Chronic widespread pain in the spectrum of rheumatological diseases

Fabiola Atzeni, Marco Cazzola, Maurizio Benucci, Manuela Di Franco, Fausto Salaffi, Piercarlo Sarzi-Puttini

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Fibromyalgia (FM) is a rheumatic disease characterised by musculoskeletal pain, chronic diffuse tension and/or stiffness in joints and muscles, fatigue, sleep and emotional disturbances and pressure pain sensitivity in at least 11 of 18 tender points. There are currently no instrumental tests or specific diagnostic markers, and the characteristic symptoms of the disease overlap those of many other conditions classified in a different manner. FM is often associated with other diseases that act as confounding and aggravating factors, including primary Sjögren's syndrome (pSS), systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). It has been reported to coexist in 25% of patients with RA, 30% of patients with SLE and 50% of patients with pSS. Its clinical diagnosis is not easy because FM-like symptoms are frequent, and its differential diagnosis with other causes of chronic diffuse pain is difficult. This is even more true in the case of patients who are positive for antinuclear antibodies (ANAs) because, although sensitive, ANA positivity is not specific for SLE or connective tissue diseases, and can also be found in 10-15% of FM patients. Furthermore, composite indices such as the disease activity score (DAS)-28, which are widely used in everyday clinical practice and clinical trials, may be insufficient to evaluate real inflammatory activity in patients with RA associated with chronic pain syndromes such as FM, and can lead to an overestimate of disease activity in RA. The presence of diffuse pain in autoimmune rheumatic diseases compromises the quality of life of the patients, although overall mortality is not increased. A misdiagnosis harms the patients and the community. Rheumatologists should be able to recognise and distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes.

Original languageEnglish
Pages (from-to)165-171
Number of pages7
JournalBest Practice and Research: Clinical Rheumatology
Volume25
Issue number2
DOIs
Publication statusPublished - Apr 2011

Fingerprint

Fibromyalgia
Chronic Pain
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Antinuclear Antibodies
Rheumatic Diseases
Patient Harm
Pain
Musculoskeletal Pain
Muscle Fatigue
Affective Symptoms
Connective Tissue Diseases
Diagnostic Errors
Autoimmune Diseases
Sleep
Differential Diagnosis
Joints
Quality of Life
Clinical Trials
Guidelines

Keywords

  • Differential diagnosis
  • Diffuse pain
  • Fatigue
  • Fibromyalgia
  • Rheumatic diseases

ASJC Scopus subject areas

  • Rheumatology

Cite this

Atzeni, F., Cazzola, M., Benucci, M., Di Franco, M., Salaffi, F., & Sarzi-Puttini, P. (2011). Chronic widespread pain in the spectrum of rheumatological diseases. Best Practice and Research: Clinical Rheumatology, 25(2), 165-171. https://doi.org/10.1016/j.berh.2010.01.011

Chronic widespread pain in the spectrum of rheumatological diseases. / Atzeni, Fabiola; Cazzola, Marco; Benucci, Maurizio; Di Franco, Manuela; Salaffi, Fausto; Sarzi-Puttini, Piercarlo.

In: Best Practice and Research: Clinical Rheumatology, Vol. 25, No. 2, 04.2011, p. 165-171.

Research output: Contribution to journalArticle

Atzeni, F, Cazzola, M, Benucci, M, Di Franco, M, Salaffi, F & Sarzi-Puttini, P 2011, 'Chronic widespread pain in the spectrum of rheumatological diseases', Best Practice and Research: Clinical Rheumatology, vol. 25, no. 2, pp. 165-171. https://doi.org/10.1016/j.berh.2010.01.011
Atzeni, Fabiola ; Cazzola, Marco ; Benucci, Maurizio ; Di Franco, Manuela ; Salaffi, Fausto ; Sarzi-Puttini, Piercarlo. / Chronic widespread pain in the spectrum of rheumatological diseases. In: Best Practice and Research: Clinical Rheumatology. 2011 ; Vol. 25, No. 2. pp. 165-171.
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