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The Copenhagen Declaration recommends the adoption of the two criteria established by ACR for research purposes, since they work as a standardising protocol. However, it enhances ACR's definition into a pragmatic and clinical perspective:
"The diagnosis is commonly entertained in the presence of unexplained widespread pain or aching, persistent fatigue, generalized (morning) stiffness, non-refreshing sleep, and multiple tender points.
Most patients with these symptoms have 11 or more tender points. But a variable proportion of otherwise typical patients may have less than 11 tender points at the time of the examination."
Besides, says the document, fibromyalgia is often "part of a wider syndrome encompassing headaches, irritable bladder, dysmenorrhoea, cold sensitivity, Raynaud's phenomenon, restless legs, atypical patterns of numbness and tingling, exercise intolerance and complaints of weakness."
"I believe this is a strong document," says Bente Danneskiold-Samsoe, president of the congress. "Many of the patients will not have to be considered as hypochondriacs any more." Fibromyalgia, which has a prevalence of 0.6% in Denmark, is often accompanied by symptoms of depression and anxiety(3).
Although the
etiology (cause) is unknown, members of the consensus panel tended to rule out psychological distress as a cause of the muscular pain and tenderness in fibromyalgia. It could be the other way around, suggests the declaration: psychological state could be mainly an effect of the pain patients suffer.
Muscle biopsy has revealed important morphological changes but no characteristic ones, and other tests (eg serum levels of muscle enzymes, electromyography, exercise testing and nuclear magnetic resonance spectroscopy ) have not been helpful. Laboratory tests can be important to rule out conditions that mimic fibromyalgia, such as hypothyroidism, polymyalgia rheumatica, or generalized osteoarthritis. Regional myofascial pain syndrome can be excluded clinically because it is associated with limited pain distribution.
"With the Copenhagen Declaration, these people will now have better chances that governments and insurance companies accept their conditions as a cause for invalidity pensions and early retirement," says Finn Kamper-Jorgensen, of the Danish Institute for Clinical Epidemiology, chairman of the consensus panel(4). - Claudio Csillag |