Fibromialgiya: clinic, diagnosticsFibromialgiya (FM) - the simptomokompleks, being characterised chronic diffuzny musculoskeletal pain, existence of painful points, a depression, dream violation, morning constraint, an adynamy.

Prevalence of FM in the general population makes not less than 4 %. Much more often FM suffer women. Ratio of women and men слставляет 7-10:1. FM can be observed at any age, however the most able-bodied period from 25 to 45 years is prevailing.

Disease history

For the first time the clinical syndrome of FM has been described more than 150 years ago. In 1904 of W. Govers in article about люмбаго calls a syndrome of diffuzny muscular pains "fibrozity", emphasising a role of inflammatory changes in muscles as the reasons of painful feelings. In 1947 of E. Boland has put forward the concept of «psychogenic rheumatism» which has supporters and now. In the 50-60th years a number of researchers was carried by FM to a psychosomatic disease. In 1981 after emergence of the publication about the diagnostic criteria of a disease offered M. Yunus and A. Masi, the term "fibromialgiya" was strongly fixed in literature. Researchers have divided FM on primary and secondary.

Primary FM shows the isolated form of a disease, develops in lack of contributing factors.

Secondary FM is imposed on other condition with the expressed pain syndrome. To secondary FM, as a rule, points a certain anamnesis: existence rheumatic (osteoarthritis, revmatoidny arthritis, system red volchanka) or not rheumatic (гиперпаратиреоз, hypothyroidism, paraneoplastic syndromes, энтероколит, anaemia) diseases, traumas.

Proceeding from it, authors have undertaken attempt of allocation of obligatory, main and additional criteria of primary FM.

And. Obligatory criteria: generalizovanny morbidity, pains or constraint at least in 3 anatomic zones within 3 months and more; lack of other reasons of primary FM (not changed laboratory indicators and normal roentgenograms).

B. Main criteria: existence at least 5 painful points.

Century. Additional criteria: communication of symptoms with physical activity; their communication with weather factors; strengthening of symptoms under the influence of excitements and stresses; general fatigue; generalizovanny weakness or fatigue; chronic headache; syndrome of the angry thick gut; subjective feelings of a swelling of joints and muscles; subjective feelings of an onemeniye in them.

The diagnosis is indisputable in the presence of criteria And, B and 3 points B or A, 3-4 painful points and 5 points B.

Clinical picture

Almost at 30 % of patients of FM develops since the childhood. In a disease debut at children the severe pains which are localising in skeletal muscles and area of joints are often noted. For FM of children's age the subjective feeling of a swelling in painful joints (in 100 % of cases) is characteristic. FM ratio at children's age among boys and girls makes about 1:1. At 2/3 children the disease passes completely within several years.

At the age of 60-79 years prevalence of FM makes about 7 %. The disease is characterised by more expressed pain syndrome. In this age group the whole simptomokompleks of somatic and mental violations is noted. Intensity of a pain syndrome in direct ratio increases with age both at men, and at women.

The main manifestation of FM is the pain observed in all cases. It is possible to define it as generalizovanny, i.e. diffuzny, bilateral, symmetric, involving top and bottom half of a body or as axial (in a neck, a back, area of a forward thorax, a waist). Duration of pain exceeds 3 last (to the address to the doctor) month. In 60 % of cases at FM pain is characterised by constancy. Data that the most frequent sites of painful feelings at FM are neck area, plechelopatochny area, lumbar department of a backbone and a zone of coxofemoral joints are interesting.

Pain at FM carries aching, deep, exhausting, monotonous character and becomes aggravated in a condition of fatigue, an emotional pressure, superfluous physical activity, and also an immovability, cooling, a long pozny overstrain. Pains under the influence of heat, massage are facilitated, at observance of a mode of impellent activity, rest. In spite of the fact that intensity of pain changes within days and in different days, it accompanies the person constantly, and, as a rule, he cannot specify day when his health was "normal".

Besides pain, for FM it is characteristic and some more symptoms. About 90 % of patients note morning constraint in joints more than 15 mines with average duration of 2-3 h. Constraint in the form of restriction of mobility has indistinct, indistinct borders and is not localised in this or that articulate area (it considerably distinguishes FM from revmatoidny arthritis at which constraint is localised in joints).

Fatigue or adynamy are observed at 81,4 % of patients with FM. Often fatigue is so high that is the symptom most disturbing them.

Violations of a dream belong to the most frequent symptoms of FM (74,6 %). The characteristic complaint reflecting violation of a dream, absence at patients of satisfaction with a night dream is. The combination of pain, morning constraint, an adynamy and violations of a dream is noted more than at 75 % of patients.

Painful points

To FM existence of the multiple painful points (tender points) having a number of regularities is specific. One of most characteristics is reproducibility of pain when after a palpation of painful points pain is reproduced. Painful points are located more often in places of an attachment of muscles and sinews and are characterised by symmetry. Sensitivity of muscular areas in others, than localisation of points, places not above, than at healthy people.

Representation is high at FM of tunnel syndromes, somatic, mental and other violations. Among the last allocate panic attacks - 59 %, a hyper ventilating syndrome - 56 %, a syndrome of angry intestines - 53 %, violations of a warm rhythm - 42 %, дисменорею - 40,6 %, Reynaud's syndrome - 12,8 %, sinkopalny conditions - 21 %, a syndrome of the angry bladder - 14 %.

In recent years there were publications about possible communication between a depression and FM. The depression was widespread among relatives of the first degree of relationship of the surveyed patients with FM.

Criteria of diagnostics of FM (1990)

Criteria include two points.

I. Existence of the diffuzny pain extending on both half of a trunk, the top and bottom extremities which can be axial (in a neck, area of a thorax, lumbar area). The fact of existence of pain at least within the last 3 months is obligatory. Thus presence of other clinical pathology does not exclude FM diagnosis.

II. Existence not less than 11 of 18 specific painful (sensitive) points.

Zones of a palpation of painful points:

- occipital area - a place of an attachment of m. suboccipitalis;

- neck area

- forward departments of spaces between cross-section shoots С5 - С7;

- a trapezoid muscle - the middle of the upper edge;

- a nadostny muscle in a place of its attachment;

- area of a grudinoreberny joint at level of the II edge on its upper edge;
- area on 2 cm distalny external an elbow nadmyshchelka;
- buttock area - the top external kvadrant of a buttock on a first line of muscles;
- big spits of a hip;
- area of a knee joint - a medial fatty pillow.

Forecast at a fibromialgiya

FM is a chronic disease with a flyuktuiruyushchy current. Symptoms of FM remain for years a
nd decades, slightly changing under the influence of certain factors. However it is necessary to explain methodically to the patient that damage of body or a fabric does not occur at FM that the disease is quite compatible to life, thereby involving it in active counteraction of an illness.

Literature:

Tabeeva, Levin Ya. I., Korotkov S. B., Hanunov I. G. Fibromialgiya. Zhurn of neurology and psychiatry 1998; 98: 4: 40-43

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