Do you know someone who has been told that he or she has fibromyalgia? It seems as if almost everybody who walks into my office lately has received this diagnosis.
Fibromyalgia is a chronic pain condition seen more often in women than in men. It's fairly common, affecting 5 percent to 15 percent of the population.
Still, I think that it is overdiagnosed, and that means too many patients aren't getting the medical help that could best help them with their pain, fatigue and other symptoms.
There are no specific lab tests or X-rays that can confirm fibromyalgia. Fibromyalgia is what we call an invisible illness.
But the suffering is real, defined as chronic, widespread musculoskeletal pain lasting at least three months and found in all areas of the body. Extreme fatigue, sleep disturbances and multiple tender trigger points are also common symptoms.
It's thought that the normal processing of sensory input is somehow disrupted, creating intense discomfort from sensations that most people would find tolerable. It's a challenging condition for patients and doctors to manage.
Sadly, I have seen numerous patients who were told that they have fibromyalgia when there were other -- and more readily treatable -- explanations for their symptoms.
I remember evaluating a 35-year-old woman who had generalized muscle pain, soreness and profound fatigue for more than six months. She also had difficulty sleeping and concentrating and had lost interest in daily tasks. She had seen orthopedic surgeons, pain-management specialists, psychiatrists and primary-care providers, who concluded that her diagnosis was fibromyalgia.
I noticed that her neck seemed unusually full. An ultrasound revealed a large goiter, and lab tests confirmed the presence of thyroid antibodies commonly found in Hashimoto's thyroiditis, in which not enough thyroid hormone is produced. She was started on thyroid-replacement therapy and, after a few months of follow-up and medication adjustments, most of her symptoms subsided.
In another case, a 42-year-old woman with joint pain, fatigue and morning stiffness was told she had fibromyalgia and depression. Although rheumatoid arthritis had initially been ruled out, her symptoms persisted, and she was referred to me.
I saw that her knuckles, ankles and feet were all inflamed; a more specific blood test than what she had earlier received revealed active inflammation and the presence of an antibody for rheumatoid arthritis. Within a few months of beginning RA treatment, her symptoms were resolved.
These are just two conditions often associated with or mistaken for fibromyalgia. Others include:
-- Autoimmune disorders such as lupus and inflammatory bowel disorders.
-- Infections.
-- Diabetes.
-- Neurological disorders such as myasthenia gravis or multiple sclerosis.
-- Psychiatric illness: bipolar disorder, depression, anxiety or substance abuse.
Fibromyalgia should be considered only after all of these possibilities have been eliminated; it should never be an "easy out" to explain complicated symptoms.
The cause of fibromyalgia is not known. What we do know is that it can be effectively treated using a multidisciplinary approach consisting of medications, counseling, exercise and improving sleep quality.
Studies document the fact that patients who have fibromyalgia are more likely to have minor psychiatric disorders than patients who do not have fibromyalgia. This does not mean that patients' symptoms are "all in their head." It does mean that including a mental-health professional in the treatment team helps achieve optimum success.
If you or a loved one receives a diagnosis of fibromyalgia, make sure that a comprehensive physical examination with appropriate tests has been done. Be sure that other possible diagnoses have been considered and excluded.
Don't settle for a quick diagnosis. Challenge your health-care professional.
(Dr. Edgard Janer is a board-certified physician practicing rheumatology in the Tampa Bay area since 1996. He can be reached at edrheuma@aol.com.)
(Distributed by Scripps Howard News Service www.scrippsnews.com)
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