Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Fibromyalgia or not? 10 other things it could be
Posted in Arthritis by Dr. Sharon Orrange on Sep 12, 2008

Fibromyalgia is a common chronic musculoskeletal disorder characterized by diffuse musculoskeletal pain and fatigue. The two major criteria are widespread musculoskeletal pain and excess tenderness in at least 11 of 18 predefined anatomic sites. The problem is, these symptoms are often reported in other diseases and I have had several patients who carried a diagnosis of fibromyalgia when we discovered a very different cause for their pain. Many of you may wonder, is it fibromyalgia? Could it also be something else?

1) Rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus: These autoimmune diseases may coexist and also share symptoms of musculoskeletal pain and fatigue with fibromyalgia. How else do they mimic fibro? Raynaud phenomena (blue/white fingertips when you are cold), dry eyes, and dry mouth are classic features of these illnesses and are present in 25 to 50 percent of patients with fibromyalgia. Some studies have shown that 22% of Lupus patients met criteria for fibro and 12% of patients with Rheumatoid Arthritis had fibromyalgia. How can you and your doctor make the distinction? A careful history and physical examination (and blood tests if they are warranted), should be sufficient to differentiate fibromyalgia from a connective tissue disease. The synovitis (red, inflamed, swollen joints) seen with connective tissue diseases are usually NOT features of fibromyalgia. Blood tests such as an ANA panel can be done if your doctor has high enough suspicion.


2) Ankylosing spondylitis: Ankylosing spondylitis or other inflammatory back conditions may present with skeletal pain and stiffness similar to that of fibromyalgia. These disorders may be differentiated, however, by the fact that spinal motion in fibromyalgia is generally normal, and patients with ankylosing spondylitis have specific findings on xray that are absent in fibromyalgia.


3)    Polymyalgia rheumatica:  Polymyalgia rheumatica (PMR) may mimic fibromyalgia, although this disorder can be differentiated by the history and laboratory tests. Tender points are not present in patients with PMR and stiffness is more prominent than pain. A blood test called an ESR (sedimentation rate) is elevated in patients with PMR, but is normal in patients with fibromyalgia.


4)    Inflammatory myositis (Inflammatory muscle diseases): Fibromyalgia is distinguished from inflammatory myositis by the following features: myositis causes muscle weakness and muscle fatigue, but is not usually associated with diffuse pain. Patients with fibromyalgia do not have significant muscle weakness. Additionally, patients with myositis will have abnormal muscle enzyme tests (CPK or CK)


5)    Infection: Fibromyalgia may mimic a chronic viral infection such as mononucleosis. Fibromyalgia, as well as chronic fatigue syndrome, has been noted to follow or accompany infections including hepatitis, Lyme disease and HIV. Approximately 25 to 40 percent of patients with documented Lyme disease who are treated appropriately with antibiotics will develop persistent pain and fatigue, consistent with fibromyalgia and CFS. However, there has been no evidence of persistent microbial infection in the vast majority of these patients.


6) Hypothyroidism: Hypothyroidism may be difficult to distinguish from fibromyalgia, since patients with hypothyroidism often complain of generalized aches, fatigue, and interrupted sleep. Thyroid function studies (usually a TSH level) should be obtained in patient with suspected fibromyalgia. The unfortunate thing is even when we find there is hypothyroidism, correcting the thyroid abnormality does not usually ameliorate the fibromyalgia symptoms.


7)    Neurologic disorders: Neurologic disorders (such as multiple sclerosis and myasthenia gravis) may mimic fibromyalgia. Multiple sclerosis and myasthenia gravis are associated with post-exercise muscle fatigue as well as generalized fatigue. However, chronic, widespread pain is unusual. A careful neurologic exam should also help differentiate between fibro and a neurologic disorder such as MS or Myasthenia.


8)    OVERLAPPING SYNDROMES: The most confusing conditions when trying to settle on the diagnosis of fibro include depression, irritable bowel syndrome, migraine, CFS, and myofascial pain syndrome. This group of disorders may be best considered as part of the spectrum of fibromyalgia and distinguishing between them may be impossible but here are some tidbits. Patients with myofascial pain complain of pain in one anatomic region, such as the right side of the neck and shoulder, with tenderness being confined to that area.  Chronic fatigue syndrome (CFS) bears a striking resemblance to fibromyalgia. As an example, one study of 90 patients (30 each with CFS, fibromyalgia, and multiple chemical sensitivities) found that 70 percent of the patients with fibromyalgia met the criteria for CFS.


