Fibromyalgia syndrome

Introduction to fibromyalgia syndrome 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 (OA), rheumatoid arthritis (RA) and various non-rheumatic diseases (such as hypothyroidism, malignant tumors) )Wait. This type of fibromyalgia syndrome is called secondary fibromyalgia syndrome. If it is not accompanied by other disorders, it is called primary fibromyagiasyndrome. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: sleep disorders

Cause of fibromyalgia syndrome

Sleep disorders (60%):

Sleep disorders involving 60-90% of patients, manifested as sleep awake, more dreams, morning fatigue, fatigue, systemic pain and morning stiffness, nighttime EEG recording found that alpha wave intervention in stage IV sleep wave In the middle, ringing the volunteers with non rapid eye movement can also induce the above EEG patterns and clinical symptoms. Other factors affecting sleep such as mental stress, environmental noise can aggravate fibromyalgia syndrome. Symptoms, therefore, speculate that this type IV sleep abnormality plays an important role in the development of fibromyalgia syndrome.

Abnormal neurotransmitter secretion (15%):

The precursor of serotonin is tryptophan. After the tryptophan in the food protein is absorbed in the intestine, most of it binds to plasma protein, and a small part is in a free state. Free tryptophan can be carried by the carrier through the blood-brain. The barrier enters the brain tissue, and then 5-HT is produced by hydroxylation and decarboxylation in 5-HT neurons, 5-HT released into the synaptic cleft, reabsorbed in part by presynaptic nerve endings, and partially mitochondria Monoamine oxidase produces inactive 5-hydroxyindole acetic acid, which is also present in the digestive tract mucosa, platelets and breast cells. Because it is difficult to pass the blood-brain barrier, the central nervous system The 5-HT in peripheral blood belongs to two systems. It is found that: 1 The plasma free tryptophan and its transportation ratio are reduced in patients with fibromyalgia syndrome, and the degree of reduction is related to musculoskeletal pain. The lower the plasma concentration and the rotation ratio, the more obvious the pain. The high-affinity 5-HT receptor on the platelet membrane, imipramine can compete with 5-HT for binding to the platelet receptor, labeled with strontium. Imipramine determination of small blood The 5-HT receptor density on the membrane was found to be more effective than normal in the fibromyalgia syndrome. The 5-HT premuscular syndrome was significantly reduced in 5-HT compared with normal human brain tissue. Experiments showed that 5-HT It can regulate non-rapid eye movement sleep, reduce sensitivity to pain, improve depression, and enhance the analgesic effect of anesthesia. Amitriptyline and cyclobenzaprine can be 5-HT to 5 - Hydroxyl acetylase conversion, increased 5-HT concentration, it has a certain effect on fibromyalgia syndrome, on the contrary, the administration of tryptophan hydroxylase inhibitor - parachlorophenylalamine will appear fibromuscular Pain syndrome-like pain, the pain disappeared after the drug was stopped.

Another neurotransmitter associated with fibromyalgia syndrome is substance P. Littlejohn found that physical or chemical stimulation can induce significant cutaneous hyperemia in patients with fibromyalgia syndrome. This overreaction may be consistent with persistence. Because of these stimuli, the polymodal cutaneous nociceptor reflexively releases a pathological amount of substance P from the nerve endings, which in turn causes local vasodilation, enhanced vascular permeability, and a nerve. Neurogenic inflammmation, after the release of substance P at the nerve endings, the primary sensory nerves of the dorsal root ganglia will not synthesize more substance P in order to maintain a constant level. Due to its slow but long-lasting and intense excitatory effects, the central nervous system is bound to be affected.

It has also been found that in the presence of normal or high levels of 5-HT, substance P has a damping effect on the release of sensory nerve impulses. In the absence of 5-HT, it will lose this control and cause hyperalgesia.

Immune disorder (15%):

Some authors report the deposition of immunoreactants at the dermal-epidermal junction of patients with fibromyalgia syndrome. Electron microscopy revealed swelling of muscle capillary endothelial cells in patients with fibromyalgia, suggesting acute vascular injury; tissue hypoxia and Increased permeability, unexplained weight gain, and diffuse swelling of the hands and nocturia may be associated with increased permeability.

In addition, preliminary studies have found that interleukin-2 (IL-2) levels are elevated in fibromyalgia syndrome, and patients with tumors treated with IL-2 will develop fibromyalgia syndrome-like symptoms, including a wide range of Pain, sleep disturbance, morning stiffness and tenderness point, etc., also found that alpha interferon can cause fatigue, the above phenomenon suggests immune regulation disorder, abnormal cytokine levels in the body may be related to the onset of fibromyalgia syndrome.

Fibromyalgia syndrome prevention

As the cause of this disease is unclear, there are currently no effective preventive measures.

Complications of fibromyalgia syndrome Complications, sleep disorders

Common complications of this disease are:

Pain

2. Sleep disorders;

3. Intestinal irritation syndrome.

Symptoms of fibromyalgia syndrome Common symptoms Epidemic myalgia Muscle cramps Muscle tenderness Anxiety Overwork Myalgia Insomnia Tiredness

Fibromyalgia syndrome is more common in women. The most common age of onset is 25-45 years old. The clinical manifestations are various, but there are mainly four groups of symptoms:

1. The main symptoms: extensive pain in the whole body is a symptom of all patients with fibromyalgia syndrome. Although some patients only complain of one or several pains, 1/4 of the patients have more than 24 pain points. In all places, especially the central axis bone (neck, thoracic vertebrae, lower back) and scapula belt, pelvic belt, etc. are common, other common parts are knee, head, elbow, ankle, foot, upper back, middle back, wrist, On the buttocks, thighs and calves, most patients described the pain as stinging and the pain was distracting.

