Fibromyalgia (FM),previously referred to as fibrositis,is a complex syndrome of aching that has only been
defined as a medical condition for approximately 20 years. It is characterized by a multitude of symptoms including chronic
pain, fatigue,and stiffness. Its associated with a lot of tenderness in the muscles and is not associated with swelling in
the joints.
This condition is very controversial because it can mimic other disease like Lyme disease and systemic lupus erythematosus,and
it often coexists with other illnesses,such as depression. Although painful,FM does not appear to cause permanent damage to
connective tissue.
The etiology of FM is unknown,and there is no cure. Twenty percent to 70 % of people with FM also fit the criteria for
chronic fatigue syndrome. FM has also been associated with tension headache,Gulf War Syndrome,premenstrual syndrome,substance
abuse,chemical sensitivities,and other,sometimes controversial syndrome.
Elevations in substance P and nerve growth factor have been detected in patients with FM. Similarily,lower levels of
serotonin have been documented in these patients. Activation of N-methly-D-asparate (NMDA) receptors that interact with excitatory
amino acids and increase chronic pain may also play a role.
Other abnormalities include reduced response of cortisol to physiologic stress, decreased night-time hormone release,and
disturbances in rapid eye movement (REM) sleep resulting in daytime sleepiness
Another theory explaining FM focuses on it being a psychiatric disorder One trial found that patients with FM were more
likely to have histories of sexual, physical,or drug abuse,eating anxiety,or panic disorders, phobias, depression, or alcoholism
in their families.
Others attribute its onset to a variety of triggers including problems with the joints in the neck and low back,motor
vehicle accidents,work-related injuries,viral illness,surgery,infection,emotional trauma, or physical or emotional stress.
The diagnosis criteria for fibromyalgia:
*One must have experienced widespread pain for a period of 3 months or longer.
*The pain must be above and below the waist,and on both left and right sides of the body.
*Another characteristic feature of fibromyalgia is the existence of at least 11 (of a possible 18) distinct sites of
deep muscle tenderness that hurts when touched firmly,these include the side of the neck,the top of the shoulder blade,the
outside of the upper buttock and hip joint,and the inside of the knee.The doctor will test this by either pressing on these
spots with her or his thumb.
In addition to widespread pain and specific tenderness in 11 of the 18 points,many people of fibromyalgia experience
a wide variety of other symptoms. Because some of these symptoms are also common in other types of arthritis,the doctor may
order blood tests,x-rays and other lab tests. These tests are done to find out if other diseases are present,and they do not
specifically diagnose fibromyalgia.
Some people who experience widespread pain without having 11 of 18 tender points or who have pain that is localized in
a specific part of the body,may also have many of the same symptoms as a person with fibromyalgia. Although these people will
not be formally diagnosed with the disease,they can also benefit from treatment.
Some people are unaware of some of the tender points,they become aware, only,when the rheumatologist apply finger pressure
on the tender points when testing for FM.
Medicine are typically the same as treating depression. Some are helpful and in only a minority of patients,they increase
a person's serotonin level. Serotonin is a chemical that naturally occurs in the brain. Research has shown that low levels
of serotonin are associated with depression,and other symptoms of fibromyalgia,including bowel problems,migrane headaches
and anxiety.
NSAIDs and corticosteriods has shown to be not useful in treating FM. It is frustrating for both patient and physician
because of its unknown cause and diverse symptoms. It has a reputation for resisting treatment. But researchers at the Mayo
Clinic in Rochester recently developed a brief program that was able to provide some relief
In the first of the three half-day sessions,a team of doctors and nurses gave the patients medical, physical,physical,
psychological, educational and pharmacoligical assessments.
The second session focused on stress management techniques such as relaxation therapies and sleep hygiene.
Occupational and physical therapies including stretching and exercise were covered in the last session. One hundred
FM patients participated A month later they reported a reduction in pain,stiffness,fatigue and anxiety as well as the
number of "bad-days" per week The program benefited those patients with the more severe form. The researchers were encouraged
by being able to help with such a brief intervention.
Scleroderma--Also known as systemic sclerosis,the word scleroderma means "hard skin". It refers to several diseases that
almost always affect the skin,blood vessels,and joints. A more serious form also affects internal organs such as the lungs
and kidneys.
