without anatomical basis, and are not affected by weather or activity, patients often have mental or emotional disorders, such as psychosis , depression, schizophrenia or other mental illness, the difference between the two is important, because the former is more difficult to deal with, often requiring psychiatrists to treat.

2. Chronic fatigue syndrome: Chronic fatigue syndrome including chronic active EB virus infection and idiopathic chronic fatigue syndrome, manifested as fatigue, fatigue, but lack of basic causes, check patients with low fever, pharyngitis, neck or armpit Lymph node enlargement, determination of anti-EB virus envelope antigen antibody IgM, help to identify the two.

3. Rheumatic polymyalgia: Rheumatoid polymyalgia is characterized by extensive neck, scapular scapula, back and pelvic pain, but according to the rapid blood sedimentation, more common in the elderly over 60 years old, synovial biopsy shows inflammatory changes, on hormones Sensitive and other characteristics can be distinguished from fibromyalgia syndrome.

4. Rheumatoid arthritis: Patients with RA and fibromyalgia syndrome have generalized generalized pain, stiffness and joint swelling, but objective evidence of no swelling of the joints of fibromuscular syndrome, its morning stiffness time ratio RA is short, laboratory tests including rheumatoid factor, erythrocyte sedimentation rate, joint X-ray film, etc. are also political, fibromyalgia syndrome pain distribution is more extensive, less confined to the joints, mostly located in the lower back, thigh, abdomen, head And the hips, while the pain of RA is mostly distributed in the wrist, fingers and toes.

5. Myofascial pain syndrome: Myofascial pain syndrome, also known as localized fibrosis, also has a learning tenderness point, easy to be confused with fibromuscular points, but the two are different in diagnosis, treatment and prognosis. Where.

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