Master the board step 3

Rheumatology
Fibromyalgia Trigger Points
Treatment
Treat symptoms with the following:
··
Exercise
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Milnacipran, duloxetine, or pregabalin (the best initial therapy)
··
Tricyclic antidepressants, such as amitriptyline, are effective but have more
adverse effects.
NSAIDs are not first line for
fibromyalgia.
Polymyalgia Rheumatica (PMR)
Presents with a person > 50 years old with profound pain and stiffness of the
proximal muscles, such as shoulders and pelvic girdle. The stiffness is worse
in the morning and is localized to the muscles rather than to the joints. The
ESR is elevated, and there is an amazing response to steroids.
Pain is much more
prominent than weakness
in PMR.
Nonspecific features of PMR are the following:
··
Fever, weight loss, and malaise
··
Normocytic anemia
··
Normal CPK, EMG, aldolase, and muscle biopsy
··
No muscle atrophy
• Age > 50 + Proximal
muscle pain + ↑ESR =
PMR
The following table compares chronic fatigue syndrome, fibromyalgia, and
polymyalgia rheumatica.
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