Yunus Muhammad B
Section of Rheumatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA.
Best Pract Res Clin Rheumatol. 2007 Jun;21(3):481-97. doi: 10.1016/j.berh.2007.03.006.
Patients with widespread pain or fibromyalgia syndrome have many symptoms besides musculoskeletal pain: e.g. fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches and restless legs syndrome. There is evidence for central sensitization in these conditions, but further studies are needed. Anxiety, stress and depression are also present in 30-45% of patients. Other factors that may contribute to symptoms include endocrine dysfunction, psychosocial distress, trauma, and disrupted sleep. Evaluation of a patient presenting with widespread pain includes history and physical examination to diagnose both fibromyalgia and associated or concomitant conditions. Fibromyalgia should be diagnosed by its own characteristic features. Some patients with otherwise typical symptoms of fibromyalgia may have as few as four to six tender points in clinical practice. Patients with rheumatoid arthritis and systemic lupus erythematosus should be evaluated for fibromyalgia, since 20-30% of them have associated fibromyalgia, requiring a different treatment approach.
患有广泛性疼痛或纤维肌痛综合征的患者除了肌肉骨骼疼痛外，还有许多症状：例如疲劳、睡眠困难、组织肿胀感、感觉异常、认知功能障碍、头晕，以及诸如肠易激综合征、头痛和不宁腿综合征等重叠病症的症状。有证据表明在这些病症中存在中枢敏化，但还需要进一步研究。30%-45%的患者还存在焦虑、压力和抑郁。其他可能导致症状的因素包括内分泌功能障碍、心理社会困扰、创伤和睡眠紊乱。对出现广泛性疼痛的患者进行评估包括病史和体格检查，以诊断纤维肌痛以及相关或伴随病症。纤维肌痛应根据其自身特征进行诊断。在临床实践中，一些具有典型纤维肌痛症状的患者可能只有四到六个压痛点。类风湿性关节炎和系统性红斑狼疮患者应评估是否患有纤维肌痛，因为其中20%-30%的患者患有相关的纤维肌痛，需要采用不同的治疗方法。
