Presentation of patients with fibromyalgia and treatment options

Fibromialgija je jedan od generaliziranih bolnih sindroma, uključujući CFS i sindrom višestrukog bursitis-tendinitisa. Radi se o najčešćem uzroku generalizirane boli koji pogađa 2% populacije s omjerom žena i muškaraca do 7: 1. Hiperalgezija i alodinija karakteristike su ove difuzne boli koju često prati širok raspon simptoma uključujući umor, poremećaj spavanja, poteškoće kognicije te svakodnevnog funkcioniranja, sindrom iritabilnog crijeva, depresiju, ukočenost i još mnogo toga. FMS karakterizira nefunkcionalna bol, što je dokazano sa fMRI i detaljnim somatosenzornim ispitivanjima. To je heterogeni sindrom što se tiče simptoma. Depresija je česta, ali se ne javlja kod svih bolesnika. Bez obzira na ovaj podatak, raspoloženje bi trebalo procijeniti kod svih bolesnika. Za FMS ne postoji test ili patohistološki nalaz te se dijagnoza temelji na simptomima i isključenju drugih bolesti. Kriteriji Američkog fakulteta za reumatologiju (ACR) 1990. obično se koriste kao dijagnostički alat za FMS. Nedavno je ACR objavio dijagnostičke kriterije utemeljene na analizi FMS koji zahtijevaju prisutnost raširene boli tijekom najmanje 3 mjeseca. Međutim, broj bolnih točaka u prvotnim kriterijima zamijenjeni su upitnicima sa popisom simptoma sadržanih u indeksu raširenosti boli i u ljestvici ozbiljnosti simptoma. Kako do postavljanja dijagnoze može proći i do 10 godina, medicinski troškovi su visoki i stoga je vrlo važno smanjiti ih sa konstruktivnim dijagnosticiranjem. Nefarmakološke intervencije (npr. stupnjevana tjelovježba i kupka s toplom vodom) su podjednako važne kao i one farmakološke opisane u preporukama EULAR-a. Pacijente treba upozoriti da bol može prolazno nastati pri počimanju vježbanja, ali treba ostati uporan. Ostale mogućnosti liječenja uključuju kognitivno-bihevioralnu terapiju, opuštanje, rehabilitaciju, fizioterapiju i psihološku podršku, koje se mogu koristiti kod nekih pacijenata, a sam izbor ovisi o kliničkim manifestacijama.Fibromyalgia is one of generalised pain syndromes including CFS and multiple bursitis-tendonitis syndrome. It's the most common cause of generalised pain affecting 2% of the popuation with a female to male ratio of up to 7:1. Hyperalgesia and allodynia are the characteristics of this diffuse pain which is often accompained by a wide range of symptoms, including fatigue, sleep disturbance, functional impairment, cognitive dysfunction, variable bowel habits, depression, stiffness, and more. FMS is characterised by maladaptive pain which has been demonstrated by fMRI scan and detailed somatosensory testing. It is a heterogenous syndrome regarding the symptoms. Depression is common, but it does not occur in all patients. Regardless this information, mood should be assessed in all patients. There is no assay or pathological test for it and the diagnosis is based on symptoms and exclusion of other illnesses. The American College of Rheumatology (ACR) 1990 classification criteria are commonly used as a diagnostic tool for FMS. Recently, the ACR published survey based diagnostic criteria for FMS which requires the presence of widespread pain for at least 3 months. However, tender point count has been replaced by a symptom checklist which includes the Widespread Pain Index and Symptom Severity Scale. As it can take up to 10 years before diagnosis, medical costs are high and thus it is very important to reduce them by a constructive diagnosis. Non-pharmacological interventions are important (e.g. graded exercise and warm water bath). Patients should be warned that pain may wprsen transiently when starting exercise, but they should preserve. Other options include cognitive-behavioral therapy, relaxation, rehabilitation, physiotherapy and psychological support, which may be used in some patients. Pharmacological treatments, as described in the EULAR recommendations, may be useful adjuncts to non-pharmacological treatments and should be considered. Choice will depend on clinical manifestations