Carpal tunnel syndrome and subsequent rheumatoid arthritis in the 'fibrositis ' syndrome

SUMMARY Eight of 11 patients who satisfy Smythe's criteria for the 'fibrositis ' syndrome have subsequently developed carpal tunnel syndrome. Six of the 8 patients have gone on to develop an inflammatory polyarthritis, 3 of whom are seropositive and satisfy the criteria for classical rheumatoid arthritis. The relationship between the 'fibrositis ' syndrome and rheumatoid arthritis is not clear, but the additional complication of carpal tunnel syndrome in 'fibrositis ' points to certain patients with 'fibrositis ' developing an inflammatory polyarthritis of rheumatoid type. Acceptance on a definition of 'fibrositis ' would enable further prospective studies to take place, but at present the term is used to describe many other nonarticular conditions that do not satisfy Smythe's criteria. Fibrositis can be interpreted as being a condition of generalised aches and pains in which the patient complains bitterly of discomfort, may have tender areas or trigger spots, is often depressed, and in whom investigations reveal no abnormality. All rheumatologists see patients who fit into this cate-gory of nonarticular rheumatism, yet there is no agreement on the precise terminology that should be applied to this form of rheumatism. In this paper fibrositis is used to describe the 'fib-rositis ' syndrome as defined by Smythe. ' Eleven patients satisfying Smythe's criteria (Table 1) have been seen over a 5-year period. The 11 patients attended a routine rheumatology outpatient clinic at Worthing Hospital and represented 0 17 % of new referrals from general practitioners in the Worthing District to the author during that period. The criteria for the diagnosis of 'fibrositis ' include 14 areas of deep tenderness, which are located in the trapezius, the second costochondral junctions, the lateral epicondyles, the supraspinatus muscle, the Table 1 Criteria for the diagnosis of the 'fibrositis' syndrome (Smythe'