Fibromyalgia syndrome

Introduction to fibromyalgia syndrome Fibromyalgia syndrome (FS) is a non-articular rheumatism. The clinical manifestations are multiple pains and stiffness in the musculoskeletal system, and there are tender points in special areas. Fibromyalgia syndrome can be secondary to trauma. , a variety of rheumatism, such as osteoarthritis, rheumatoid arthritis and various non-rheumatic diseases (such as hypothyroidism, malignant tumors). The disease belongs to the Chinese medicine sputum syndrome, which is the category of sputum, tendon and low back pain. basic knowledge The proportion of illness: 10% Susceptible people: multiple women Mode of infection: non-infectious Complications: headache, insomnia, depression, anxiety

Cause of fibromyalgia syndrome

(1) Causes of the disease

The cause of the disease is still unclear and may be related to sleep disorders, abnormal neurotransmitter secretion and immune disorders.

(two) pathogenesis

The pathogenesis of this disease is still unclear, and the literature reports are related to sleep disorders, abnormal neurotransmitter secretion and immune disorders.

1. Sleep disorders sleep disorders involving 60% to 90% of patients, manifested as sleep easy to wake up, more dreams, morning fatigue, fatigue, generalized pain and morning stiffness, night EEG recording found that alpha wave intervention In stage IV delta sleep waves, the above-mentioned EEG patterns and clinical symptoms can also be induced by ringing the non-rapid eye movement of the volunteers. Other factors affecting sleep such as mental stress and environmental noise are observed. It can aggravate the symptoms of fibromyalgia syndrome, so it is speculated that this stage IV sleep abnormality plays an important role in the pathogenesis of fibromyalgia syndrome.

2. Abnormal secretion of neurotransmitters The literature reports that neurotransmitters such as serotonin (5-HT) and substance P (substance P) play an important role in the pathogenesis of this disease.

3. Immune Disorders 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 syndrome, suggesting acute vascular injury. Tissue hypoxia and increased permeability, patients with unexplained weight gain, diffuse hand swelling and nocturia may be associated with increased permeability.

4. Infection Some people think that FS is associated with infection, especially EB virus, Burgdorferi spirochete infection.

Fillingim pointed out that pain symptoms are related to childhood masturbation habits, John McBeth pointed out: there is a relationship between mental illness and pain syndrome, and another study found that FS patients with pain threshold decreased, suggesting that FS is a pain regulating abnormal disease.

Chinese medicine believes that the disease is related to wind, cold and dampness. After being fatigued, people are affected by wind, cold and dampness. For example, sleeping in wetlands or being blown by the wind can cause muscle ischemic spasm, produce a lot of harmful metabolites in the muscles, and stimulate nerve receptors to cause pain.

Fibromyalgia syndrome prevention

1. Eliminate and reduce or avoid the disease factors, improve the living environment space, improve the development of good living habits, prevent infection, pay attention to food hygiene, reasonable diet, avoid cold and damp.

2. Pay attention to exercise, increase the body's ability to resist disease, do not over-fatigue, excessive consumption, quit smoking and alcohol, maintain balance, and overcome anxiety and tension.

3. Early detection and early diagnosis and early treatment, establish confidence in the fight against disease, adhere to treatment.

Complications of fibromyalgia syndrome Complications, headache, insomnia, depression, anxiety

Can be complicated by irritable bowel syndrome, headache, depression and anxiety.

Symptoms of fibromyalgia syndrome Common symptoms Morning stiffness Fatigue myalgia Multi-dream muscle pain Depression Awkward anxiety Dull pain

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

1. The main symptoms of generalized extensive pain and widespread tenderness are the symptoms of all patients with fibromyalgia syndrome, pain throughout the body, especially the central axis bone (neck, thoracic vertebrae, lower back) and shoulder straps, Pelvic bands are common, and other common parts are knee, hand, elbow, ankle, foot, upper back, middle back, wrist, buttocks, thighs and calves. Most patients describe this pain as stinging and pain. It is distracting, the patient often reports self-reported joint pain, but the question asks that the joints, muscles and even the skin are painful.

Another symptom of all patients is the widespread tenderness points, which are present in tendons, muscles and other tissues, often distributed symmetrically. At the point of tenderness, patients and normal people respond differently to pressing. However, there is no difference in other parts, measured by a pain meter, lower than the pressure of normal people, can lead to tenderness.

