Muhammad B. Yunus

The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.

Primary fibromyalgia (fibrositis): Clinical study of 50 patients with matched normal controls

Detailed clinical study of 50 patients with primary fibromyalgia and 50 normal matched controls has shown a characteristic syndrome. Primary fibromyalgia patients are usually females, aged 25-40 yr, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety, poor sleep, headaches, irritable bowel syndrome, subjective swelling in the articular and periarticular areas and numbness. Physical examination is characterized by presence of multiple tender points at specific sites and absence of joint swelling. Symptoms are influenced by weather and activities, as well as by time of day(worse in the morning and the evening). In contrast, symptoms of psychogenic rheumatism patients have little fluctuation, if any, and are modulated by emotional rather than physical factors. In psychogenic rheumatism, there is diffuse tenderness rather than tender points at specific sites. Laboratory tests and roentgenologic findings in primary fibromyalgia are normal or negative. Primary fibromyalgia should be suspected by the presence of its own characteristic features, and not diagnosed just by the absence of other recognizable conditions. This study has also shown that primary fibromyalgia is a poorly recognized condition. Patients were usually seen by many physicians who failed to provide a definite diagnosis despite frequent unnecessary investigations. A guideline for diagnosis of primary fibromyalgia, based upon our observations, is suggested. Management is usually gratifying in these frustrated patients. The most important aspects are a definite diagnosis, explanation of the various possible mechanisms responsible for the symptoms, and reassurance regarding the benign nature of this condition. A combination of reassurance, nonsteroidal antiinflammatory drugs, good sleep, local tender point injections, and various modes of physical therapy is successful in most cases.

Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study.

Restless legs syndrome is characterised by an unpleasant, difficult-to-describe sensation in the legs that produces an invariable urge to move them frequently.1 2 3 This symptom typically occurs at rest or before sleep and is alleviated by activity.1 2 3 Restless legs syndrome may occur without or with an associated condition, such as rheumatoid arthritis.1 3 We investigated the prevalence of restless legs syndrome and of leg cramps in patients with fibromyalgia syndrome, a common condition with widespread musculoskeletal aching and tender points,2 4 and in controls. One hundred and thirty five consecutive new female patients referred with primary fibromyalgia, 54 women with rheumatoid arthritis without concomitant fibromyalgia, and 87 healthy, pain free women acting as controls were studied at our outpatient rheumatology clinic. All patients with fibromyalgia …

Relationship between body mass index and fibromyalgia features

Objective: to evaluate the relationship between body mass index (BMI) and features of the fibromyalgia syndrome (FMS). Methods: 211 female patients with FMS seen consecutively in our rheumatology clinic were analyzed. Spearman correlation was used. Further, FMS features were compared at different levels of BMI (kg/m 2 ), e.g., < 25.00 vs S 25.00 (normal vs overweight). P value of h 0.01 was accepted as significant. Results: A significant positive correlation was found between BMI and age (p < 0.001) and a negative correlation between BMI and education (p < 0.009). Health Assessment Questionnaire (HAQ) score was significantly correlated with BMI (p < 0.001), whereas fatigue and number of tender points (TP) showed a trend (p = 0.035 and 0.037, respectively). Conclusion: The HAQ score is significantly associated with BMI in FMS with a trend towards significance for fatigue and TP. Weight loss may improve physical functioning in this disorder.

Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome

&NA; The responses of 45 primary fibromyalgia syndrome (PFS) patients, 29 rheumatoid arthritis (RA) patients and 31 healthy non‐pain controls (NC) on the Zung Self‐Rating Depression scale were compared. No difference between the PFS and RA groups was found, although the former has no known organic pathology, unlike the latter. Therefore, the hypothesis that the presentation of chronic pain in the absence of a known organic pathology is a variant of ‘depressive disease’ was not supported in the case of PFS. However, a subgroup of PFS (28.6%) and RA (31.0%) patients appeared to be experiencing significant depressive symptomatology.

The Prevalence of Fibromyalgia in Other Chronic Pain Conditions

Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.

Relationship between fibromyalgia features and smoking.

Objective. The objective of this study was to examine a possible relationship between smoking and fibromyalgia features among 233 female patients with fibromyalgia syndrome. Methods. Data on clinical and psychological features were collected by a protocol. Smoking status was evaluated by a question inquiring about the packs of cigarettes smoked per day. Differences between the smokers and non-smokers were tested by Mann Whitney U test. To adjust data for age and education, a partial correlation test was used. A p value of h 0.01 was accepted as the level of significance. Results. Fifty-one patients (21.9%) smoked. After adjustment for age and education, significantly positive relationship was found between smoking and pain, patient global severity, functional disability, and numbness. There was no difference between smokers and non-smokers for fatigue, morning fatigue, sleep difficulties, tender points (TP), depression, anxiety and stress. Conclusions. Smokers reported significantly more pain, numbness, patient global severity, and functional difficulties than non-smokers. There was no significant difference between smokers and non-smokers for fatigue and TP.

Fibromyalgia syndrome among the elderly. Comparison with younger patients.

Thirty‐one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self‐assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P < .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.

The fibromyalgia family study: a genome-wide linkage scan study.

OBJECTIVE Familial aggregation of fibromyalgia has been increasingly recognized. The goal of this study was to conduct a genome-wide linkage scan to identify susceptibility loci for fibromyalgia. METHODS We genotyped members of 116 families from the Fibromyalgia Family Study and performed a model-free genome-wide linkage analysis of fibromyalgia with 341 microsatellite markers, using the Haseman-Elston regression approach. RESULTS The estimated sibling recurrence risk ratio (λs ) for fibromyalgia was 13.6 (95% confidence interval 10.0-18.5), based on a reported population prevalence of 2%. Genome-wide suggestive evidence of linkage was observed at markers D17S2196 (empirical P [Pe ]=0.00030) and D17S1294 (Pe=0.00035) on chromosome 17p11.2-q11.2. CONCLUSION The estimated sibling recurrence risk ratio (λs ) observed in this study suggests a strong genetic component of fibromyalgia. This is the first report of genome-wide suggestive linkage of fibromyalgia to the chromosome 17p11.2-q11.2 region. Further investigation of these multicase families from the Fibromyalgia Family Study is warranted to identify potential causal risk variants for fibromyalgia.

The clinical concept of fibromyalgia as a changing paradigm in the past 20 years.

Fibromyalgia (FMS) is a valid clinical condition that affects 2%–4% of the population with a pivot symptom of widespread body pain. The cause and cure of FMS are as yet unknown. The concept of FMS has evolved over the past two decades to incorporate symptoms beyond pain as contributing to the global spectrum of suffering. FMS is now recognized to be grounded in the neurological domain with evidence of dysregulation of pain processing. Appreciation of the neurophysiologic mechanisms operative in FMS has contributed to rational treatment recommendations, although a “gold standard treatment” does not currently exist. Ideal treatments for FMS patients should be individualized with emphasis on active patient participation, good health practices, and multimodal intervention, incorporating nonpharmacologic and pharmacologic treatments. Predictors of outcome, which is favourable in over 50% of patients, are unknown, but those with better outcome do more physical activity and use fewer medications.