Concluded Case

Fibromyalgia

45 years old male c/o generalised fatigue multiple small joints pai. n muscles pain and muscle weakness more thn 3 months... H!/ O episodes of migraine and depression.. gastritis irritable bowel symptoms.... General examination normal blood test normal... Considering as a case of fibromyalgia amitryptalin half tab 25 mg HS Started... Stopped due to side effect of dry mouth now gabapentin started at low dose with mecobalamin.... How much dose of gabapentin may b effective Anyone using guaifenesin in fibromyalgia Any other test

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Concluded answer
Fibromyalgia is a diagnosis of exclusion Get CBC, ESR, crp( quantitative), RF quantitative, anti-ccp, ana by ifa, SGPT, SGOT, ALP, CPK, LDH, serum calcium, serum creatinine , random blood sugar, S.tsh, urine routine microscopy, cxr before stamping it Fibromyalgia If all tests r normal, then it is fibromyalgia Then start tab duloxetine 20 mg of HS for 1 week, if he tolerates increase to 30 mg after 1 week Also give tab Gabapentin 100 mg OD HS as starting dose, increase it slowly to 100 mg bd and then 300 mg of HS depending on the response
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Rule Out Hypothyroidism Rheumatoid arthritis Systemic lupus erythematosus Polymyalgia rheumatic Other inflammatory or autoimmune disorders Serious cardiac conditions in those with chest pain, dyspnea, and palpitations Complete blood count with differential Metabolic panel Urinalysis Thyroid-stimulating hormone level 25-hydroxy vitamin D level Vitamin B12 level Iron studies, including iron level, total iron binding capacity, percent saturation, and serum ferritin level -Magnesium level -Erythrocyte sedimentation rate -Antipolymer antibody assay *Medications used in the management of fibromyalgia include the following:- Analgesics (eg, tramadol) Antianxiety/hypnotic agents (eg, alprazolam, clonazepam, zolpidem, zaleplon, trazodone, buspirone, temazepam, sodium oxybate) Skeletal muscle relaxants (eg, cyclobenzaprine) Antidepressants (eg, amitriptyline, duloxetine, milnacipran, venlafaxine, desvenlafaxine) Anticonvulsants (eg, pregabalin, gabapentin, tiagabine) Alpha 2 agonists (eg, clonidine) Other agents used in fibromyalgia may include the following: Vitamins and minerals Malic acid and magnesium combination Antioxidants Amino acids Herbs and supplements
Middle age man with fatigue and polyarthralgia elaborate which joint?? and myalgia Muscle weakness can u grade ,which muscle proximal or distal Past history of migrain ,IBS and depression are u sure about ibs ,can it be ibd Is there any back pain ,neckpain psoriasis Do a hemoglobin ,crp ,CPK ,stool obt ,fecal calprotectin ,xray plelvis Rule out diabetes ,anemia ,heart disease . Do a through physical examination Ask for any fever ,weight loss constitution symptoms, sicaa symptoms Then u subject to other test like ana profile ,as male pt unlike to get autoimmune disease unless any clinical findings
Blood tests normal sure h/ o migraine depression and IBS... Typical tender points symmetrically... Subjective muscle weakness.. .. Numbness tingling palms
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Fibromyalgia is a diagnosis of exclusion Get CBC, ESR, crp( quantitative), RF quantitative, anti-ccp, ana by ifa, SGPT, SGOT, ALP, CPK, LDH, serum calcium, serum creatinine , random blood sugar, S.tsh, urine routine microscopy, cxr before stamping it Fibromyalgia If all tests r normal, then it is fibromyalgia Then start tab duloxetine 20 mg of HS for 1 week, if he tolerates increase to 30 mg after 1 week Also give tab Gabapentin 100 mg OD HS as starting dose, increase it slowly to 100 mg bd and then 300 mg of HS depending on the response
All blood tests normal. Sir... Typical tender points symmetrically present....
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Why and how you confident about diagnosis of fibromyalgia ?? So many differential are there with above mentioned symptoms.. Are they ruled out with appropriate investigations..??? In era of evidence based medicine and consumer protection act don't go beyond your limit.. Best wishes
All blood tests normal.... . Paired tender points as per fibromyalgia criteria... ( it is not included now) other symptoms of digression migration irritable bowel.... What other things to consider thanx
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Do Muscle enzymes CK ( CPK ,LDH), ESR ,TFT.Muscke weakness,what about the muscle power and reflexes?. For fibromyalgia FDA approved drug is Pregabalin ,start with 50 mg 0-0-1 for 5 days and the. 75 mg 0-0-1 to continue.Simultaneoysly you exclude vasculitis also.
Blood tests normal... Muscle power appear 5/5 objectively.. Subject reports muscle weakness.. Tingling numbness in palm
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Do ESR ,CRP ,RF ,Anticcp ,ANA,CPK , Thyroid,lipid ,ECG ,USG whole abdomen.. Rule out other possible differentials before labelling it as fibromyalgia. Start Pregabalin NT 75 mg hs Tab Naxdom 500 mg BD x 3 days VIt b12 ,ViT E Rest as per diagnosis
Ask for CBC ESR Blood SUGAR T3T4TSH CKP LDH AND FURTHER TREAT WITH CAP PREGABA M 75 ONE DAILY
START WITH.. 300MG.. DAY .. LATER ON CAN BE REDUCED UP TO.. 100MG .. DAY ..
Thank you doctor
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Usually 300mg maintenance is sufficient

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