Fibromyalgia: rheumatic disease

Is a rheumatic disease chronicle that affects affects a 3% of the population with a clear predominance in the female (around 50 years), although it has also been described in men. It is currently the most common cause of musculoskeletal pain chronic generalized.

Why is it produced?

The specific mechanism that produces fibromyalgia is not known, although it has been proposed that its appearance is probably multifactorial, with strong emphasis on a probable pain modulation dysfunction. Among the other associated factors, the following stand out:

• Psychogenic disorders
• Sleep disturbances
• Hormonal disturbances
• Neurotransmitter alterations

Fibromyalgia symptoms

• The pain it is usually poorly defined, deep, and accompanied by stiffness with worsening in the morning. Exercise tends to aggravate pain, which is why affected patients tend to do not exercise.
• It is also experienced fatigue to different degrees, and at the same time incapacitating for the accomplishment of the habitual daily tasks, like for example getting dressed or preparing the table.
• A characteristically also appears non-restorative sleep. Its treatment improves the pain and fatigue of fibromyalgia.

It is not uncommon to associate these symptoms with disorders of anxiety, tdepressive cramps, headaches, alterations in bowel rhythm, dysmenorrhea, sensitivity to cold, restless legs, etc.

Fibromyalgia patients frequently enter a state of depression as a consequence limitation they have to lead a normal life, knowing that there is no specific curative treatment added to the difficulty in objectively determining the degree and nature of their pain.

Diagnosis

It is fundamentally clinical, insisting on the characteristics of the pain and its location, as well as the factors that trigger it and the degree of affectation that it produces on your daily life.

The physical examination consists primarily of the palpation of certain points on the body, also called with the aim of locating pain (of more than 3 months) through pressure in more than 11 of the 18 points concrete (9 bilateral pairs) and other pathologies having been ruled out before. The most sensitive areas of pain are located in the region:

• Posterior cervical
• Shoulders
• Breastbone
• Hips
• Elbows
• Knees
• Buttocks
• Buttocks

The differential diagnosis It should be done with other diseases such as: polymyalgia rheumatica, rheumatoid arthritis and hypothyroidism among the most frequent.

Treatment

It is essential to explain well to the patient the nature benign of the illnessas well as the fact that it is a chronic disease that does not produce deformities.

The treatment pharmacological are used to improve pain, sleep and anxiety-depressive symptoms and must be accompanied by a good program of daily gymnastics. The anti-inflammatory non-steroids, as they are the most widely used drugs for good analgesia. In order to improve the quality of sleep, drugs with antidepressant and / or anxiolytic activity are used. Have recently appeared antidepressant drugs with analgesic effects that are having a good response in these patients.

The supportive psychotherapy It is very useful and necessary in these patients, who in many cases spend months until their diagnosis with the corresponding aggravation of pain and thus favoring the appearance of depressive symptoms. In some hospitals, there are Fibromyalgia Units, which focus on the disease, its evolution and treatment in a multifactorial way, thus obtaining better results in pain control.

Remember to protect your family with it to be protected before any disease such as fibromyalgia that requires diagnosis, tests and treatment appears.

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Dra. Laura Cristel Ferrer Family and Community Medicine Specialist