Recognize Comorbid Fibromyalgia Syndrome in Order to Better Evaluate Selected Rheumatic Diseases

Abstract

The prevalence of comorbid fibromyalgia syndrome in autoimmune rheumatic diseases is clinically significantly higher than is fibromyalgia syndrome in the general population. By increasing pain sensitivity and fatigue, it disproportionately inflates subjective signs and symptoms, thereby obfuscating composite indices used to measure biological disease activity, the degree of disability, and the quality of life. By modifying primary disease phenotype, it also interferes with diagnostic precision. This review documents its effects on rheumatoid arthritis, the spondyloarthropathies, and systemic lupus erythematosus; and offers a general remedial strategy.

Introductory Chapter: A Challenge to the Concept that Inflammation Plays a Prominent Pathogenic Role in Fibromyalgia

“…These include reference to sulfur springs considered to inhibit interleukin-2 and interferon-gamma [1], introductory explanations of FMS pathogenesis that invokes inflammatory dysfunction [2], and mention of inflammatory cytokine production associated with autonomic nervous system dysfunction-stimulated microglial and astrocyte cell activation [3]. The discussion in the fourth chapter about the impact of FMS on the evaluation of inflammatory diseases assumes the opposite that clinically significant inflammation is not a feature of FMS [4].…”