Jaime F. Bravo

Yes, Fibromialgia is not a good diagnosis

I agree with G. Erlich that Fibromialgia is not a definite entity. My impression is that it includes, what we used to call Psicogenic Rheumatism and many cases of undiagnosed Benign Joint Hypermobility Syndrome (BJHS), which is usually undiagnosed in most parts of the world. To me there is no coincidence that the trigger points are exactly the areas of enthesis, tendinitis or bursitis. I have been very interested in the BJHS for the last 3 years and they constitute 34 % of my private rheumatological practice, in Santiago, Chile. I agree with R. Grahame, in London, that BJHS is probably the main cause of musculo-scletal pain. We all need to learn and use the Brighton Criteria to diagnose these patients.

Jaime F. Bravo

Chronic Fatigue in Fibromialgia

Chronic Fatigue related to depression as seen in Fibromialgia is a symptom noted by the patient upon awakening. The fatigue that many of these patients experience at mid-day or after standing or walking slowly is most likely related to Disautonomia, secondary to Benign Joint Hypermobility Syndrome (BJHS). Here the genetic alteration of collagen fibers in the wall of the veins tends to produce Ortosthatic Hypotension and fatigue, dizziness and even syncopal episodes. Most of these patients have cold intolerance and tendency to have chronically low blood pressure. Many have told me that they feel like "my batteries have became discharged" and they feel better after lying down. Many complain of swollen hands or feet, specially in AM or after long trips by plane. Disautonomia can easily be confirmed with a Tilt Test. I wonder how many "Chronic Fatigue patients with the diagnosis of Fibromialgia" would have a positive Tilt test, which would to me indicate that they have Disautonomia, probably secondary to BJHS and probably not Fibromialgia.

Jaime F. Bravo

Would appreciate any comments to my messages. My E-Mail Address is:
jaime.bravos@gmail.com
my web page is:
www.reumatologia-dr-bravo.cl
www.clinicaarauco.cl
I am a Reumatologist working at Cl?ica Arauco and at San Juan de Dios Hospital,
in Santiago. Chile
I was a Clinical Professor of Medicine at the University of Colorado. I worked at the Denver Arthritis Clinic, for 22 years, till I came back to Chile in 1998.

monique camerlain

Mind the opioids and CME.

I fully agree with Dr. Fitzcharles, being a Quebec, Canada, rheumatologist as she is. Most of the CME on fibromyalgia and chronic pain is presently done by opioid companies who use family physicians who are not the best experts on this topic.Please refer to the article:

Rheumawire - Apr 17, 2002
OxyContin linked to more than 450 deaths
Most of these deaths occured in women of poor socio-economic status which is the profile of many of our fibromyalgia patients according to the Wichita epidemiologic study and what we know of past victimization experiences in fibromyalgia.
Poor diagnostic skills and unsrupu;ous marketting may lead to even more deaths in this type of patient.
Monique

mary-ann fitzcharles

Thank you to Dr Jaime Bravo and Dr Monique Camerlain for comments on our manuscript reporting inaccuracy in the diagnosis of fibromyalgia. We agree with Dr Bravo that there may be many other diagnoses lumped into the big grab bag of FM. Hypermobility is observed in almost 13% of young caucasian females and does account for aches and pains that commonly move from site to site. This is often interpreted as "diffuse" body pain, rather than localised pain at multiple body sites. Once again, a little time taking the history will sort out this confusion.
The overlap between fatigue, chronic fatigue syndrome and fibromyalgia remains often a difficult issue to unravel. Fatigue is an important component of many rheumatological conditions, including fibromyalgia. Additionally fatigue is a prominent symptom in some purely psychogenic conditions such as depression. In that fatigue has gained such prominence in FM, it can be understood how a combination of pain and fatigue can easily be attributed to FM in the absence of more careful history and examination.
We agree with Dr Camerlain that caution should be exercised in the indrisciminate use of medications, including opiods. FM patients are generally poorly responsive to pharmacologic treatments, and tend to discontinue treatments over time. There are however some patients who will respond favourably to some pharmacologic intervention, often through trial and error. We have observed that about 15% of FM patients do obtain some degree of pain relief with the use of opiods, mostly the weak ones such as codeine. It is however important for a physician to be alert as to whether an intervention continues to retain efficacy and warrants continued prescription.
With thanks,
Mary-Ann Fitzcharles

Hannequin Jean-Ren鼯b>

Fibromyalgia

Fibromyalgia is too much diagnosed. In my patients, i find many cases of "fibromyalgias" who are Gougerot-Sj?ren syndromes with polyalgias.