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Fibromyalgia is characterised by chronic diffuse pain, intense fatigue and sleep disturbances often associated with anxiety or depression. It was recognised as a rheumatic disease by the WHO in 1992. Fibromyalgia is not a rare disease: the prevalence is estimated at between 2 and 5% of the general population, but values vary depending on the study and population assessed. Fibromyalgia is more common in women than in men (4:1) and in most cases onset occurs between 30 and 50 years of age. Physical or psychological trauma is often the triggering factor. The pain is generally diffuse but may predominantly involve the spinal column or peripheral joints. It is often associated with a swelling sensation and joint stiffness, symptoms that resemble the early stages of inflammatory rheumatism. The pain is permanent, but tends to worsen in response to physical effort, cold, humidity, stress and lack of sleep. It responds poorly to treatment with common analgesics. Asthenia and sleep disturbances (non-restorative sleep) occur in 90% of patients. Other symptoms may include irritable bowel syndrome, migraines or tension headaches, pelvic pain, irritable bladder syndrome, jaw dysfunction, dysautonomia with orthostatic hypotension, and physiological disturbances (anxiety, depression, pessimism, kinesiophobia and cognitive difficulties). The cause of fibromyalgia is unknown. Diagnosis is made in patients with a three month history of diffuse pain and with at least 11 tender pressure points (out of a total of 18 specified sites). It is important to exclude forms of chronic inflammatory rheumatism (in particular Gougerot syndrome, see this term) and other pathologies associated with diffuse pain (such as Parkinson disease (see this term) and hypothyroidism). Fibromyalgia is always a diagnosis of exclusion as there is no anatomical lesion, or specific biological or radiological sign for the syndrome. Treatment is symptomatic. Non-steroidal antiinflammatory drugs are of little or no benefit. Tramadol chlorhydrate, and certain anticonvulsants (such as gabapentin) and antidepressants are effective against the pain in some patients. Hypnotic drugs may be useful for treatment of the sleep disturbances. Management should include drug treatment, physiotherapy with a progressive introduction of physical activity (swimming, yoga, postural stretching and aerobic exercise), and cognitive behavioural and relaxation therapy. Fibromyalgia is a chronic disease of variable severity. However, the fatigue and pain may be disabling and the prognosis may be hindered by widespread misdiagnosis. |