Differential diagnosis of fibromyalgia

Obtaining an accurate diagnosis of fibromyalgia
With the exception of tender points, the physical examination may be unrevealing because the patient’s symptoms are common and non-specific (e.g. fatigue).

The diagnosis may be confused with other conditions, including myofascial syndrome, rheumatoid arthritis or osteoarthritis, among other conditions. An accurate diagnosis is critical because the treatments are very different.

Conditions similar to fibromyalgia
A few similar conditions include:

• Fibromyalgia is perhaps most commonly confused with myofascial pain syndrome. Myofascial pain syndrome is regional pain syndrome, characterized by palpable, "trigger points" that produce pain in a referred distribution (another part of the body) (21).

• Rheumatoid arthritis and osteoarthritis resemble fibromyalgia early in the course of the disease. In one study concurrent fibromyalgia was identified in 13% and 10% of patients with rheumatoid arthritis and osteoarthritis, respectively. In general, these individuals had a higher level of severity of pain and disability (23).

By: Thomas K. Van Sistine, MD
January 20, 2000