Medicine / Rheumatology
ATTN: Medical Professionals - Want to get published and be heard on nyjsm.com?
Click Here to Submit your Educational Article or Professional Medical Opinion

Advertisement:

Kaplan Test Prep and Admissions (Kaptest.com)


Did they tell you that you have fibromyalgia?

February 14, 2008

Frank Vasey, MD



I write because I am the fibromyalgia practitioner at the University Of South Florida College Of Medicine in Tampa. Some of my rheumatology colleagues will refuse to see you if you tell the appointment person you have fibromyalgia.

I write because I dispute the conventional wisdom that your problem is psychological. Sure you are upset and depressed. Who wouldn't be! You feel like you have the world's worst flu every day. The psychological problems come from the illness ... they are not causing it, in my experience.

Hugh Smythe, a rheumatologist from Toronto, worked with a psychiatrist in the 1960's to show there was a sleep disturbance as a central feature of this disorder. They studied rapid eye movement [REM] sleep and sounded a buzzer to disturb sleep. They were able to produce tender muscles. They used the term fibrositis, but on muscle biopsy there was no inflammation. The term was changed to fibromyalgia.

There is no dispute that people have chronic "tender points and trigger zones" in their muscles. The traditional concept of personality became the cause of fibromyalgia. You are tense, anxious, compulsive, and industrious and you don't sleep well. My suggestion is you don't sleep well because your muscles hurt ... not because of your personality. In most people, but not all, the immune system has gone "haywire" to cause the myalgias.

So how do you tell what you have ... because all your blood tests are normal? My "top secret" method is an almost 60 year old treatment ... a trial of low dose prednisone as is given for polymyalgia rheumatica. The dose is prednisone 5 mg. 3 times a day for 2 weeks. If you feel much better you are inflamed. Remember too there is no arthritis [swollen joints] of fibromyalgia. One proviso is if you are double jointed you may retain water easily and swell for that reason and even be bloated and in pain for that reason. Try a water pill (the idiopathic edema is in the medical literature but the association with joint hyper mobility is not). Also, make sure you can take cortisone as it has many side effects over the long term but for 2 weeks at low doses, it is pretty safe. The body makes prednisone 7 mg normally. Your blood sugar can go up if you are diabetic. If it doesn't work try Cymbalta, neurontin or Lyrica. If it does work, you are suffering from an inflammatory process. You need a better diagnosis and a treatment that will substitute for the cortisone.

See your rheumatologist. The following are possibilities:
- normal sedimentation rate polymyalgia rheumatica (a form of rheumatoid arthritis [RA], the clue could be a close relative with RA.)
- psoriatic arthritis
- reactive arthritis to food poisoning Salmonella, etc. or Chlamydia; see my "safe sex" article on NYJSM.com
- anklyosing spondylitis, supposedly 10 to1 in men, but frequently missed in woman.
- inflammatory bowel disease arthritis (i.e. Crohns disease and ulcerative colitis, but remember the colitis can be occult as in collagen colitis and microscopic colitis)
- arthritis of acne and hydradidinitis suppurtiva (sweat gland infections under the arms, groin and scalp)

There are old and new treatments which can help. Good Luck.

NYJSM.com on Social Media