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ORIGINAL ARTICLEReumatismo, 2008; 60: Supplemento 1: 15-24Symptoms and signs in fibromyalgia syndromeI segni e i sintomi della sindrome fibromialgicaG. Cassisi 1 , P. Sarzi-Puttini 2 , A. Alciati 3 , R. Casale 4 , L. Bazzichi 5 , R. Carignola 6 , R.H. Gracely 7 ,F. Salaffi 8 , F. Marinangeli 9 , R. Torta 10 , M.A. Giamberardino 11 , D. Buskila 12 , M. Spath 13 , M. Cazzola 14 ,M. Di Franco 15 , G. Biasi 16 , S. Stisi 17 , L. Altomonte 18 , G. Arioli 19 , G. Leardini 20 , R. Gorla 21 ,A. Marsico 22 , F. Ceccherelli 23 , F. Atzeni 2 (Italian Fibromyalgia Network)1Rheumatology Branch, Specialist Outpatients' Department, Belluno, Italy; 2 Rheumatology Unit, L.Sacco University Hospital, Milan,Italy; 3 Department of Psychiatry, L. Sacco University Hospital, Milan, Italy; 4 Department of Clinical Neurophysiology and PainRehabilitation Unit, Foundation Salvatore Maugeri, IRCCS, Scientific Institute of Montescano, Montescano (PV), Italy; 5 Department ofInternal Medicine, Division of Rheumatology, S. Chiara Hospital, University of Pisa, Italy; 6 S.C.D.U. Internal Medicine I, Departmentof Clinical and Biological Science, University of Turin, Italy; 7 Department of Medicine, University of Michigan Health System, AnnArbor, USA; 8 Department of Rheumatology, Polytechnic University of the Marche Region, Ancona, Italy; 9 Department ofAnesthesiology and Pain Medicine, L'Aquila University, L'Aquila, Italy; 10 Department of Neuroscience, University of Turin, A.S.O.San Giovanni Battista of Turin, Turin, Italy; 11 Ce.S.I. “G. D’Annunzio” Foundation, Department of Medicine and Science of Aging,“G. D’Annunzio”, University of Chieti, Italy; 12 Department of Medicine H, Soroka Medical Center and Faculty of Health Sciences,Ben Gurion University, Beer Sheva, Israel; 13 Friedrich-Baur-Institute, University of Munich, Germany; 14 Unit of RehabilitativeMedicine “Hospital of Circolo”, Saronno (VA), Italy; 15 Chair of Rheumatology, University la Sapienza Rome, Rome, Italy;16Unit of Rheumatology, University of Siena, Siena, Italy; 17 Rheumatology Unit, “G. Rummo” Hospital, Benevento, Italy;18UOC of Rheumatology Hospital S. Eugenio, Rome, Italy; 19 Division of Rehabilitative Medicine and Rheumatology, General Hospitalof Pieve di Coriano (Mantua), Italy; 20 Rheumatology Unit, SS Giovanni e Paolo Hospital, Venice, Italy; 21 Rheumatology and ClinicalImmunology, Spedali Civili and University of Brescia, Italy; 22 Rheumatology Unit, Hospital of Taranto, Taranto, Italy;23IOV (Veneto Cancer Institute), IRCCS, Department of Pharmacology and Anesthesiology, University of Padua, ItalyCompeting interests: none declaredRIASSUNTO67,814La sindrome fibromialgica (FM) è una comune condizione di dolore cronico che interessa almeno il 2% della popolazione.Il dolore cronico diffuso è l’elemento caratterizzante la FM, ma i pazienti possono riferire una varietà di altrisintomi, compresi disturbi del sonno, astenia, sindrome da colon irritabile, cefalea, e disturbi del tono dell’umore.L’eziologia della FM non è completamente conosciuta e la sindrome viene influenzata da una varietà di fattori qualistress, malattie mediche e una molteplicità di condizioni dolorose. Stabilire la diagnosi può essere difficile a causadella natura multiforme della sindrome e della sovrapposizione con altre sindromi dolorose croniche. Un’ipotesi unificatriceè che la FM risulti dalla sensibilizzazione del sistema nervoso centrale; questo nuovo concetto potrebbe giustificarela varietà di caratteristiche cliniche della sindrome. I sintomi della FM possono essere muscolo scheletrici,non-muscoloscheletrici o una combinazioni di entrambi e molti pazienti sperimentano un insieme di sintomi o condizionicliniche. I criteri classificativi ACR si focalizzano solamente sul dolore e non considerano altri sintomi importanti,ma tre sintomi-chiave, dolore, astenia e disturbi del sonno sono presenti praticamente in ogni paziente affettoda FM. Parecchi altri disturbi associati comprendenti i sistemi circolatorio, nervoso, digestivo, e genito-urinatio sonoprobabilmentre parte della cosiddetta sindrome da sensibilizzazione centrale. Una minoranza dei pazienti (30-40%)ha un significativo disturbo psicologico. I disturbi psichiatrici più comunemente descritti sono i disturbi del tonodell’umore, ma le patologie psichiatriche non costituiscono un fattore necessario nella eziopatogenesi della FM.Reumatismo, 2008; 60: Supplemento 1: 15-24INTRODUCTIONFibromyalgia (FM) is currently classified aschronic widespread pain with widespread al-Corresponding author:Fabiola Atzeni, MD, PhDRheumatology UnitL. Sacco University Hospital, Milan, ItalyE-mail: atzenifabiola@hotmail.comlodynia/hyperalgesia to pressure pain and is categorizedamong the large group of soft-tissue painsyndromes. FM remains an elusive condition ofunknown etiology in which patients report not onlychronic widespread pain but also a variety ofother complaints, so that it is one of several relativelycommon overlapping syndromes characterizedby otherwise unexplained chronic pain and fatigue(1, 2).
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