Monday, 30 May 2016

Most Common Disease of 50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Fibromyalgia - The Misdiagnosis

Kyle J. Norton (Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


Fibromyalgia, according to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

                   The Misdiagnosis 

1. Inflammatory arthritis
Inflammatory arthritis is an auto immune diseases induced tender and swollen joints causing pain, stiffness and joint damage my be misdiagnosed as Fibromyalgia fue to FM have a marked impact on tender joint count scores, resulting in a disproportionately high tender joint count to swollen joint count ratio similar to those of inflammatory arthritis(67). Dr. Pöyhiä R and colleagues at the McGill University Health Center,, said,"Patients with FM report a high rate of varied pain and adverse experiences throughout life" and "Patients with FM reported significantly more irritable bowel syndrome, migraine headaches, severe menstrual pain, physical and psychological trauma affecting well being, family history of FM, and family pain environment than subjects with IA or controls"(68).

2. Spondyloarthropathies (SpA) and connective tissue disease (CTD)
Spondyloarthropathies (SpA) and connective tissue disease (CTD) are joint disease similar to those of FM. According to the Sapienza University of Rome, although is FM is a wellknown clinical entity, differentiation of SpA, CTD and inflammatory arthritis can still be diagnosed as FM(69). But incorrect diagnosis can be avoid if rheumatologists recognise and distinguish primary and secondary FM(70).

3. Serotonin syndrome
Serotonin syndrome is a over production of hormone serotonin due to serotonergic medications, causing wide spread pain may be misdiagnosed as fibromyalgia, accordin to a 42-year-old woman referred for physical therapy with a diagnosis of fibromyalgia(71). But careful evaluation by the physical therapist indicated that signs and symptoms may alter intitial diagnosed Dr. Alnwick GM said.

4. Others
Dr. Shapiro AP and Dr. Teasell RW in the study of Misdiagnosis of chronic pain said "
it is not surprising that chronic pain disorders are often misdiagnosed as hysterical or psychological in origin" and  "can significantly increase the likelihood of treatment failure"(72).

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(67) Joint counts in inflammatory arthritis by Scott IC1, Scott DL.(PubMed)
(68) Previous pain experience in women with fibromyalgia and inflammatory arthritis and nonpainful controls by Pöyhiä R1, Da Costa D, Fitzcharles MA.(PubMed)
(69) Misdiagnosis in fibromyalgia: a multicentre study by Di Franco M1, Iannuccelli C, Bazzichi L, Atzeni F, Consensi A, Salaffi F, Pietropaolo M, Alessandri C, Basili S, Olivieri M, Bombardieri S, Valesini G, Sarzi-Puttini P.(PubMed)
(70) Chronic widespread pain in the spectrum of rheumatological diseases by Atzeni F1, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P.(PubMed)
(71) Misdiagnosis of serotonin syndrome as fibromyalgia and the role of physical therapists by Alnwick GM1.(PubMed)
(72) Misdiagnosis of chronic pain as hysterical by Shapiro AP1, Teasell RW2.(PubMed)

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