2 P. Sarzi-Puttini et al.The meeting held in Rome in February 2008 wasthe first gathering of health professionals from differentspecialties within the field of FM in Italy.Three international experts joined us for this occasionand gave a strong contribution to this successfulexpert consensus.The papers produced in this supplement representthe outcome of this meeting and should constitute,according to the participants, the first Italian consensusspecific to FM.There is still a long road ahead, one that requiresgood physicians and health care personnel, but italso requires assistance from the health care system,which must contribute resources to this syndrome.In the next few years, we expect officialrecognition of this syndrome and therapeutic strategiesto be delivered through the national health caresystem. The patient association is also growing,and we know that this association is valuable forits political strength.In conclusion, we need to reshape the pain perceptionof our FM patients and the perception ofhealth care personnel toward patients. Moreover,we need to give patients the chance to be treatedproperly; none of these patients should be ignoredor left to face such an invisible and debilitating diseasewithout help.REFERENCES1. Mease P, Arnold LM, Bennett R, Boonen A, BuskilaD, Carville S, Chappell A, et al. Fibromyalgia syndrome.J Rheumatol 2007; 34: 1415-25.2. Williams DA, Gracely RH. Biology and therapy of fibromyalgia.Functionalmagnetic resonance imagingfindings in fibromyalgia. Arthritis Res Ther 2006; 8(6): 224.3. Abeles M, Solitar BM, Pillinger MH, Abeles AM. Updateon fibromyalgia therapy. Am J Med 2008; 121:555-61.4. Sarzi-Puttini P, Buskila D, Carrabba M, Doria A,Atzeni F. Treatment Strategy in Fibromyalgia Syndrome:Where are we now? Semin Arthritis Rheum2008; 37: 353-65.5. Cazzola M, Sarzi-Puttini P, Buskila D, Atzeni F. Pharmacologicaltreatment of fibromyalgia. Reumatismo2007; 59: 280-91.6. Goldenberg DL. Multidisciplinary modalities in thetreatment of fibromyalgia. J Clin Psychiatry 2008; 69Suppl. 2: 30-4.7. Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F,Branco JC, Buskila D, et al. EULAR evidence-basedrecommendations for the management of fibromyalgiasyndrome. Ann Rheum Dis 2008; 67: 536.8. Lachapelle DL, Lavoie S, Boudreau A. The meaningand process of pain acceptance. Perceptions of womenliving with arthritis and fibromyalgia. Pain Res Mansag2008; 13: 2<strong>01</strong>-10.
ORIGINAL ARTICLEReumatismo, 2008; 60: Supplemento 1: 3-14Fibromyalgia syndrome:definition and diagnostic aspectsLa sindrome fibromialgica: definizione ed aspetti diagnosticiM. Cazzola 1 , P. Sarzi Puttini 2 , S. Stisi 3 , M. Di Franco 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 , G. Biasi 14 ,G. Cassisi 15 , R. Casale 16 , L. Altomonte 17 , G. Arioli 18 , A. Alciati 19 , A. Marsico 20 , F. Ceccherelli 21 ,G. Leardini 22 , R. Gorla 23 , F. Atzeni 2 (Italian Fibromyalgia Network)1Unit of Rehabilitative Medicine “Hospital of Circolo”, Saronno (VA), Italy; 2 Rheumatology Unit, L. Sacco University Hospital, Milan,Italy; 3 Rheumatology Unit, “G. Rummo” Hospital, Benevento, Italy; 4 Chair of Rheumatology, University la Sapienza Rome, Rome,Italy; 5 Department of Internal Medicine, Division of Rheumatology, S. Chiara Hospital, University of Pisa, Italy; 6 S.C.D.U. InternalMedicine I, Department of Clinical and Biological Science, University of Turin, Italy; 7 Department of Medicine, University of MichiganHealth System, Ann Arbor, Michigan, USA; 8 Department of Rheumatology, Polytechnic University of the Marche Region, Ancona, Italy;9Department of Anesthesiology and Pain Medicine, L'Aquila University, L'Aquila, Italy; 10 Department of Neuroscience, University ofTurin, A.S.O. San Giovanni Battista of Turin, Turin, Italy; 11 Ce.S.I. “G. D’Annunzio” Foundation, Department of Medicine and Scienceof Aging, “G. D’Annunzio”, University of Chieti , Italy; 12 Department of Medicine H, Soroka Medical Center and Faculty of HealthSciences, Ben Gurion University, Beer Sheva, Israel; 13 Friedrich-Baur-Institute, University of Munich, Germany; 14 Unit ofRheumatology, University of Siena, Siena, Italy; 15 Rheumatology Branch, Specialist Outpatients’ Department, Belluno, Italy;16Department of Clinical Neurophysiology and Pain Rehabilitation Unit, Foundation Salvatore Maugeri, IRCCS, Scientific Institute ofMontescano, Montescano (PV), Italy; 17 UOC of Rheumatology Hospital S. Eugenio, Rome, Italy; 18 Division of Rehabilitative Medicineand Rheumatology, General Hospital of Pieve di Coriano (Mantua), Italy; 19 Department of Psychiatry, L. Sacco University Hospital,Milan, Italy; 20 Rheumatology Unit, Hospital of Taranto, Taranto, Italy; 21 IOV (Veneto Cancer Institute) - IRCCS, - Department ofPharmacology and Anesthesiology, University of Padua, Italy; 22 Rheumatology Unit, SS Giovanni e Paolo Hospital , Venice, Italy;23Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, ItalyCompeting interests: none declaredRIASSUNTOFin dalla prima descrizione la FM è stata considerata tra le diagnosi più controverse in ambito reumatologico, dalmomento che non tutti accettano l’esistenza della FM come un’entità clinica indipendente. La sensibilità e la specificitàdei criteri diagnostici sono ancora oggetto di discussione tra i vari specialisti (non solo tra i reumatologi), chesollevano come critica principale il fatto che i criteri dell’American College del 1990 identificano solamente un subsetdi pazienti non rappresentativo della pratica clinica quotidiana. Inoltre, i sintomi caratteristici della FM sono similia quelli osservati in altre condizioni cliniche. Negli ultimi anni, questo ha portato a considerare la FM sempremeno come un’ entità clinica indipendente e sempre più come una possibile manifestazione tipica delle alterazioni delsistema psico-neuroendocrino (lo spettro dei disturbi affettivi) o del sistema di reazione allo stress (sintomi disfunzionali).Recentemente, sono stati sollevati dubbi su queste classificazioni; e attualmente sembra corretto includere laFM tra le sindromi di “sensibilizzazione del sistema nervoso centrale”, che considerano il meccanismo patogeneticocausa di sindromi muscolari ed extra-muscolari della FM o delle altre sindromi disfunzionali.Reumatismo, 2008; 60: Supplemento 1: 3-14INTRODUCTIONAlthough the term “fibromyalgia” (FM) is relativelynew, the condition characterised bychronic musculoskeletal pain that is accompaniedCorresponding author:Fabiola Atzeni, MD, PhDRheumatology UnitL. Sacco University Hospital, Milan, ItalyE-mail: atzenifabiola@hotmail.comby numerous extra-skeletal symptoms has been describedin the medical literature for many years underdifferent names. The term “fibrositis,” whichwas originally used in 1904 by Sir William Gowersto define a type of lumbalgia, became a synonymfor diffuse musculoskeletal pain until 1976(1). In the mid-1970s, Smythe and Moldofsky usedthe term “fibrositic syndrome” to describe the presenceof tender points (TPs), sleep disturbances andother accompanying symptoms such as asthenia
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