Context
Fibromyalgia is a disease of exclusion. There is a huge overlap between symptoms of fibromyalgia and a lot of rheumatic, endocrinal, and metabolic diseases. Confirming the diagnosis of fibromyalgia might mask the diagnosis of a lot of conditions especially with the lack of periodic reevaluation to fibromyalgia patients.
Objective
The aim was to evaluate the diagnosis of fibromyalgia in unresponsive patients after more than a year of diagnosis.
Patients and methods
This is a cross-sectional observational study performed on 100 patients diagnosed with primary fibromyalgia for more than 1 year and that showed no response to two or three lines of treatments. Patients were investigated for erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibody, in addition to serum vitamin D levels, total serum calcium, serum phosphorus, thyroid-stimulating hormone, parathormone hormone, and Dual energy Xray Absorptiometry (DEXA) scan. Patients were regrouped after laboratory investigations into two groups. Group I are patients who showed no abnormalities in their laboratory investigations. Group II are patients who showed abnormalities in their laboratory investigations. Functional assessment was performed for all patients by the fatigue assessment scale, insomnia severity index, and the visual analog scale for pain for patients in the beginning of the study and after 6 months.
Results
Less than 20% of the patients remained with no abnormality in their laboratory investigations, while about 80% showed laboratory abnormalities for other associated conditions.
Conclusion
Fibromyalgia patients showing response to treatment should be investigated on a regular basis even for markers that were shown to be normal. Treatment of any associated condition can improve symptoms of fibromyalgia dramatically.