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Aktuelle Rheumatologie 2020; 45(05): 422-429
DOI: 10.1055/a-1182-5630
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Update Fibromyalgiesyndrom

Update Fibromyalgia Syndrome
Winfried Häuser
Innere Medizin 1, Klinikum Saarbrücken gGmbH, Saarbrücken
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Zusammenfassung

In der neuen Klassifikation der Krankheiten (ICD-11) der Weltgesundheitsorganisation wurde das FMS – ohne Absprache mit rheumatologischen Fachgesellschaften – aus dem Kapitel „Erkrankungen des muskuloskelettalen System und des Bindegewebes“ entfernt und in ein neu geschaffenes Kapitel „Chronischer Schmerz“ aufgenommen. Pathologische Befunde an den kleinen Nervenfasern bei einer Untergruppe von Patienten belegen nicht, dass das FMS eine Neuropathie der kleinen Nervenfasern ist. Die Überprüfung der sogenannten Tender Points zur Diagnose des FMS ist nicht mehr erforderlich. Es wurden mehrere neue diagnostische Kriterien entwickelt, welche zur symptombasierten Diagnose neben chronischen Schmerzen in mehreren Körperregionen nicht-erholsamen Schlaf und Müdigkeit (körperlich und / oder geistig) erfordern. Die nach klinischen Kriterien durchführbare Schweregradeinteilung (leicht, mittel, schwer) des FMS ist wichtig für eine abgestufte Versorgung. In Abhängigkeit von psychologischen Befunden stehen verschiedene evidenzbasierte psychotherapeutische Verfahren zur Verfügung, welche bei schweren Formen des FMS eingesetzt werden sollen. Ein komorbides (sekundäres) FMS ist bei entzündlich-rheumatischen Erkrankungen häufig und führen zu falsch hohen Aktvitätsscores. Cannabisbasierte Arzneimittel sind eine Therapieoption für eine Untergruppe von FMS-Patienten.

Abstract

In the upcoming classification of diseases (ICD-11) of the World Health Organisation, FMS has been shifted – without consulting rheumatology associations – from the chapter “Diseases of the musculoskeletal system and connective tissue” into a new chapter, entitled “Chronic Pain”. Small fibre pathology findings in a subgroup of FMS-patients do not prove that FMS is a small fibre neuropathy. Tender point examination is no longer required for the clinical diagnosis of FMS. New diagnostic criteria require the history of chronic widespread pain, non-restorative sleep and fatigue (physical and / or mental). Severity of FMS (slight, moderate, severe) can be assessed by clinical criteria. Severity assessment is needed for graduated and stepwise treatment. Depending on psychological findings, different evidence-based psychological therapies are available for severe forms of FMS. Comorbid (secondary) FMS is frequent in inflammatory rheumatic diseases and inflates activity scores. Cannabis-based medicines hold promise for a subgroup of FMS patients.

Schlüsselwörter

Fibromyalgiesyndrom - Klassifikation - Diagnose - Therapie

Key words

Fibromyalgia syndrome - Classification - Diagnosis - Therapy


Publication History

Article published online:
14 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • Literatur