There is significant overlap with sleep disturbances, irritable bowel syndrome, migraine and fibromyalgia. Approximately 25 percent of patients with fibromyalgia have current major depression, and 50 percent have a lifetime history. Migraine headache and irritable bowel syndrome are present in 50 to 75 percent of patients with fibromyalgia, and these disorders may develop concurrently.


 Ideally you can find a primary care doctor who will work with you, listen to your symptoms and together you can come up with the proper diagnosis. Fibro or not.


Dr O.


 


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25
I went to the doctor and was diagnosed with lupus due to the pain and also a positive ANA test. Further testing for arthritis was negative and the doctor just blurted out fibro. No other tests nothing. Just gave me topamax and sent me on my way. A couple years ago I had a MRI done which showed lesions in my frontal lobe white matter and left cerebral. I have been concerned because the pain is so bad especially in my legs. Unfortunately,with the economy as it is no health benifits yet with job. Don't know what to do.
By invyzabul  Dec 19, 2008
24
How do you find a Dr. to work with you when your on a Hmo insurance that just masks the problem with pain meds and antidepressants. Where would I start to look for a Dr.that would give me more testing and how do I ask for it? Help in southern CA. Patricia .
By bigandy  Oct 12, 2008
23
I had all the symptoms of Fibro. But I have Non Tropical Celiac Sprue. If your Fibro is degenerative, you should find a doctor who will do more testing.
By catlovesdi  Oct 09, 2008
22
Thanks and good to see a Neuropathy team on DS. I am not a GP (General Practitioner) thats what we call someone who dose 1 year of internship after medical school and practices....and Im not a family medicine doctor who does three years in pediatrics/adult medicine...I am an Internist or Adult Medicine Specialist....and I understand neuropathy. EMG (electromyography)/NCS (nerve conduction studies) done on patients with fibromyalgia are normal..unlike with diabetic neuropathy or neuropathy from other acquired causes. Is your understanding that fibro causes a peripheral neuropathy?
Dr O.
By DrOrrange  Sep 28, 2008
21
What you're not bringing up in here (because you are a GP and not someone with a neuro background...

ALL of this is related to and effects your autonomic / small fiber nerve system.

There are tests for autonomic issues... by going to a neurologist.
Yes there are many overlaps but if you put in ANY one of these words + AUTONOMIC you will see that it's ALL related.

Small Fiber Nerves = Autonomic Nerve System

You may want to check out the neuropathy group.

http://dailystrength.org/groups/neu...

You'll find a lot of resources and photos there to help you better understand nerve disorders and conditions.
By NeuropathyTeam  Sep 27, 2008
20
MsCris32: 41 isnt that high for an ESR (sed rate), we worry more about autoimmune disease and PMR if your sed rate is above 80...
By DrOrrange  Sep 23, 2008
19
I have been dx with fibro but I read in this article that polymyalgia rheumatica there is a high sed rate. My sed rate is 41 but the drs wont and cant tell me why. Help!!!!
By mscris32  Sep 22, 2008
18
My Doc. says Fibro is just a trashcan diagnosis. Personally I have given up on the medical profession. Just live one day at a time.
By Comluc  Sep 21, 2008
17
well i am being tested for cushings and also been diagnosed with fibromyalgia and hypothyroid which are common to most cushings patients hay wait whats cushings? thats the problem not many know about it in the uk only reason i know is i did my own diagnosis and reasearch about it take a look at cushings help this has to be made more aware tc moon
By moonface  Sep 17, 2008
16
All i know is i don't feel well...tired all the time, very little tolerance for exercise, heat, odors, certain foods...i just get so discouraged.
By NitaSue62  Sep 16, 2008
15
A lot of the pain I chalked up to fibromyalgia turned out to be chronic myofascial pain. Most doctors know this and often note it in a patients' chart but fail to mention it to them leaving them to suffer needlessly. It's relatively easy to control with trigger point massage.
By hayleydaniels  Sep 16, 2008
14
Finding a GOOD doctor, pcm or specialist is EXTREMELY DIFFICULT. Most doctors either misdiagnose, over medicate (first choice is stuff em with anti-d's or now the "wonder" drug (NOT!) Lyrica, or blow off patients by passing them off to other useless doctors. I'm talking from over 30 years experience, even after I was diagnosed. Interesting that you did not mention that Lyme Disease is a great imitator of most every disease you mentioned.

