Transcript Document

Fibromyalgia:
A Chronic Widespread
Neurologic Pain Condition
Disease Overview, Diagnosis, and Management
PBP00542 © 2009 Pfizer Inc. All rights reserved. Printed in USA/September 2009
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What is Fibromyalgia?
Pathogenesis of Fibromyalgia
Clinical Features and Diagnosis of Fibromyalgia
Management of Fibromyalgia
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Clinical Presentation of FM
Pain in all 4 quadrants
of the body ≥3 months1,2
Patient descriptors3
Aching, Nagging, Hurting
Chronic
Widespread
Pain and
Tenderness
Hallmark features of FM
Hyperalgesia & Allodynia3
Sensitivity to
pressure stimuli2
Pain is the core symptom of FM, however patients may also present
with the following complaints2,4-6
•
•
•
Fatigue
Sleep disturbance
Numbness or
tingling sensations
•
•
•
•
Morning stiffness
Headaches/migraines
IBS
Mood symptoms
1Leavitt
4Roizenblatt
2Wolfe
5Harding
F, et al. Arthritis Rheum. 1986;29:775-781.
F, et al. Arthritis Rheum. 1995;38:19-28.
3Staud R. Arthritis Res Ther. 2006;8(3):208-214.
S, et al. Arthritis Rheum. 2001;44:222-230.
SM. Am J Med Sci. 1998;315:367-376.
6Weir PT, et al. J Clin Rheumatology. 2006;12(3):124-128.
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FM Patients Experience
Widespread Pain
In Patients with FM, Pain Presented in More Areas
Than Other Chronic Pain Conditions
Chronic Pain Controls (n=265)
FM Patients (n=293)
*
97
100
*
% of Patients
80
*
*
85
79
72
69
60
46
51
40
24
20
0
Widespread Pain
Thoracic Pain
*p<0.001 N-558
Wolfe F, et al. Arthritis Rheum. 1990;33:160-172.
Lumbar Pain
Cervical Pain
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FM Patients Experience
Widespread Pain
•
•
In this pain drawing, a
typical FM patient is asked
to shade the areas of the
body that are painful1
This drawing indicates that
FM patients experience
widespread pain all over
the body1
Back
Front
Adapted from pain drawing provided courtesy of L Bateman
1Silverman
SL and Martin SA. In: Wallace DJ, Clauw DJ, eds. Fibromyalgia & Other Central
Pain Syndromes. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005:309-319.
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ACR Manual Tender Point Exam
for the Diagnosis of FM1
OCCIPUT
At nuchal muscle
insertion
LOW CERVICAL
Anterior aspects of C5, C7
intertransverse spaces
FOREHEAD
SECOND RIB SPACE
Upper border of
trapezius, midportion
SUPRASPINATUS
About 3 cm lateral
to sternal border
At attachment to medial
border of scapula
ELBOW
Muscle attachments to
Lateral Epicondyle
TRAPEZIUS
RIGHT FOREARM
LEFT
THUMB
KNEE
Medial fat pad of knee
proximal to joint line
GLUTEAL
Upper outer quadrant of
gluteal muscles
GREATER
TROCHANTER
Muscle attachments just
posterior to GT
Manual Tender Points Exam2
• Presence of 11 tender points on palpation to a maximum of 4 kg of pressure
(just enough to blanch examiner’s thumbnail)
• ACR criteria are both sensitive (88.4%) and specific (81.1%)3
Control Points
Tender Points
*Based on 1990 ACR FM Criteria
1National Fibromyalgia Association. Available at: http://www.fmaware.org/site/News2?page=NewsArticle&id=6263. Accessed September 12, 2009.
2Adapted from Chakrabarty S and Zoorob R. Am Fam Physician. 2007;76(2);247-254.
3Wolfe F, et al. Arthritis Rheum. 1990;33:160-172.
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Patients with FM Are More Likely to Have
Concomitant Chronic Pain Conditions
Associations of Pain-Related Conditions Among Patients
Diagnosed with FM in the DMBA Database Between 1997 and 20021
FM Patients
Female (n=906)
Male (n=1689)
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Risk Ratio
‡
6
5
4
3
2
Baseline†
1
0
SLE
RA
IBS
Headache*
• 20% of patients with SLE, RA and OA have concomitant FM2
• Because patients with FM are often diagnosed with other pain-related conditions, FM may go undetected1
DMBA = Deseret Mutual Benefits Administration
SLE = Systemic lupus erythematosus; RA = Rheumatoid Arthritis; IBS = Irritable Bowel Syndrome
*Headache = headache, tension headache, migraine
†Baseline from 52,698 females and 52,232 males without FM
‡Risk ratio = The probability of each condition occurring in FM patients as compared to a normal, healthy control group (baseline=1)
1Weir PT, et al. J Clin Rheumatology. 2006;12(3):124-128.
2Wolfe F and Rasker JJ. Fibromyalgia. In: Firestein, ed. Kelly’s Textbook of Rheumatology, 8th Edition. St. Louis, MO: WB Saunders Co; 2008.
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Patient Health Dissatisfaction
Diagnosis of FM Improves
Health Satisfaction1
Lower number indicates
improved patient satisfaction
4
3.0
3
2.2 *
2
1
0
Baseline
Post-Diagnosis
n=100
*Statistically significant versus baseline (P value not provided) as a change in the 5-point Likert scale
1Goldenberg DL, et al. JAMA. 2004;292:2388-2395.
2Adapted from White KP, et al. Arthritis Rheum. 2002;47:260-265.
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