Fibromyalgia Workup

  • Author: John Buckner Winfield, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Dec 20, 2011
 

Approach Considerations

Patients with fibromyalgia do not have characteristic or consistent abnormalities on laboratory testing. However, routine laboratory and imaging studies are important to help rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia. In addition to complete blood cell (CBC) count and differential count, basic metabolic panel, and urinalysis, the following limited evaluation is reasonable.

  • Thyroid-stimulating hormone: Hypothyroidism shares many clinical features with fibromyalgia, especially diffuse muscle pain and fatigue
  • Creatinine phosphokinase (CPK): This study is used to exclude inflammatory myopathies
  • Erythrocyte sedimentation rate (ESR)
  • Antinuclear antibodies (ANA)
  • Rheumatoid factor
  • Serum transferrin saturation and serum ferritin screening
  • Antipolymer antibodies

The ESR is normal in patients with fibromyalgia. This contrasts with the high ESR in patients with inflammatory disorders (eg, elderly patients with polymyalgia rheumatica) or occult malignancy. A low-titer ANA level is common in the general population, so this finding may be of no clinical significance in a patient with fibromyalgia. However, a positive ANA in a patient with diagnostic features of systemic lupus erythematosus (SLE) or related autoimmune disorders is a significant finding, as many patients with fibromyalgia have comorbid SLE.

Many patients with rheumatoid arthritis (RA) have comorbid fibromyalgia. However, a positive result for rheumatoid factor does not support a diagnosis of RA in the absence of objective evidence of characteristic joint inflammation. A positive result for rheumatoid factor is diagnostically nonspecific in other clinical settings.

Laboratory sleep studies may be useful in patients whose sleep [#WorkupOtherTests]does not improve with the usual conservative measures (eg, elimination of caffeine, prescription of hypnotics or nighttime tricyclics). These studies can be performed as part of a formal assessment by a neurologist experienced in sleep disorders.

Serum transferrin saturation and serum ferritin screening can be useful for detecting the unusual cases of hemochromatosis in which patients present with diffuse arthralgias and myalgias. Consider screening with a serum transferrin saturation and a serum ferritin concentration in patients aged 40-60 years, especially those with small-joint arthropathy in the hands and/or calcium pyrophosphate dihydrate deposition disease (CPPD).

The antipolymer antibody assay is a blood test. Antipolymer antibodies are present in approximately 50% of patients with fibromyalgia. This biologic marker may provide conclusive evidence for a subgroup of people with fibromyalgia.

Carefully assess possible causal or perpetuating factors. Investigate psychological and sociocultural factors and identify any specific regional sources of ongoing nociceptive pain (eg, degenerative spondylosis, bursitis).

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Self-report Forms

While waiting to see the physician, the patient, in a few minutes, can complete a simple self-report form[77] that incorporates visual analogue scales for pain and fatigue and a global self-assessment of overall status, along with validated scales for physical and psychological health status such as the following:

  • Modified Health Assessment Questionnaire
  • Fibromyalgia Impact Questionnaire
  • Checklist of current symptoms
  • Scales for helplessness and cognitive performance

Easily adaptable to a busy practice, the use of self-report forms provides information that is invaluable for the psychosocial assessment of pain, both for aiding with diagnosis and monitoring the response to therapy.

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Psychometric Testing

Psychometric testing includes the following:

  • Minnesota Multiphasic Personality Inventory
  • Social Support Questionnaire
  • Sickness Impact Profile
  • Multidimensional Pain Inventory (MPI)

In multidisciplinary settings, information obtained from these tests is useful for a more comprehensive assessment. For example, subgroups of patients with chronic pain can be identified based on MPI responses that appear to predict response to interdisciplinary therapeutic interventions.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

John Buckner Winfield, MD  Herman and Louise Smith Distinguished Professor of Medicine in Arthritis Emeritus, Department of Medicine, Senior Member, Neurosensory Disorders Center, University of North Carolina at Chapel Hill; Consulting Rheumatologist, Appalachian Regional Rheumatology

John Buckner Winfield, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Immunologists, American Clinical and Climatological Association, American College of Rheumatology, American Federation for Clinical Research, American Pain Society, American Society for Clinical Investigation, Association of American Physicians, and North Carolina Medical Society

Disclosure: Pfizer Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Additional Contributors

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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A neurophysiologist's view of pain. Courtesy of Alan R. Light, PhD.
Tender points in fibromyalgia.
Pressure algometer (dolorimeter).
Biopsychosocial model of fibromyalgia.
 
 
 
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