In scleroderma, there is abnormal and excessive production of collagen (a fiber-like protein) in the skin or internal
organs. Current studies are focusing on three areas of the disease: Overproduction of collagen,blood vessel injury,and abnormal
immune system activity.
Researchers hope to discover how these 3 elements interact with each other. One recent study involved patients
before developing scleroderma. The study suggests that fetal cells may play a role in scleroderma by maturing immune cells
that promote the overproduction of collagen. Scientists are continuing to study the implication of this finding.
Early on,the skin involved ( generally the skin of the hands and feet,and often the skin of the face ) may be reddened
and puffy. This period is brief, and in typical scleroderma the skin becomes shiny and tight. The fingers and hands are particularily
affected.
Wrinkles,and even the fine hairs on the backs of the fingers,disappear. The skin on the back of fingers resists pinching,
Tightness restricts finger movement, and its difficult to straighten fingers fully or make a fist. Fingertips are easily injured,and
cracks may be hard to heal
The extent of this change varies from patient to patient. In some it may be limited to the fingers and hands in others
it may involve the arm,face,trunk or legs. The process seems to spread from the fingers and toes,and move centrally. There
are different forms of the disease.
Sjogren's syndrome is a chronic disorder that causes damage to the salivary glands,resulting in dry mouth and the tear
glands,resulting in dry eyes. It can also affect other parts of the body including joints,muscles and nerves,organs such as
the lungs,kidneys,liver,pancreas,stomach and brain,or glands such as the thyroid gland.
About half the people diagnosed with Sjorgen's syndrome have other rheumatic conditions or connective tissue diseases,lupus,
scleroderma or polymyositis. It can be present in some RA patients. It is "secondary" Sjogren's syndrome when it occurs
in people who have a rheumatic condition. It is named "primary" Sjorgen's syndrome when dry eyes and mouth are not associated
with a rheumatic condition.
Juvenile rheumatoid arthritis--This is the most common form of arthritis in childhood, causing pain,stiffness and swelling,and
loss of function in the joints. Symptoms are often similar to adult RA,but it can involve more than just rheumatoid.
JRA may be mild that causes few problems overtime,but it can be persistent and cause joint and tissue damage. JRA can produce
serious complications in others.
*Pauciarticular JRA affects four or fewer joints.
*Polyarticular JRA affects five or more joints.
*Systemic JRA affects at least one joint,may cause rash and inflammation of internal organs. The type of JRA is usually
determined based on the symptoms of the child has had during the first six months of the illness.
Ankylosing spondylis--This type of arthritis primarily affects the spine, but may also cause arthritis in the hips,shoulders,and
knees. The tendons and ligaments around the bones and joints in the spine become inflamed,resulting in pain and stiffness,especially
in the lower back. The joints and ligaments that normally permit the back to move may fuse together. It tends to affect people
in late adolescence or early adulthood.
Gout--This type of arthritis results from deposits of needle-like crystals of uric acid in the connective tissue,joint
spaces,or both. Uric acid is a normal breakdown product of purines,which are present in body tissues and many foods.
Usually,uric acid passes through the kidney into urine and is eliminated. If the concentration of uric acid in the blood
rises above normal levels,sodium urate crystals may form in the tendons, ligaments, and cartilage of the joints. These needle-like
crystals cause inflammation, swelling,and pain in the affected joint. The joint most affected is the big toe.
The word "pseudogout" means "fake" or "imitation gout" Like the disease Gout,pseudogout can come on as a sudden,recurrent
attacks of pain and swelling in a joint. However,gout is caused by the build up of uric acid crystals.
Pseudogout results from build up of calcium crystals (calcium pyiophosphate dihydrate) in a joint Gout usually
attacks the big toe.
Pseudogout attacks the knee. The calcium deposits cause parts of the joint structure to weaken and break down. Bits of
cartilage may break off in the joint space and irritate soft tissues,such as muscles and cause trouble with movement.
Reactive arthritis--Reiter's syndrome is arthritis that produces pain, redness, swelling and heat in a joint. It is one
of a family of arthritis disorders called spondylarthropathies
It affects the spine and sacroiliac joints. Other parts of the body including arms and legs may be affected. Main characteristics
features are inflammation of the joints,ulceration of skin and mouth and infection of the urinary tract (bowel etc.)
