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Introduction
Fibromyalgia syndrome (FMS) is relatively common, occurring in
approximately 2 percent of the general population. Women are more likely to have
symptoms of FMS than men. Ten percent to 30 percent of patients seen in an
average rheumatology practice will have fibromyalgia. The average yearly cost to
treat FMS is approximately $2,000, about the same cost as the treatment of
osteoarthritis.
Definition
All patients with FMS complain of widespread pain. Other very common
symptoms include fatigue, sleep difficulties, and often some depression or
anxiety. Other non-specific symptoms include intermittent constipation and
diarrhea, frequent urination, headaches, numbness and tingling of the arms and
legs, and difficulty concentrating.
The American College of Rheumatology classification criteria for FMS include
the physical finding of tenderness at anatomic areas called tender points.
Eighteen such tender points have been designated. Patients with FMS will feel
tenderness at palpation of at least 11 of these 18 points. Traditional
laboratory tests and X-rays should be normal.
Conditions that might mimic FMS include other muscle diseases such as
polymyositis, endocrine diseases such as hypothyroidism or abnormalities of
calcium metabolism, inflammatory diseases such as polymyalgia rheumatica, and neurologic conditions such as Parkinsonism. Most of these conditions can be
diagnosed by history and physical examination with minimal laboratory testing.
(Figures to the right: These show common areas of pain and tenderness
(called "tender points") in people who have fibromyalgia.)
The cause of FMS
In the mid 1970s, patients with FMS were studied in a sleep
laboratory and discovered to have brain wave abnormalities during deep sleep.
This discovery resulted in great interest in the pathophysiology of FMS.
Currently, a number of neurohormonal abnormalities
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