22 What is Fibromyalgia? Pathogenesis of Fibromyalgia Clinical Features and Diagnosis of Fibromyalgia Management of Fibromyalgia
3 Clinical Presentation of FM Fatigue Fatigue Sleep disturbance Sleep disturbance Numbness or tingling sensations Numbness or tingling sensations Morning stiffness Morning stiffness Headaches/migraines Headaches/migraines IBS IBS Mood symptoms Mood symptoms Pain is the core symptom of FM, however patients may also present with the following complaints 2,4-6 Chronic Widespread Pain and Tenderness 1 Leavitt F, et al. Arthritis Rheum. 1986;29:775-781. 2 Wolfe F, et al. Arthritis Rheum. 1995;38:19-28. 3 Staud R. Arthritis Res Ther. 2006;8(3):208-214. 4 Roizenblatt S, et al. Arthritis Rheum. 2001;44:222-230. 5 Harding SM. Am J Med Sci. 1998;315:367-376. 6 Weir PT, et al. J Clin Rheumatology. 2006;12(3):124-128. Pain in all 4 quadrants of the body ≥ 3 months 1,2 Hallmark features of FM H yperalgesia & Allodynia 3 Patient descriptors 3 Aching, Nagging, Hurting Sensitivity to pressure stimuli 2
4 FM Patients Experience Widespread Pain *p<0.001 N-558 Wolfe F, et al. Arthritis Rheum. 1990;33:160-172. * * * * In Patients with FM, Pain Presented in More Areas Than Other Chronic Pain Conditions
5 FM Patients Experience Widespread Pain In this pain drawing, a typical FM patient is asked to shade the areas of the body that are painful 1 This drawing indicates that FM patients experience widespread pain all over the body 1 FrontBack Adapted from pain drawing provided courtesy of L Bateman 1 Silverman SL and Martin SA. In: Wallace DJ, Clauw DJ, eds. Fibromyalgia & Other Central Pain Syndromes. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005:309-319.
6 ACR Manual Tender Point Exam for the Diagnosis of FM 1 Manual Tender Points Exam 2 Presence of 11 tender points on palpation to a maximum of 4 kg of pressure (just enough to blanch examiner’s thumbnail) ACR criteria are both sensitive (88.4%) and specific (81.1%) 3 TRAPEZIUS Upper border of trapezius, midportion LOW CERVICAL Anterior aspects of C5, C7 intertransverse spaces SECOND RIB SPACE About 3 cm lateral to sternal border ELBOW Muscle attachments to Lateral Epicondyle KNEE Medial fat pad of knee proximal to joint line OCCIPUT At nuchal muscle insertion GLUTEAL Upper outer quadrant of gluteal muscles GREATER TROCHANTER Muscle attachments just posterior to GT SUPRASPINATUS At attachment to medial border of scapula RIGHT FOREARM FOREHEAD LEFT THUMB Control Points Tender Points *Based on 1990 ACR FM Criteria 1 National Fibromyalgia Association. Available at: http://www.fmaware.org/site/News2?page=NewsArticle&id=6263. Accessed September 12, 2009. 2 Adapted from Chakrabarty S and Zoorob R. Am Fam Physician. 2007;76(2);247-254. 3 Wolfe F, et al. Arthritis Rheum. 1990;33:160-172.
7 Patients with FM Are More Likely to Have Concomitant Chronic Pain Conditions DMBA = Deseret Mutual Benefits Administration SLE = Systemic lupus erythematosus; RA = Rheumatoid Arthritis; IBS = Irritable Bowel Syndrome *Headache = headache, tension headache, migraine † Baseline from 52,698 females and 52,232 males without FM ‡ Risk ratio = The probability of each condition occurring in FM patients as compared to a normal, healthy control group (baseline=1) 1 Weir PT, et al. J Clin Rheumatology. 2006;12(3):124-128. 2 Wolfe F and Rasker JJ. Fibromyalgia. In: Firestein, ed. Kelly’s Textbook of Rheumatology, 8 th Edition. St. Louis, MO: WB Saunders Co; 2008. FM Patients Baseline † 20% of patients with SLE, RA and OA have concomitant FM 2 Because patients with FM are often diagnosed with other pain-related conditions, FM may go undetected 1 ‡ Associations of Pain-Related Conditions Among Patients Diagnosed with FM in the DMBA Database Between 1997 and 2002 1
8 1 Goldenberg DL, et al. JAMA. 2004;292:2388-2395. 2 Adapted from White KP, et al. Arthritis Rheum. 2002;47:260-265. Diagnosis of FM Improves Health Satisfaction 1 Lower number indicates improved patient satisfaction Patient Health Dissatisfaction * n=100 *Statistically significant versus baseline (P value not provided) as a change in the 5-point Likert scale