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

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Abstract

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.

References (88)

  • HF Klinefelter

    Primary fibrositis and its treatment with the pyrazolone derivatives, butazolidin and tandearil

    Johns Hopkins Med J

    (1972)
  • WSC Copeman

    Non-articular rheumatism

    Br J Clin Pract

    (1965)
  • PH Wood

    Rheumatic complaints

    Br Med Bull

    (1971)
  • O Abel et al.

    Fibrositis

    J Miss State Med Assoc

    (1939)
  • W Graham

    The fibrositis syndrome

    Bull Rheum Dis

    (1953)
  • The American Rheumatism Association Committee on Rheumatologic Practice

    A description of rheumatologic practice

    Arthritis Rheum

    (1977)
  • WR Gowers

    Lumbago: Its lessons and analogues

    Br Med J

    (1904)
  • R Stockman

    Rheumatism and arthritis

  • G Glogowski et al.

    Ein beitrag zur klinik and histologie der muskelharten (myogelosen)

    Z Orthop

    (1951)
  • H Kaplan et al.

    Histochemical study of muscle in rhematic disease

    Arthritis Rheum

    (1971)
  • K Miehlke et al.

    Klinische und experimentelle Untersuchungen zum fibrositissyndrom

    Z Rheumaforsch

    (1960)
  • DG Simons

    Muscle pain syndromes—part II

    Am J Physical Med

    (1976)
  • LJ Llewellyn et al.

    Fibrositis

    (1915)
  • EF Traut

    Fibrositis

    J Amer Geriatric Society

    (1968)
  • H Kraus

    Trigger points

    NY State J Med

    (1973)
  • J Travell

    Referred pain from skeletal muscle

    NY State J Med

    (1955)
  • C Long

    Myofascial pain syndromes—part II

    Henry Ford Hosp Med Bull

    (1956)
  • AA Michele et al.

    Scapulocostal syndrome

    Arch Phys Med Rehabil

    (1968)
  • GA Ibrahim et al.

    Interstitial myofibrositis: serum and muscle enzymes and lactate dehydrogenase-isoenzymes

    Arch Phys Med Rehabil

    (1974)
  • GH Kraft et al.

    The fibrositic syndrome

    Arch Phys Med Rehabil

    (1968)
  • TP Almy

    Irritable colon

  • F Plum

    Migraine syndrome

  • RD Adams

    Tension headache and various other cranial pains with psychiatric disease

  • GJ Friou et al.

    Interaction of nuclei and globulin from lupus erythematosus serum demonstrated with fluorescent antibody

    J Immunol

    (1958)
  • NH Nie et al.

    Statistical Package for the Social Sciences (SPSS)

    (1975)
  • H Kaplan

    The treatable trio: Polymyositis, polymyalgia rheumatica and fibrositis

    Med Times

    (1977)
  • CL Christian

    Fibrositis

  • RL Swezey

    Rehabilitation aspects in arthritis

  • M Mannik et al.

    Fibrositis

  • JT LaMont et al.

    Irritable colon syndrome

  • GW Waylonis

    Long-term follow-up on patients with fibrositis treated with acupuncture

    Ohio State Med J

    (1977)
  • C Long

    Myofascial pain syndrome—part I

    Henry Ford Hosp Bull

    (1955)
  • DF Hill

    Climate and arthritis

  • AE Sola et al.

    Myofascial pain syndromes

    Neurology

    (1956)
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      The core symptoms of FMS are generalized aches and pains often worse with cold and humidity, fatigue, and nonrestorative sleep.28,29 Other common symptoms are tenderness to touch, stiffness, dryness of mouth and/or eyes, headaches, dizziness, temporomandibular joint complaints, nausea, abdominal pain and bloating, diarrhea often alternating with constipation, frequent urination at night, sensations of subjective swelling, intermittent paresthesias, and environmental sensitivity5,30 (Table 2). Classification criteria for FMS require a minimum of 3 months of symptoms, but most of the patients had symptoms for years, so physicians should be cautious diagnosing FMS in patients with short duration of symptoms, as none of these symptoms are specific for FMS and consider potential “red flags” that may suggest other conditions (Table 3).

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    1

    From the Division of Rheumatology, Department of Medicine, Peoria School of Medicine, Peoria, Illinois.

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