Summary
Definition
History and exam
Key diagnostic factors
- widespread pain and stiffness
- sleep disturbance/fatigue
- cognitive difficulties
Other diagnostic factors
- allodynia and/or hyperalgesia
- diffuse tenderness on exam
- sensitivity to sensory stimuli
- headaches
- mood disturbance
- numbness/tingling sensations
Risk factors
- family history of fibromyalgia (FM)
- rheumatologic conditions
- age between 20 and 60 years
- female sex
- stressful events
- sleep problems
- infections
- vitamin D deficiency
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- erythrocyte sedimentation rate (ESR)/CRP
- thyroid function test
- CBC
- rheumatoid factor
- anti-cyclic citrullinated protein (CCP) antibody
- antinuclear antibody or anti-DNA antibody
- vitamin D level
- creatinine kinase
- ferritin
- overnight oximetry/polysomnography
Treatment algorithm
mild or moderate fibromyalgia
severe fibromyalgia
Contributors
Authors
Matthew A. Bartlett, MB, BCh, BAO
Assistant Professor of Medicine
Fibromyalgia Clinic
Division of General Internal Medicine
Department of Internal Medicine
Mayo Clinic
Rochester
MN
Disclosures
MAB declares that he owns stock in Johnson & Johnson. No products developed or marketed by Johnson & Johnson are included in this topic.
Christopher V. Anstine, MD
Assistant Professor of Medicine
Fibromyalgia Clinic
Division of General Internal Medicine
Department of Internal Medicine
Mayo Clinic
Rochester
MN
Disclosures
CVA declares he has no competing interests.
Acknowledgements
Dr Matthew A. Barlett and Dr Christopher V. Anstine would like to gratefully acknowledge Dr Daniel J. Clauw and Dr Lisa Ware Corbin, previous contributors to this topic.
Disclosures
LWC and DJC declare that they have no competing interests.
Peer reviewers
Don Goldenberg, MD
Emeritus Professor of Medicine
Tufts University School of Medicine
Boston
MA
Disclosures
DG declares that he has no competing interests.
Robert Bennett, MD
Professor of Medicine and Nursing Research
Oregon Health & Science University
Portland
OR
Disclosures
RB declares that he has no competing interests.
Differentials
- Rheumatoid arthritis (RA)
- Polymyalgia rheumatica (PMR)
- Systemic lupus erythematosus (SLE)
More DifferentialsGuidelines
- ACTTION-APS Pain Taxonomy (AAPT) diagnostic criteria for fibromyalgia
- EULAR revised recommendations for the management of fibromyalgia
More GuidelinesPatient information
Fibromyalgia: what is it?
Fibromyalgia: what treatments work?
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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