Another interesting thing is that, based on my experience, most doctors act like they don't want to be bothered with patients whose blood work comes back relatively normal. Their motto is" If you can't test it or x-ray it, then it doesn't exist." I can't tell you how many times I haven't been informed of abnormal test results - only to discover them when I ask for copies.

Just a quick example, I have hypothyroidism and have been taking synthroid for years. My numbers are great, but I still feel like crap. Not one thyroid-associated symptom has improved - not one!!! I asked to try armour thyroid because there seems to be at least some success with people who have fibro. Yet my endo guy says no, can't do that. It really bugs me that most doctors don't treat us as INDIVIDUALS, instead we're just test results and if the numbers are ok, then we're ok. NOT!!!

I also find it interesting that most doctors don't seem to want to be bothered with finding out WHY we have so many co-issues. I have yet to meet a CURIOUS doctor, willing to step outside of the medical box. How in the world will we ever find an effective way to deal with fibro, let alone a cure, when the big pharms push pills to fix something when the ROOT CAUSE is still unknown???
By SeaNymph  Sep 15, 2008
13
Dr. O. I also found out that I have Chlamydia Pneumonia and have felt better since starting treatment. When our immune system is compromised like mine was during my sick building exposure I became infected with this bacteria or re-infected.
By SharonHanson  Sep 15, 2008
12
Dear Dr. O.

Thank you for your thoughtful post regarding FM. I have been diagnosed with FM by two different doctors and I am hypothyroid and I have Secondary Adrenal Insufficiency diagnosed by a professor of endocrinology at a university hospital. You are correct in saying that there are overlapping syndromes. One day I was healthy and the next I was sick and it all coincided with a metal clip they implanted in my breast after a biopsy. I have a genetic sensitivity to the nickel in the clip but to my surprise it was unsanitary conditions at the time of the biopsy that caused fungus to grow in my breast. After talking to my radiologist about my case (she was very interested) she told me that many women with implants after mastectomy are showing up very sick with mold and bacteria infections around their implants. The interesting thing is they are diagnosed with all of the above diseases, some with two of three of them. I myself have lesions on my brain and I believe I was headed for diagnoses of MS. I am better now and have returned to work because I was treated for biotoxin disease (I was also exposed to a sick building at work). I fought to get answers and I wouldn't give up. I read and researched medicine for about two years because I knew something caused my illness and I was right.

Why it is the medical profession is so willing to give you the above diagnoses and then say we don't know what causes it. Isn't it true that we do know that mold exposure, Lyme disease, vaccines and toxins all can cause the above diseases?
By SharonHanson  Sep 15, 2008
11
do you believe even when blood tests are in a majority normal that a rheumatic disease can still exist?
By loveparadise  Sep 14, 2008
10
thanks this is helpful
By SunflowerRose  Sep 14, 2008
9
Hiit is a confusing mess, I had lyme disease rashes in 1996 got sick shortly after dr. said RA non-seronegative but recommeded HIV test. Rashes were gone by the time i got to doctor after getting very very sick went to lyme doc got better but couldn't get well w/o relapse, I got frustrated and I knew hubbys job was shaky and even with ins treatment was somewhat expensuve, kept local doc she is a PA she thinks its fibro, I don't have any ins now and pain is my major problem. My brother (s) are sick one with lyme diagnosis one with lyme/ fibro and the other with mogellons, that is not how it is spelled he has open sores with black ooze coming out with fibers. isn't this somethin?
By suninsky  Sep 13, 2008
8
This post is so helpful, thank you for writing this! I am going to print this out. It will be very useful to me.
By lizgirl  Sep 13, 2008
7
Tyhank you for this information,next time I go to the doctor iI will aks if these were the blood test that were done.xxx's,toriv
By toriv  Sep 13, 2008
6
I knew a woman who was told she had fibromyalgia and it turned out to be some kind of weird allergic reaction that just made her hurt instead of getting hives or anything... I don't know how common that is though. Just a thought
By FracturedFairytales1  Sep 12, 2008

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