In all other patients, there are symptoms of widespread tenderness. These tender points are present in tendons, muscles, and other tissues. They tend to be symmetrically distributed. At the point of tenderness, the patient responds differently to the "press". But there is no difference in other parts.

2. Characteristic diseases: This group of symptoms includes sleep disorders, fatigue and morning stiffness. About 90% of patients have sleep disorders, which are characterized by insomnia, easy to wake up, multiple dreams, lack of energy, and nighttime EEG shows alpha wave intervention. In the non-fast eye rhythm, the lack of sleep, 50-90% of patients have fatigue, about half of the patients have more severe fatigue symptoms, so that they feel "too tired to work", morning stiffness is seen in 76-91% of patients The severity is related to sleep and disease activity.

3. Common symptoms: The most common symptoms in this group of symptoms are numbness and swelling. Patients often complain of joints, swelling around the joints, but no objective signs, followed by headache, irritable bowel syndrome, headache can be divided into migraine or non-bias Headache headache, the latter is a kind of oppressive dull pain in the occipital region or the entire head. Psychological abnormalities including depression and anxiety are also common. In addition, the patient's labor ability is reduced, about 1/3 of the patients need to change jobs, and a small part People can't stick to their daily work. The above symptoms are often aggravated by the cold weather, nervousness, overwork, local heat, mental relaxation, good sleep, and moderate activity.

4. Mixed symptoms: Primary fibromyalgia syndrome is rare, most patients with fibromyalgia syndrome have a certain rheumatism at the same time, then the clinical symptoms are the interweaving and overlapping of the two symptoms, fibromuscular Pain syndrome often makes the symptoms of rheumatism coexist with it more serious. Failure to recognize this condition often leads to overtreatment and examination of the latter.

Examination of fibromyalgia syndrome

Auxiliary inspection

Unless there are other diseases, there is no laboratory abnormality in fibromuscular syndrome. However, it has been reported that the level of IL-1 is increased in patients with fibromyalgia syndrome, the activity of natural killer cells and serotonin is decreased, and the concentration of substance P in cerebrospinal fluid is increased. /3 patients have Raynaud's phenomenon, in this group of patients may have anti-nuclear antibody positive, C3 levels are reduced.

Since Smythe first proposed the diagnostic criteria for fibromyalgia syndrome in the 1970s, many diagnostic criteria have been published, but these standards are different in methodology and content, which brings some difficulties to epidemiology and clinical research. To this end, foreign scholars have studied the clinical symptoms and tender points of a large number of patients on the basis of previous standards through multi-center collaboration, and selected one of the most discriminating clinical symptoms and 18 tender points, and proposed the fibrils of 1990. Classification criteria for pain syndrome.

1. Systemic pain lasting more than 3 months: the left and right sides of the body, the upper, lower and middle axis of the waist (cervical or front or thoracic or lower back) are considered to be systemic pain .

2. Press with a thumb (about 4kg pressure) at least 11 pain points in 18 tender points. The 18 (9 pairs) tender points are: the suboccipital muscle attachment; the upper edge of the trapezius muscle; 5 to the front of the 7th cervical transverse process gap; the beginning of the supraspinatus muscle, the proximal medial edge of the scapular spine; the distal end of the lateral iliac crest 2 cm; the junction of the second rib and the cartilage, just above the upper edge of the junction; Hip I upper quadrant, anterior gluteal fold; large trochanter posterior; proximal side of the knee fat pad joint wrinkle line, while satisfied with the above two conditions, can be diagnosed as fibromyalgia syndrome.

The application of this standard can make the definition of fibromyalgia syndrome more consistent. The standard emphasizes the difference between fibromyalgia syndrome and other similar diseases, and thus does not include characteristic features of the syndrome, such as fatigue, sleep disorders, morning Stiff, etc., when applying this standard, considering the above characteristics, it will increase the reliability and correctness of the diagnosis, but this standard cannot distinguish between primary fibromyalgia syndrome and secondary fibromyalgia syndrome. Therefore, fibromuscular muscle After the diagnosis of pain syndrome is established, it is also necessary to check for the presence or absence of other concomitant diseases to distinguish between primary and secondary fibromuscular syndrome. This distinction is clearly necessary in clinical studies and therapeutic observation.

Diagnosis and diagnosis of fibromyalgia syndrome

diagnosis

1. Epidemiological data

2. Clinical manifestations

3. Laboratory data

Differential diagnosis

Symptoms of fibromyalgia syndrome are fatigue, and pain is a clinically common symptom that requires identification of the following diseases.

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.

The tender point of myofascial pain syndrome is usually called the point of stimulation. When you press this point, the pain will radiate to other parts. Although the patient feels pain, they may not know anywhere in the excitation point.

Myofascial syndrome usually has only one or several localized excitation points. The excitation points originate from the muscles, and the affected muscles are restricted in activity. Passive traction or active contraction of the muscles can cause pain, using 1% procaine. The closed excitation point temporarily eliminates pain. Unlike fibrosis, it does not have extensive pain, stiffness or fatigue. However, if persistent pain causes stage IV sleep disorders, myofascial syndrome may develop into fibromyalgia. Syndrome.

Myofascial syndrome is usually caused by trauma or overwork, and the general prognosis is better.

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