1813 01 REUMA3 Editoriale - ME/CFS Australia

12 M. Cazzola et al.teria, three subsets of FM patients can be identifiedbased on individual pain-emotional and neurobiologicalcharacteristics that respond differently tospecific therapeutic strategies.Many common musculoskeletal conditions canmimic FM and, thus, may be misdiagnosed as FM.Moreover, many patients do not completely satisfythe FM criteria; rather, they only present with afew symptoms. FM may co-occur or overlap severalrheumatic and non-rheumatic conditions. Inpatients with widespread pain and fatigue, it is necessaryto rule out the presence of any other medicalcondition or disease known to cause thesesymptoms (27, 28).A simple and rational approach to evaluating thesepatients should include a complete clinical history,a physical examination and laboratory tests; andpatients with a history that suggests FM should undergofurther investigation of their vital signs; TPs;joints and tendons; neurological, abdominal andthyroid status; and signs of connective tissue orother concomitant diseases (49). Laboratory assessmentsshould include a complete blood cellcount for common anemias, infections and bonemarrow diseases. Although ESR and C-reactiveprotein are non-specific, they can help to confirmsystemic inflammation or infection. Patients presentingwith fatigue and widespread pain shouldundergo routine thyroid function tests. A standardchemistry panel (liver and kidney function, serumfasting glucose, blood lipids) is useful to evaluateoverall systemic health. If the physical examinationfindings suggest joint involvement and soft tissueinflammation, additional serological tests such asrheumatoid factor, ANAs or others should be performed(27). There is agreement that the differentialdiagnosis of FM should be ruled out as far aspossible by adding a number of simple blood teststo the physical examination, which would be justifiedif the history and physical examination suggestanother concomitant or associated condition.Finally, FM should be diagnosed on the basis of itsown characteristics and not just by exclusion; thepresence of a concomitant disease such as arthritisor hypothyroidism does not exclude a diagnosis ofFM (25,49).SUMMARYEver since it was first defined, fibromyalgia (FM) has been considered one of the most controversial diagnoses in thefield of rheumatology, to the point that not everybody accepts its existence as an independent entity. The sensitivityand specificity of the proposed diagnostic criteria are still debated by various specialists (not only rheumatologists),whose main criticism of the 1990 American College of Rheumatology criteria is that they identify subsets of particularpatients that do not reflect everyday clinical reality. Furthermore, the symptoms characterising FM overlap withthose of many other conditions classified in a different manner. Over the last few years, this has led to FM being consideredless as a clinical entity and more as a possible manifestation of alterations in the psychoneuroendocrine system(the spectrum of affective disorders) or the stress reaction system (dysfunctional symptoms). More recently, doubtshave been raised about even these classifications; and it now seems more appropriate to include FM among the centralsensitisation syndromes, which identify the main pathogenetic mechanism as the cause of skeletal and extra-skeletalsymptoms of FM and other previously defined “dysfunctional” syndromes.Key words - Diagnosis, ACR criteria, overlap syndrome, dysfunctional syndromes.Parole chiave - Diagnosi, criteri ACR, sindrome da overlap, sindromi disfunzionali.REFERENCES1. Gowers WR. Lumbago: its lessons and analogues. BrMed J, 1904; 1: 117-21.2. Smythe HA, Moldofsky H. Two contributions to understandingof the fibrositis syndrome. Bull Rheum Dis1977; 28: 928-31.3. Yunus M, Masi AT, Clabro JJ, Miller KA, FeigenbaumSL. Primary fibromyalgia (fibrositis): clinical study of50 patients with matched normal controls. SeminArthritis Rheum 1981; 11: 151-71.4. Wolfe F, Smythe HA, Yunus MB, Bennett RM, BombardierC, Goldenberg DL, et al. The American Collegeof Rheumatology 1990 criteria for the classification offibromyalgia. Report of the multicenter criteria committee.Arthritis Rheum 1990; 2: 160-72.5. Tunks E, McCain GA, Hart LE, Teasell RW, GoldsmithCH, Rollman GB, et al. The reliability of examinationsfor tenderness in patients with myofascial pain,chronic fibromylagia and controls. J Rheumatol 1995;22: 944-52.6. Wolfe F, Smons DG, Fricton J, Bennett RM, Golden-