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Fibromyalgia

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of fibromyalgia.

Alternative Names

Fibromyositis; Fibrositis; Myofascial pain syndrome

Conditions with Similar Symptoms

Between 10 - 30% of all doctors' office visits are due to symptoms that resemble those of fibromyalgia, including fatigue, malaise, and widespread muscle pain. Since no laboratory test can confirm a diagnosis of fibromyalgia, doctors will usually first test for similar conditions. It should be noted that a diagnosis of many of the disorders below may not always rule out fibromyalgia, since it can accompany other common and similar conditions.

Diseases with Similar Symptoms to Fibromyalgia
Disease	Specific Subtypes
Osteoarthritis
Infectious Arthritis	Lyme disease, septic arthritis, bacterial endocarditis, mycobacterial and fungal arthritis, viral arthritis
Postinfectious or Reactive Arthritis	Reiters syndrome (a disorder characterized by arthritis and inflammation in the eye and urinary tract), rheumatic fever, inflammatory bowel disease
Crystal Induced Arthritis	Gout and pseudogout
Rheumatic Autoimmune Diseases	Rheumatoid arthritis, systemic vasculitis, systemic lupus erythematosus, scleroderma, juvenile rheumatoid arthritis (also called Still's disease), Behcet's disease
Other Diseases	Chronic fatigue syndrome, hepatitis C, familial Mediterranean fever, cancers, AIDS, leukemia, bunions, Whipple's disease, dermatomyositis, Henoch-Schonlein purpura, Kawasaki's disease, erythema nodosum, erythema multiforme, pyoderma gangrenosum, pustular psoriasis

Conditions That Do Not Rule Out Fibromyalgia

Chronic fatigue syndrome, myofascial pain syndrome, depression, primary headaches, and certain stress-related disorders commonly occur with fibromyalgia, and have overlapping symptoms. In fact, some experts believe these disorders so often interact that they may all be part of one general condition.

Other conditions may also occur that are similar to fibromyalgia but do not rule out a diagnosis of fibromyalgia. They include:

• Irritable bowel syndrome
• Temporomandibular joint disorders (TMJ)
• Juvenile rheumatoid arthritis (JRA) -- usually diagnosis is clear-cut, but the conditions may coexist. JRA should be considered in children with fibromyalgia if their condition worsens.
• Osteoarthritis -- a common form of arthritis than can coexist with fibromyalgia. The two conditions may be confused, particularly in elderly people. Osteoarthritis, however, causes joint pain, not widespread or generalized pain.

• Chemicals and environmental toxins -- exposure to various chemicals and environmental toxins such as solvents, pesticides, or heavy metals (cadmium, mercury, or lead) can cause fatigue, chronic pain, and other symptoms of fibromyalgia.

Some tests may be positive for one or more of these diseases. However, if the results are uncertain or weak, or if these conditions have been treated successfully, fibromyalgia should not be ruled out if the patient still meets the criteria for it.

Conditions That Usually Rule Out Fibromyalgia

Rheumatoid Arthritis and Other Autoimmune Diseases. Autoimmune diseases are conditions in which the person's immune system attacks the body's own tissues. Many autoimmune conditions resemble fibromyalgia. (Fibromyalgia itself may be an autoimmune disorder.) Autoimmune diseases, like fibromyalgia, also occur more often in women than in men, and early symptoms are often muscle and joint pain, and fatigue. The following are some autoimmune disorders that may be confused with fibromyalgia:

• Rheumatoid arthritis is most likely to resemble fibromyalgia, and the similarities present diagnostic problems in both young people and adults. Symptoms include morning stiffness, fatigue, and tender points. Pressing such points, however, does not produce the intense pain that occurs with fibromyalgia. In addition, abnormal laboratory tests can usually tell this disorder apart from fibromyalgia. Juvenile rheumatoid arthritis may coexist with fibromyalgia.

• Hashimoto's thyroiditis, a disorder marked by low levels of thyroid hormone, can cause widespread muscle aches, depression, and fatigue, if left untreated. This condition is usually easy to diagnose with thyroid hormone tests.

• Systemic lupus erythematosus resembles fibromyalgia, although most patients with lupus also have a rash. Doctors can diagnose lupus with a blood test.

• Multiple sclerosis (MS) has symptoms similar to those of fibromyalgia. There is no definitive test for diagnosing it. Magnetic resonance imaging (MRI) scans, however, detect patches of injured tissue in the brain. These lesions suggest MS.

• Sjogrens syndrome, a condition characterized by dry eyes and mouth, is sometimes mistaken for fibromyalgia.

Autoimmune diseases generally develop slowly. Even if a doctor determines that a patient is most likely to have fibromyalgia, the doctor should keep track of any changes in symptoms over time in case one of these other illnesses is actually present.

Lyme Disease. Lyme disease is a bacterial disease transmitted by ticks. Health care providers can usually diagnose early Lyme disease correctly, but a delayed response or recurrence of this disorder may be mistaken for fibromyalgia. Some experts believe that between 15 - 50% of patients referred to clinics for Lyme disease actually have fibromyalgia. Late Lyme disease can usually (but not always) be ruled out using blood tests that identify the organism that causes this disease. If fibromyalgia patients are incorrectly diagnosed and treated for Lyme disease with prolonged courses of antibiotics, the drugs may have serious side effects.

Drugs and Alcohol. Fatigue is a side effect of many prescription and over-the-counter medications, such as antihistamines. In addition, dependency on or abuse of alcohol or illegal drugs may show as constant fatigue. Medications should be considered as a possible cause of fatigue if an individual has recently started, stopped, or changed medications. Withdrawal from caffeine can produce depression, fatigue, and headache.

Polymyalgia Rheumatica. Polymyalgia rheumatica is a condition that causes pain and stiffness, and generally occurs in older women. Tender points are also present with this disorder, although they almost always occur in the hip and shoulder area. Morning stiffness is common, and patients may also experience fever, weight loss, and fatigue. A higher than normal value of erythrocyte sedimentation rate (ESR) can suggest polymyalgia rheumatica. Elevated ESR, however, also occurs with other conditions. Polymyalgia rheumatica often resolves in about a year, but there is a risk of persistent disease. Worse, it is sometimes associated with a rare condition called temporal arteritis, which may cause blindness if not treated, so an accurate diagnosis of polymyalgia rheumatica is important.

Other Diseases That May Rule Out Fibromyalgia.

• Hepatitis -- Hepatitis C may prove to be a cause of some cases of fibromyalgia.
• Anemia
• Diabetes
• Infections -- For example, infectious mononucleosis is marked by fatigue and swollen glands. It primarily affects adolescents and young adults. Some patients may have lingering fatigue that lasts for many months.
• Cancer
• Neuromuscular diseases such as myasthenia gravis

• Review Date: 12/15/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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