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Clinical classification of fibromyalgia according to disease progression

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Introduction

The number of fibromyalgia patients has recently been increasing in Japan. We currently studied numerous patients with early to severe neuropathic pain on not only 'specific sites' according to American College of Rheumatology ACR-90 criteria, but also widespread severe pain such as hyperpathia or allodynia.

Symptoms in these patients are sometimes accompanied with extra-muscular symptoms such as irritable colon, interstitial cystitis, severe dry eye and mouth, and various psychogenic symptoms. Twenty-seven patients with severe and systemic complications were misdiagnosed with other psychogenic disorders. We classified patients with fibromyalgia in five categories according to disease progression.

Patients and method

A total 153 patients with fibromyalgia who visited our rheumatology or psychiatry clinics in the past 2 years were assessed; 132 (86.5%) female patients and 21 (13.5%) male patients. The mean age was 52.3 ± 15.0 years for females, 50.4 ± 18.6 years for males. These patients were classified into five stages according to clinical symptoms (Table 1).

Table 1 Classification of fibromyalgia according to disease progression frequency in 153 cases

Results and discussion

As shown in Table 1, 64 patients fulfilled the ACR-90 criteria. Patients classified in stages II-IV had painful symptoms that spread through the whole body and were extremely severe. Eight of 153 patients had extramuscular systemic symptoms. The results of the SPECT study revealed that 80% of the 40 patients clearly identified a low level in regional blood flow. Twenty-seven cases of the patients were misdiagnosed with psychogenic or neurological disorders for a long time. Based on such clinical diversity, it is essential to classify fibromyalgia according to disease progression.

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Keywords

  • Neuropathic Pain
  • Fibromyalgia
  • Cystitis
  • Psychiatry Clinic
  • Systemic Symptom