The pattern of pain and tenderness without signs of inflammation, the symptoms of poor sleep and fatigue and the history of IBS and depression are all commonly associated with fibromyalgia.
Diagnostic criteria for fibromyalgia
The 2010 American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia suggest a scoring system based on:
the widespread pain index (WPI) – the number of areas in which the patient has had pain over the last week
the symptom severity (SS) score over the last week –
the level of severity of fatigue
the extent of somatic symptoms in general.
The benefit of using the ACR criteria is that they can help to add certainty – for both you and the patient – to the clinical diagnosis.
There may be some other key pointers in the history. It's worth going back through the patient's notes if you suspect fibromyalgia, as there may be other features in their history associated with increased risk of fibromyalgia.
Note that there's no objective swelling in fibromyalgia. This is key, as many patients will report subjective swelling.
It's sometimes helpful to ask patients to take a photo of any swollen joints to try to help with objective assessment in the surgery.
Further reading and resources
score sheet (PDF, 124KB) based on the ACR diagnostic criteria for fibromyalgia.
Download our Hands On guide
Fibromyalgia syndrome: management in primary care (PDF, 313 KB). Back to Case study – Fahmida