Department of Behavior Medicine and Psychiatry, West Virginia University , Morgantown, WV, USA.
Department of Medicine, Division of Rheumatology, West Virginia University , Morgantown, WV, USA.
Postgrad Med. 2020 Sep;132(7):575-580. doi: 10.1080/00325481.2020.1758426. Epub 2020 May 20.
Health care has become increasingly fragmented, partly due to advancing medical technology. Patients are often managed by various specialty teams when presenting with symptoms that could be manifestations of different diseases. Approximately one third of them are referred to specialists, at over half for outpatient appointments. Fatigue, pain, depression, dry mouth, headaches, and arthralgia are common complaints and frequently require referral to specialist physicians. Differential diagnoses include fibromyalgia (FM), Sjogren's syndrome (SS), and depression. Evaluations involve various sub-specialist especially physicians like those practicing pain management, rheumatology, and psychiatry. Thresholds for referring vary. Patients sometime feel lost in a 'medical maze'. Disagreement is frequent between specialties regarding management. Each discipline has its own diagnostic and treatment protocols and there is little consensus about shared decision-making. Communication between doctors could improve continuity. There are many differences and similarities in the pathophysiology, symptomatology, diagnosis, and treatment of fibromyalgia, Sjogren's syndrome, and depression. Understanding the associations between fibromyalgia, Sjogren's syndrome and depression should improve clinical outcome via a common holistic approach.
医疗服务变得越来越碎片化，部分原因是医疗技术的进步。当患者出现可能是不同疾病表现的症状时，通常会由多个专科团队进行管理。其中约有三分之一的患者被转介给专科医生，超过一半的患者是门诊预约。疲劳、疼痛、抑郁、口干、头痛和关节痛是常见的主诉，通常需要转介给专科医生。鉴别诊断包括纤维肌痛（FM）、干燥综合征（SS）和抑郁症。评估涉及各种亚专科医生，尤其是从事疼痛管理、风湿病学和精神病学的医生。转诊的标准不同。患者有时会感到迷失在“医疗迷宫”中。不同专科之间的治疗意见经常存在分歧。每个学科都有自己的诊断和治疗方案，对于共同决策几乎没有共识。医生之间的沟通可以提高连续性。纤维肌痛、干燥综合征和抑郁症在病理生理学、症状学、诊断和治疗方面存在许多差异和相似之处。通过共同的整体方法理解纤维肌痛、干燥综合征和抑郁症之间的关联，应该可以改善临床结果。
