What are the diagnostic considerations for fibromyalgia?

Updated: Apr 23, 2020
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
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Although no basis for many of the multiple symptoms of patients with fibromyalgia will be found upon physical examination or laboratory testing, the physician must remain alert for organic illness (eg, colon carcinoma in a patient with irritable bowel syndrome).

The clinical assessment may reveal objective evidence for a discrete illness, such as hypothyroidism, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyalgia rheumatica, or another inflammatory or autoimmune disorder. Such findings do not exclude comorbid fibromyalgia. Indeed, approximately 25% of patients with RA and approximately 50% of patients with SLE also have fibromyalgia, and the provision of optimum care in such cases impels recognition and treatment of both illnesses.

It is important to recognize that treatment of an autoimmune disorder in a patient with comorbid fibromyalgia usually does not improve fibromyalgia symptoms. Recognition and treatment of fibromyalgia in these patients is vitally important to avoid overtreatment with immunosuppressive drugs, which can result when providers falsely ascribe symptoms of fibromyalgia to the autoimmune condition.

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