Fibromyalgia – syndrome of chronic widespread pain – a case report

Cilj: Prikaz slučaja bolesnice s fibromialgijom koja se inicijalno prezentirala kroničnom proširenom boli te je proveden dijagnostičko-terapijski postupak. Prikaz slučaja: Bolesnica u dobi od 61 godine liječena je pri Zavodu za fizikalnu i rehabilitacijsku medicinu s reumatologijom zbog jakih kroničnih bolova u zglobovima i mišićima. Bolesnica dodatno opisuje poteškoće sa spavanjem, tegobe depresije i anksioznosti. Boluje od hipotireoze, a prethodno su na magnetskoj rezonanciji utvrđene degenerativne promjene kralježnice. Opsežnom je dijagnostičkom obradom isključena upalna reumatska bolest, neurološka bolest, paraneoplastični sindrom, neregulirana hipotireoza te kronična infekcija. Dijagnostički upitnik za fibromialgiju potvrdio je sumnju da bolesnica boluje od fibromialgije temeljem rezultata upitnika (Widespread pain index (WPI) 15; symptom severity scale (SSS) 9). Procjena umora kronične bolesti dala je izrazito loš rezultat (The Functional Assessment of Chronic Illness Therapy (FACIT-F) 15/52), što je ukazalo na lošu kvalitetu života. Provedeno je nefarmakološko liječenje koje se sastojalo od edukacije, individulane kineziterapije i fizikalno-terapijskih procedura te multimodalno farmakološko liječenje. Izborom lijekova djelovalo se na nociceptivnu i neuropatsku vrstu boli, kao i na anksioznost bolesnice s povoljnim terapijskim odgovorom. Navedenim pristupom liječenja postignuto je značajno poboljšanje tegoba sindroma fibromialgije u naše bolesnice. Zaključak: U bolesnika s proširenom kroničnom boli, kroničnim umorom i poremećajima mentalnog stanja treba posumnjati na fibromialgiju. Dijagnostičkom je obradom potrebno isključiti drugu ozbiljnu bolest. Za postavljanje dijagnoze fibromialgije koriste se dijagnostički kriteriji iz 2016. godine – American College of Rheumatology (ACR). Ovim prikazom bolesnice željeli smo podignuti svijest o ovoj bolesti koja je u svijetu prepoznata kao ozbiljan zdravstveni problem iako ponekad zanemaren i nepriznat.Aim: To present a case of a patient with fibromyalgia who initially presented with chronic widespread pain and a diagnostic-therapeutic procedure. Case report: A 61-year-old patient was treated at the Department of physical and rehabilitation medicine with rheumatology for severe chronic joint and muscle pain. The patient additionally describes difficulty of sleeping, depression, and anxiety. She suffers from hypothyroidism and degenerative changes of the spine have been previously determined on magnetic resonance imaging. Extensive diagnostic treatment ruled out inflammatory rheumatic disease, neurological disease, paraneoplastic syndrome, unregulated hypothyroidism, and chronic infection. The Fibromyalgia Diagnostic Questionnaire confirmed the suspicion that the patient was suffering from fibromyalgia based on the results of the questionnaire Widespread pain index (WPI) 15 and symptom severity scale (SSS) 9. The Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) gave an extremely poor result, 15 points. Non-pharmacologic treatment was conducted, consisted of education, individual exercise, physical therapy procedures and multimodal pharmacological therapy, with the choice of drugs affected the nociceptive and neuropathic type of pain, as well as the anxiety of the patient with a favorable therapeutic response. This approach to treatment has achieved a significant improvement in the symptoms of fibromyalgia syndrome in our patient. Conclusion: Fibromyalgia should be suspected in patients with widespread chronic pain, chronic fatigue, and mental disorders. It is necessary to exclude another serious disease by diagnostic processing. The 2016 American College of Rheumatology (ACR) diagnostic criteria are used to diagnose fibromyalgia. With this presentation of the patient, we wanted to raise awareness about this disease, which is recognized in the world as a serious health problem, although sometimes neglected and unrecognized