Diagnosing Fibromyalgia
Before doctors can diagnose fibromyalgia, they need to rule out a host of other conditions. Typically, they'll order blood tests to rule out other medical disorders with similar symptoms, including hypothyroidism, infections, polymyalgia rheumatica, rheumatoid arthritis or lupus.
Doctors may also order other lab and imaging tests. Until recently, no test could definitively diagnose fibromyalgia, but a new blood test is is now showing promise in some preliminary studies. It involves antipolymer antibodies, which may be found in about half of the people with FMS.
Fibromyalgia is typically diagnosed and treated by rheumatologists. The American College of Rheumatology in 1992 established two criteria for a diagnosis of fibromyalgia:
- Pain in all four quadrants of the body and in the axial skeleton (bones of the head, throat, chest and spine) that's been present on a more-or-less continuous basis for at least three months.
- Pain in at least 11 of 18 tender points, which are specific spots on the body that hurt when pressure is applied. (See diagram, top right.)
Diagnosing Chronic Fatigue Syndrome
No medical test can reliably detect chronic fatigue syndrome. The first step toward making a diagnosis is for doctors to perform tests to rule out conditions with similar symptoms, including chronic infections such as tuberculosis, mononucleosis or Lyme; fibromyalgia; autoimmune diseases such as multiple sclerosis and lupus; or psychiatric/emotional conditions.
Second, doctors evaluate the patient following guidelines set by the CDC:
- Unexplained persistent fatigue that's not due to ongoing exertion, isn't substantially relieved by rest, is of new onset and results in a significant reduction in previous levels of activitiy.
- Four or more of the following symptoms are present for six months or more:
- Impaired memory or concentration
- Post-exertional malaise (extreme, prolonged exhaustion and sickness following physical or mental activity)
- Unrefreshing sleep
- Muscle pain
- Joint pain without swelling or redness
- Headaches of a new type or severity
- Sore throat that's frequent or recurring
- Tender cervical or axillary lymph nodes
These symptoms must have been constant or recurring during at least six months of illness and must not have started before the fatigue.
To date, no medical specialty has "claimed" CFS. It's up to you to find a doctor knowledgable about the condition.
Sources:
American College of Rheumatology, 2007"Fibromyalgia"
Regina P. Gilliland, MD, Department of Internal Medicine; Division of Rehab Medicine, Mobile Infirmary Medical Center"Fibromyalgia"
Centers for Disease Control and Prevention, May 3 2006"Diagnosing CFS"
