FIBROMYALGIA presentation Year 4 Internal Medicine Notes

FIBROMYALGIA presentation Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.3 / NGUGI -- Slide 1 FIBROMYALGIA BY: JASPER OMONDI ODUOL- BMS/2020/67442 SHETI LUVUNO – BMS 2020/66987 Slide 2 Introduction. Fibromyalgia (FM) is a condition of generalised pain and consequent disability. It is a characterized by chronic widespread musculoskeletal pain. Fatigue, cognitive disturbance, psychiatric and multiple somatic symptoms often accompany the disorder.\nFibromyalgia has an unknown etiology and uncertain pathophysiology. There is no evidence of tissue inflammation despite symptoms of soft tissue pain. It is frequently associated with medically unexplained symptoms in other systems. Slide 3 Risk factors include life events that cause (unresolved) psychosocial distress relating to previous abuse, marital disharmony, alcoholism or illness in the family, poor sleep health, previous injury or assault and low income.\nFM arises in a variety of races and cultures. FM may co-exist with other inflammatory rheumatic diseases, including axial spondyloarthritis and SLE. The prevalence in the UK and United States is about 2%–3%.\nAlthough FM can occur at any age, including adolescence, it increases in prevalence with age, to reach a peak of 7% in women aged over 70. There is a strong female predominance of around 10:1. Slide 4 Epidemiology Fibromyalgia is more common in women compared to men, with the prevalence of fibromyalgia in the United States at 6.4% (7.7% in women and 4.9% in men) Studies in Europe and South America show a range from 3.3 to 8.3%. It increases with age.\nBetween the ages of 20 to 55 years, the cause of generalized musculoskeletal pain in most women is fibromyalgia. The prevalence in adolescents has been found to be similar to those in adults in many studies.\nAmongst the patients referred to a tertiary care pain clinic, more than 40% met the criteria for fibromyalgia. The risk for fibromyalgia is higher if one has an existent rheumatic disease. Slide 5 The cause of FM is poorly understood, but two abnormalities that may be interrelated and have been consistently reported in affected patients, are disturbed, non-restorative sleep and pain sensitisation, probably caused by abnormal central pain processing. There appears to be a problem with the processing of pain in the brain.\nPatients often become hypersensitive to the perception of pain.\nThe constant hypervigilance of pain is also associated with numerous psychological issues. Slide 6 Pathophysiology Changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that regulation of the autonomic and neuro-endocrine system appears to be the basis of the syndrome. Central sensitization, blunting of inhibitory pain pathways and alterations in neurotransmitters lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain. Slide 7 The frequent co-morbidity of fibromyalgia with mood disorders suggests a major role for the stress response and for neuroendocrine abnormalities. Stress adaptation response is disturbed Can be triggered by physical, emotional or environmental stressors such as car accidents, repetitive injuries and certain diseases. Sleep deprivation with disruption of delta-wave sleep (non-REM stage IV) is associated with day-time fatigue and fibromyalgia syndrome. FMS could be a neuroendocrine disturbance, particularly involving thyroid hormone imbalances and/or hypophyseal growth hormone imbalances Slide 8 Cont’ Duna & Wilke (1993) propose that disordered sleep leads to reduced serotonin production, and consequent reduction in the pain modulating effects of endorphins and increased ‘substance p’, combined with sympathetic nervous system changes resulting in muscle ischaemia and increased sensitivity to pain. Slide 9 History and physical Widespread musculoskeletal pain and fatigue are the characteristics of fibromyalgia and are often accompanied by cognitive and psychiatric disturbances. The symptoms include: Widespread musculoskeletal pain – The chief complaint is widespread musculoskeletal pain which is bilateral and involves both the upper and lower parts of the body. The pain may be localized initially, commonly in the neck and shoulders. Fatigue - Especially when waking up from sleep, but is also in the mid-afternoon. Cognitive disturbances – Often referenced as "fibro fog,"; patients have difficulty with attention and doing tasks that require rapid changes in thought( multitasking) Slide 10 Other symptoms Headache\nDysmenorrhea Extreme sensitivity to cold Restless legs Odd patterns of numbness and tingling Intolerance to exercise Stiffness\nParesthesia Palpitations Impaired concentration Problems with memory Diminished attention span Slide 11 1990 ACR classification criteria It was used in many clinical and therapeutic trials but has not been useful in diagnos