Infectious Arthritis. The symptoms of infection arthritis vary according to the type of germ causing it. If the arthritis
is caused by a bacterium,inflammation is generally,located in only one place or area. Fever and chills may be present and
its onset is sudden.
With an infection caused by a virus,there is usually no fever,but there is a aching feeling all over the body Inflammation
canbe caused by a fungal infection in one area or throughhout the body,and it occurs slowly,over weeks or months. A fever
may or not be present.
Types of bacteria include gonoccus,hemophilus,straphylocoddus,tuberculois, streptococcus. Usually,the disease is cured
by antibiotic medication.
Psoriatic arthritis--This form of arthritis occurs in some patients with psoriasis,a common scaling skin condition. PA
often affects the joints at the ends of fingers and is accompanied by changes in fingernails and toenails.
Other joints are also often affected. Some people have spinal involvement similar to A.S. It is a inflammatory
type of arthritis. Difficult to diagnose at the onset of disease when the skin condition may not appear until later. Some
cases can be mild,others may experience serious disease consequences.
There are different types of PsA. Patients are classified in the seronegative class.Five to ten percent result in primary
showing inflammation of the end knuckle of fingers and toes. Five percent have low back pain dominating. Twenty percent have
episodes of inflammation in relatively few joints in an asymmetrical pattern (one side). Seventy percent have persisting polyarthritis
with charachteristics of PsA (low back pain etc) and resemble RA but with fewer joint involvement (usually).
Polymyalgia rheumatica--This form of rheumatic disease involves tendons, muscles,ligaments,and tissues around the joints.
It does not affect the joints. Muscles may be very sore but it does not cause the muscles to becone weak.
Pain, aching, and morning stiffness in the neck,shoulders,lower back,and hips characterize the disease. It is sometimes
the first sign of giant cell arteries ( a disease of the arteries characterized by inflammation, weakness,weight loss,and
fever. The joints are not affected.
Polymyositis is a rheumatic disease that causes weakness and inflammation of muscles. It can also affect the lung
and heart. Muscles in any part of the body can be affected. After a person has chronic polymyositis for a long period, muscle
may shrink.
It is called dermatomyositis when the skin is affected. It can cause skin rashes all over the body. Disease symptoms
may get stronger and then lessen-at times.
Lyme disease is a condition caused by the bacterium Borrelia burgdorferi in which arthritis is a often a prominent symptom.
Usually involves chronic inflammation affecting joints,skin-rash,heart disease,and nervous system involvement
Lyme disease is caused by the bite of a tick infected with germ. The germ enters the body at the spot where the tick
has bitten,and can travel to different parts of the body throufg the blood.
Raynaud's phenomenon is a condition resulting from poor circulation in the extremities (i.e.,fingers and toes). It is
a condition that make it harder for blood to reach certain areas of the body.
This happens because the blood vessels under the skin tightens. When blood does not reach parts of the body,these areas
may turn blue and feel cold. It can also affect the ears and nose.
People who have Scleroderma or Sjogren's syndrome are more likely to develop Raynaud's phenomenon or Raynaud's disease
as it is sometimes called.
When an area of bone in a person with Paget's disease,the bone that replaces it is soft and porous. Soft bones can be
weak and easily bend leading to shortening of the affected part of the body The bone replacement can occur very quickly
.
This can cause the bone to get larger,be painful and break easily. The bone affected by Paget's disease also tends to
have more blood vessels than normal. This causes an increase in the blood supply to the area and as a result the area may
feel warmer than usual. Paget's disease can lead to other disease such as osteoarthritis,kidney stones and heart disease.
Osteoporosis is a condition when bone itself breaks down. Bones then become thin,britle and easily broken. The bones
most commonly affected are those in the hip,wrist and back (vertebrae) particularily those in the mid-back. As vertebrae becomes
thin,they are prone to collapse from relatively minor forces.
Usually the fronts of the vertebrae break,leading to a state called wedging, which causes a person to stoop forward (hump-back
of the upper spine). Those people who do not develop wedging may notice a progressive loss of height as bone collapse occurs.
Hip fracture are common in osteoporosis. This disease is not a direct result of arthritis.
