13/07/2013 by admin | Rheumatology

Painful, non-articular condition of unknown cause, involving muscles. Common and results in significant disability and handicap, 90% female, 40-50yo.

  1. p/c: pain/tenderness locations
    1. o Insertion of nuchal muscles into the occiput
    2. o Upper border of trapezius midportion
    3. o Muscle attachments to upper medial border of scapula
    4. o Anterior aspects of C5, C7 intertransverse spaces
    5. o 2nd rib space ~3cm lateral to sternal border
    6. o Muscle attachments to lateral epicondyle at the elbow
    7. o Upper outer quadrant of gluteal muscle
    8. o Muscle attachements just posterior to greater trochanter
    9. o Medial fat pad of the knee proximal to the joint line
  2. Pain is usually worsened by stress, cold or activity and is associated with morning stiffness
  3. Paraesthesiae of hands and feet, analgesics and NSAIDs are ineffective, sleep patterns are poor (wake exhausted), anxiety and depression are present, unexplained headaches, urinary frequency, abdo pain…
  4. Ix: exclude hypothyroid, SLE, Sjogren’s, psoriatic arthritis, inflammatory myopathy, hyperparathyroidism, osteomalacia. Check FBC, ESR, TFT, U&E, Ca2, CK, PO4, ANA, RhF, and immunoglobulins.
  5. Diagnostic criteria: Hx of widespread pain (L and R side, above and below waist, with axial pain AND pain in >11 of the 18 tender points above.
  6. Mx: MDT, support and reassurance, low dose amitriptyline 25-75mg nocte may help sleep and pain. SSRI (sertraline 25-50mg OD) may help anxiety/depression, graded exercise regimes can improve lethargy/mood/malaise, CBT, steroid injection to trigger points.


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