2. Characteristic symptoms 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, more dreams, lack of energy, and 50% to 90% of patients have fatigue. About half of the patients have more severe fatigue symptoms, and morning stiffness is seen in 76% to 91% of patients. The severity is related to sleep and disease activity.

3. Common symptoms The most common symptom of this group of symptoms is numbness and swelling. Patients often complain of joints and swelling around the joints, but no objective signs, followed by headache, irritable bowel syndrome, headache can be divided into migraine or non-migraine. Sexual 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 one-third of the patients need to change the type of work, a small part People can't stick to their daily work. The above symptoms are often aggravated by the cold weather, nervousness and overwork.

4. Mixed symptoms Primary fibromyalgia syndrome It is rare for most patients with fibromyalgia syndrome to have some kind of rheumatism at the same time. The clinical symptoms are the interweaving and overlapping of the two symptoms.

Examination of fibromyalgia syndrome

Unless there are other diseases, fibromyalgia syndrome generally has no laboratory abnormalities, but it has been reported that the level of IL-2 is increased in patients with fibromyalgia syndrome, the activity of natural killer cells and serum is decreased, and the concentration of substance P in cerebrospinal fluid is increased.

About one-third of patients have Raynaud's phenomenon. In this group of patients, anti-nuclear antibodies may be positive and C3 levels are reduced.

Diagnosis and diagnosis of fibromyalgia syndrome

Diagnostic criteria

Diagnostic criteria: FS is a syndrome, no specific laboratory tests and other auxiliary tests, based on clinical features and typical tender points to confirm.

The classification criteria for fibromyalgia syndrome in 1990 are currently used, and the contents are as follows.

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 anterior or thoracic or lower back) are considered to be systemic pain.

2. The tender point is pressed with a thumb and the pressing pressure is about 4kg. At least 11 of the 18 tender points are pressed. The 18 (9 pairs) tender points are: the suboccipital muscle attachment; the upper radius of the trapezius The front of the 5th to 7th cervical transverse process; the beginning of the supraspinatus, the proximal medial edge of the scapula; the distal 2cm of the lateral iliac crest; the junction of the 2nd rib and cartilage; the upper quadrant of the gluteal, gluteal muscle The anterior fold; the posterior aspect of the large trochanter; the proximal side of the knee joint fat pad joint fold line. At the same time, those who meet the above two conditions can be diagnosed as fibromyalgia syndrome.

Differential diagnosis

Although this syndrome is said to be associated with rheumatoid arthritis, systemic lupus erythematosus, rheumatic polymyalgia, and hypothyroidism (it is rare in China), but these diseases are characterized by their own characteristics. Difficulties, it is difficult to identify the following diseases.

1. Mental rheumatism Fibromyalgia syndrome is easily confused with mental rheumatism, but there are significant differences between the two, and mental rheumatism has emotional symptoms, such as the description of pain as a knife, fire, and pain. 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 illnesses, 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 includes chronic active EB virus infection and idiopathic chronic fatigue syndrome, which is characterized by fatigue and fatigue, but lacks the underlying cause, and examines whether the patient has hypothermia, pharyngitis, neck or axillary lymph nodes. The enlargement, determination of the anti-EB virus envelope antigen antibody LgM, helps to identify the two.

3. Rheumatic polymyalgia Rheumatic polymyalgia is characterized by extensive neck, scapular scapula, back and pelvic pain, but according to blood routine, the elderly over 60 years old, synovial biopsy shows inflammatory changes, sensitivity to hormones, etc. It can be differentiated from fibromyalgia syndrome.

4. Patients with rheumatoid arthritis RA and fibromyalgia syndrome have generalized generalized pain, stiffness and joint swelling, but there is no objective evidence of swelling of the joints of fibromyalgia syndrome. Short, laboratory tests including rheumatoid factor, erythrocyte sedimentation rate, joint X-ray film, etc. are also normal, fibromyalgia syndrome has a wide range of pain distribution, less confined to the joints, mostly located in the lower back, thighs, abdomen, head And the hips, while the pain of RA is more distributed in the wrist, fingers and toes.

5. Myofascial pain syndrome Myofascial pain syndrome, also known as localized fibrosis, also has deep tender points, which is easily confused with fibromyalgia syndrome, but the difference between diagnosis, treatment and prognosis .

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