What is it?
Fibromyalgia is a chronic rheumatic disease characterized by generalized pain in the musculoskeletal system that is accompanied by intense tiredness, decreased functional capacity, cognitive and sleep disturbances, functional symptoms in various organs, and poor mood.
This pathology can manifest at any age, but it is much more prevalent in the middle ages of life and is considered the most frequent cause of musculoskeletal pain.
Carlos Bastid Calve, head of the Locomotor System Working Group of the Spanish Society of General and Family Physicians (SEMG), details that this widespread pain persists “for more than three months.”
This disease represents 5 to 8 percent of primary care visits and 10 to 20 percent of rheumatology visits
In Spain the prevalence among the general population over 18 years “is 2.7%, very similar to that of other countries in our environment, “says Javier Rivera, spokesman for the Spanish Society of Rheumatology (SER). In other culturally different geographical areas from the West, such as Asia, “the prevalence is also high and reaches 1.7% of the population,” he adds.
Regarding the evolution of this disease, the rheumatologist comments that “in another epidemiological study also carried out in Spain 15 years ago, the prevalence was 2.4%, which suggests a slight increase.”
Although the causes of this disease are unknown, from SER they explain that today fibromyalgia is thought to be caused by an alteration of certain neurotransmitters of the nervous system, which are the substances responsible for communication between neurons.
“We know that there are many traumatic, psychological, infectious, or emotional factors capable of triggering the appearance of fibromyalgia,” Rivera says. It is also known that in these patients there is “sensitization of the central nervous system with activation of certain brain nuclei, hypo activity in others, and numerous alterations in brain neurotransmitters that explain the symptoms of the disease well.”
On the other hand, several genetic polymorphisms associated with fibromyalgia have been described, which justifies the presence of families with several members affected by the disease and therefore with a greater predisposition to suffer it.
According to SER, the most frequent clinical manifestations are:
Muscle pain: also known as myalgia, which appears chronically and can last for more than three months. This pain is diffuse, nonspecific, and affects many different parts of the body. Fibromyalgia pain has some peculiarities such as allodynia (pain due to non-painful stimuli), hyperalgesia (greater than normal pain in relation to the painful stimulus) and persistence (it is present for longer than normal).
Fatigue and tiredness: These two symptoms appear with little or no effort, and do not always disappear when resting.
Stiffness: Although stiffness can appear as a symptom of other rheumatic diseases, like fatigue and tiredness, it has a number of peculiarities that differentiate it from other pathologies such as rheumatoid arthritis, osteoarthritis or lupus.
In these cases, patients may experience numbness, leg cramps, a feeling of swelling, stiffness, muscle contractions, involuntary movements, tremor, and a feeling of blockage.
Sleep disorders: People who have fibromyalgia may have trouble falling asleep, as well as waking up repeatedly at night or not getting restful sleep.
Cognitive impairment: This disease can make it difficult for the patient to process information, memorization, or to express himself properly.
The anxiety and depression are often linked to the disease. However, specialists cannot determine if they occur before, as a consequence of the disease or appear in the course of it.
Finally, there are many symptoms related to gastrointestinal disorders, such as irritable bowel or hiatus hernia , musculoskeletal disorders, such as carpal tunnel syndrome, metabolic ( hypothyroidism ) and autonomic (dizziness, vertigo, hypotension, etc.).
On the other hand, these symptoms can often cause fibromyalgia to be confused with polymyalgia rheumatic, a pathology characterized by pain with functional impotence and stiffness. However, unlike fibromyalgia, polymyalgia rheumatic is an inflammatory disease that produces changes in blood tests and has specific diagnostic tests and treatments.
Since only the possible causes of the disease are suspected, there are currently no preventive measures to mitigate its appearance. Experts insist on the importance of early diagnosis, which allows to establish an adequate treatment early and significantly improves the prognosis.
The SER spokesperson points out that at present “there is no good classification of fibromyalgia patients. Over the past few years, quite a few classifications have been drawn up and always based on specific needs at any given time.”
The diagnosis is made by clinical examination of the patient and by the existence of different symptoms, such as pain, stiffness or sleep disorders, without an alternative explanation that justifies that it is another disease.
As indicated by SER, the result of the general physical examination is usually normal and currently there is no imaging or laboratory test to confirm the diagnosis, although the tests can help rule out other diseases such as lupus, hypothyroidism or rheumatoid arthritis.
The differential diagnosis is usually confirmed when the examination reveals a set of points, called pressure pain points , that are located in various muscular areas of the body, mainly around the neck, elbow, knees and pelvis.