UOC Neurologia IIRCCS Carlo Besta, Milan, Italy.
Department of Human Neuroscience, Sapienza University, Rome, Italy.
Neurol Sci. 2023 Jul;44(7):2561-2574. doi: 10.1007/s10072-023-06836-3. Epub 2023 May 24.
The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.
The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies.
Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016).
ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up.
The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.
中枢和/或外周神经系统功能障碍在纤维肌痛中基本起着重要作用。
本立场声明代表意大利神经病学学会神经病理性疼痛研究小组，旨在根据最近的研究结果，为神经科临床实践中纤维肌痛（FM）的临床和仪器评估提供实用指南，考虑到最近的研究结果。
研究选择和考虑的标准是原始研究、病例对照设计、使用临床实践的标准化方法以及 ACR 标准（2010 年、2011 年、2016 年）进行的 FM 诊断。
ACR 标准进行了修订。对于小纤维病理的诊断程序，共考虑了 47 项研究。应应用最近的诊断标准（ACR，2016）。似乎必须进行风湿病学就诊。小纤维的受累至少应要求 2 项 HRV+SSR 和/或激光诱发反应和/或皮肤活检和/或角膜共聚焦显微镜检查，最终根据代谢和/或免疫/和或副肿瘤学基础进行监测，并在 1 年随访时重复。
正确的 FM 诊断方法可以促进排除已知的小纤维损伤原因。对常见遗传因素的研究将有助于促进更具针对性的治疗方法。
