The Skeletal System
is a group of common non-articular rheumatic disorders characterised by achy
pain, tenderness, and stiffness of muscles, areas of tendon insertions, and
adjacent soft-tissue structures such as ligaments. These may be generalised
primary (no association with other conditions) or secondary (linked to
some underlying condition such as rheumatoid arthritis, osteoarthrosis, other
connective tissue diseases), and localised
when they are often related to overuse or microtrauma factors.
term myalgia indicates muscular
pain. In contrast, myositis is due
to inflammation of muscle tissues and is an inappropriate term for
fibromyalgia, when such inflammation is absent. Fibromyalgia
then indicates pain in muscles, tendons, ligaments, and other connective
(fibrous) tissues, and sometimes it is called fibromyalgia syndrome (FMS)
of the fibromuscular tissues may be involved, but those of the neck,
shoulders, thorax (pain in the muscles between the ribs), low back and thighs
(muscle stiffness and cramping) are especially affected. There is no specific
histologic abnormality, and the absence of inflammation justifies the
preferred terminology of fibromyalgia rather than the older terms of
fibrositis or fibromyositis.
affects estimated 2-4 % of general population. The condition occurs mainly in females, may be induced or intensified by physical or
mental stress, poor and inadequate sleep, trauma and exposure to dampness or
cold. The primary fibromyalgia syndrome is particularly likely to occur in
otherwise healthy young women who tend to be stressed, tense, depressed,
anxious, and ambitious, but may also occur in adolescents (particularly girls)
or in older adults, often associated with unrelated minor changes of vertebral
osteoarthrosis. Men are more likely to develop localised fibromyalgia in
association with a particular occupational or recreational strain.
Clinical features: < BACK TO TOP >
is gradual onset of stiffness and pain which are diffuse, and of an achy
character in generalised primary fibromyalgia (patients complain that they
ache all over).
localised forms symptoms are more often sudden and acute and related to
certain physical activity.
pain in both is characteristically aggravated by straining or overuse.
may be present, usually localised to specific small zones (‘tender
points? such as greater trochanter, upper outer quadrant of buttocks (there
is a comprehensive list of 18 tender points).
may be local tightness or muscle spasm, as well as fatigue and headaches.
can be exacerbated by emotional stress, when other psychogenic manifestations
can be noted.
Inflammation, redness and swelling are usually absent.
Certain number of patients complain of anxiety, dysmenorrhoea and irritable bowel syndrome.
Diagnosis: < BACK TO TOP >
of primary fibromyalgia is by recognition of the typical pattern of diffuse
fibromyalgia and associated non-rheumatic symptoms listed before and by
exclusion of significant contributory or underlying diseases (e.g.,
generalised osteoarthrosis, rheumatoid arthritis, or other connective tissue
disease), and (most difficult of all) exclusion of psychogenic muscle pain and
fibromyalgia requires thorough history and exclusion of other causes of
musculoskeletal pain (often difficult and time consuming).
palpation must produce pain in at least 11of total 18 tender points.
Screening tests (X-ray, CT or blood analysis) are characteristically normal.
Management < BACK TO TOP >
may remit spontaneously (in milder cases) with decreased stress but can become
chronic and persistent or recur at frequent intervals with remissions in
may be obtained from important supportive measures, such as reassurance and
explanation of the benign nature of the syndrome, as well as stretching and
other exercises (e.g., walking, bicycling, mild gym workout, swimming),
improved sleep, local applications of heat, gentle massage, and low-dose
antidepressants (e.g., amitriptyline [Trypanol, Tryptine, Endep] at bedtime to
promote deeper sleep.
are not particularly effective but may help individual patients due to their
areas of severe focal tenderness may be injected with corticosteroid-local
Functional prognosis is usually favourable with a comprehensive, supportive program, although some degree of symptoms tends to persist. In minority of patients despite all treatment effort the condition may be very disabling.
Prognosis < BACK TO TOP >
Dr Zoran Pletikosa)
15 May 2009
19 June 2005
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