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eISSN: 2084-9834
ISSN: 0034-6233
Reumatologia/Rheumatology
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5/2018
vol. 56
 
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abstract:
Editorial

Diagnostic and therapeutic challenge – fibromyalgia

Brygida Kwiatkowska

Reumatologia 2018; 56, 5: 273-274
Online publish date: 2018/10/31
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The first descriptions of fibromyalgia (FB) come from the nineteenth century, but it is still a disease that poses great diagnostic difficulties. This is due to the fact that biomarkers specific to the disease that could be used to diagnose it have not been detected so far.
Despite the existence of diagnostic criteria for FB, the mean time from the onset of the first symptoms to the diagnosis is 6.5 years. Most patients complain of chronic pain of the joints, muscles, head and the sacral area of the spine. These conditions are accompanied by fatigue, problems with falling asleep and cognitive deterioration. Often, patients also report stiffness, leg cramps, hypersensitivity to pressure, tingling and/or numbness, feelings of anxiety and depression, and facial pain [1]. A multitude of symptoms causes that the majority of patients are treated by specialists from various fields of medicine before they are directed to rheumatologist. Over 20% of patients is not able to work because of the severity of FB symptoms, and as many as 25% do not work full time for this reason [2].
Although the pathogenesis of FB remains not fully understood, a number of agents are considered as triggering factors. Among them are neuroendocrine and autonomic nervous system disorders, certain genetic factors, psychosocial factors and environmental stressors [3]. These factors are also involved in the pathophysiology of other disorders, which often coexist with FB, such as irritable bowel syndrome, disorders of the temporomandibular joint, depression and anxiety disorders. Fibromyalgia is not a rare disease, as it occurs in 2–8% of the general population. It mainly affects women aged 20–55 [3]. It has also been shown that patients with FB family history have an increased risk of developing the illness even 8.5 fold.
Patients with FB symptoms have increased sensitivity to stimuli such as heat and cold, as well as to mechanical pressure and ischemia. There is evidence that FB is characterized by increased sensory activity mediated by mechanisms associated with the central nervous system similar to those found in neuropathic pain, where abnormal concentrations of serotonin and adrenaline – neurotransmitters of endogenous pain inhibiting pathways – are being observed [4].
It has been shown that in some patients the disease is the result of past infection (Epstein-Barr virus, viral hepatitis, Lyme disease) or persistent infection, as is the case with Herpes simplex...


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