Fibromyalgia: Diagnosis [Clinical Review Discussion]

On initial examination fibromyalgia appears to be a relatively straight-forward diagnostic procedure. The patient presents with spontaneous, widespread soft tissue pain, sleep disturbances, fatigue and widely distributed tender points evaluated by procedures developed by the American College of Rheumatology (ACR) (1). Although diagnosis may seem rather simple it can, in fact, be challenging. A recent paper found only 34% of patients diagnosed with FM received an accurate diagnosis (2). Hypothyroidism, drug-induced myopathies (often associated with statins, lipid-lowering drugs), myofascial pain syndrome, lupus and other rheumatic conditions can mimic fibromyalgia. Often the diagnosis is made, at least in part, by elimination of other conditions. One must take a very careful history, perform a skilled examination and use astute observation over time. Additionally the ACR states the diagnosis of FM cannot be made until lab testing returns negative. To rule out the above mentioned conditions, the following tests are recommended: red blood cell count with differential, thyroid function tests, metabolic screening panel, C-reactive protein, erythrocyte sedimentation rate, Lyme test and rheumatic profile (3).