  • 1 World Health Organization International Classification of Diseases for Mortality and Morbidity Statistics. Eleventh Revision https://icd.who.int/icd11refguide/en/index.html Zugriff 02.02.2020
  • 2 Treede RD, Rief W, Barke A. et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain 2019; 160: 19-27
    CrossrefPubMedGoogle Scholar
  • 3 Nicholas M, Vlaeyen JWS, Rief W. et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain 2019; 160: 28-37
    CrossrefPubMedGoogle Scholar
  • 4 Häuser W, Clauw D, Fitzcharles MA. Fibromyalgia as a chronic primary pain syndrome: issues to discuss. Pain 2019; 160: 2651-2652
    CrossrefPubMedGoogle Scholar
  • 5 Henningsen P, Layer P, Fink P. et al. Chronic primary pain: a pain-centered view of the world is too narrow. Pain 2019; 160: 1683
    CrossrefPubMedGoogle Scholar
  • 6 Häuser W, Henningsen P. Fibromyalgia syndrome: a somatoform disorder?. Eur JPain 2014; 18: 1052-1059
    PubMedGoogle Scholar
  • 7 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 5. Author; Arlington, VA: 2013
    Google Scholar
  • 8 Häuser W, Wolfe F. The Somatic Symptom Disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill. J Psychosom Res 2013; 75: 586-587
    CrossrefPubMedGoogle Scholar
  • 9 Häuser W, Bialas P, Welsch K. et al. Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome. J Psychosom Res 2015; 78: 546-552
    CrossrefPubMedGoogle Scholar
  • 10 Häuser W, Hausteiner-Wiehle C, Henningsen P. et al. Prevalence and overlap of omatic symptom disorder, bodily distress syndrome and fibromyalgia syndrome in the German general population: a cross sectional study. J Psychosom Res 2020
  • 11 Wolfe F, Smythe HA, Yunus MB. et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 1990; 33: 160-172
    CrossrefPubMedGoogle Scholar
  • 12 Wolfe F, Clauw D, Fitzcharles MA. et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010; 62: 600-610
    CrossrefPubMedGoogle Scholar
  • 13 Wolfe F, Clauw D, Fitzcharles MA. et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011; 38: 1113-1122
    CrossrefPubMedGoogle Scholar
  • 14 Häuser W, Jung E, Erbslöh-Möller B. et al. Validation of the Fibromyalgia Survey Questionnaire within a cross-sectional survey. PLoS One 2012; 7: e37504
    CrossrefPubMedGoogle Scholar
  • 15 Wolfe F, Clauw DJ, Fitzcharles MA. et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016: 319-329
    PubMedGoogle Scholar
  • 16 Arnold LM, Bennett RM, Crofford LJ. et al. AAPT diagnostic criteria for fibromyalgia. J Pain 2018; 20: 611-628
    CrossrefPubMedGoogle Scholar
  • 17 Häuser W, Brähler E, Ablin J. et al. 2016 modified American College of Rheumatology fibromyalgia criteria, ACTTION-APS Pain Taxonomy criteria and the prevalence of fibromyalgia. Arthr Care&Res 2020; DOI: 10.1002/acr.24202..
    PubMedGoogle Scholar
  • 18 Salaffi F, Di Carlo M, Farah S. et al. Diagnosis of fibromyalgia: comparison of the 2011/2016 ACR and AAPT criteria and validation of the modified Fibromyalgia Assessment Status. Rheumatology (Oxford) 24.03.2020; DOI: 10.1093/rheumatology/keaa061.
    CrossrefPubMedGoogle Scholar
  • 19 Cagnie B, Coppieters I, Denecker S. et al. Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Semin Arthritis Rheum 2014; 44: 68-75
    CrossrefPubMedGoogle Scholar
  • 20 Oaklander AL, Herzog ZD, Downs HM. et al. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain 2013; 154: 2310-2316
    CrossrefPubMedGoogle Scholar
  • 21 Grayston R, Czanner G, Elhadd K. et al. A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Semin Arthritis Rheum 2019; 48: 933-940
    CrossrefPubMedGoogle Scholar
  • 22 Doppler K, Rittner HL, Deckart M. et al. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain 2015; 156: 2319-2325
    CrossrefPubMedGoogle Scholar
  • 23 Levine TD. Small Fiber Neuropathy: Disease Classification Beyond Pain and Burning. J Cent Nerv Syst Dis 2018; DOI: 10.1179573518771703.
    CrossrefPubMedGoogle Scholar
  • 24 Clauw DJ. What is the meaning of “small fiber neuropathy” in fibromyalgia?. Pain 2015; 156: 2115-2116
    CrossrefPubMedGoogle Scholar
  • 25 Harte SE, Clauw DJ, Hayes JM. et al. Reduced intraepidermal nerve fiber density after a sustained increase in insular glutamate: a proof-of-concept study examining the pathogenesis of small fiber pathology in fibromyalgia. Pain Rep 2017; 2: e590
    CrossrefPubMedGoogle Scholar
  • 26 Bakris G, Ali W, Parati G. ACC/AHA Versus ESC/ESH on hypertension Guidelines. J Am Coll Cardiol 2019; 73: 3018-3026
    CrossrefPubMedGoogle Scholar
  • 27 Walitt B, Fitzcharles MA, Hassett AL. et al. The longitudinal outcome of fibromyalgia: a study of 1555 patients. J Rheumatol 2011; 38: 2238-2246
    CrossrefPubMedGoogle Scholar
  • 28 Wolfe F, Walitt BT, Rasker JJ. et al. The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity. J Rheumatol 2015; 42: 1494-1501
    CrossrefPubMedGoogle Scholar
  • 29 Häuser W, Perrot S, Clauw DJ. et al. Unravelling Fibromyalgia-Steps Toward Individualized Management. J Pain 2018; 19: 125-134
    CrossrefPubMedGoogle Scholar
  • 30 Häuser W, Galek A, Erbslöh-Möller B. et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain 2013; 154: 1216-1223
    CrossrefPubMedGoogle Scholar
  • 31 Wolfe F, Häuser W, Hassett AL. et al. The development of fibromyalgia--I: examination of rates and predictors in patients with rheumatoid arthritis (RA). Pain 2011; 152: 291-300
    CrossrefPubMedGoogle Scholar
  • 32 Fitzcharles MA, Perrot S, Häuser W. Comorbid fibromyalgia: A qualitative review of prevalence and importance. Eur J Pain 2018; 22: 1565-1576
    CrossrefPubMedGoogle Scholar
  • 33 Curtis JR, Herrem C, Ndlovu N. et al. A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: post-hoc results from the certolizumab pegol phase 4 PREDICT trial. Arthritis Res Ther 2017; 19: 215
    CrossrefPubMedGoogle Scholar
  • 34 Molto A, Etcheto A, Gossec L. et al. Evaluation of the impact of concomitant fibromyalgia on TNF alpha blockers’ effectiveness in axial spondyloarthritis: results of a prospective, multicentre study. Ann Rheum Dis 2018; 77: 533-540
    CrossrefPubMedGoogle Scholar
  • 35 Brummett CM, Urquhart AG, Hasset A. et al. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis & rheumatology (Hoboken, NJ) 2015; 67: 1386-1394
    CrossrefPubMedGoogle Scholar
  • 36 Ablin JN, Berman M, Aloush V. et al. Effect of Fibromyalgia Symptoms on Outcome of Spinal Surgery. Pain Med 2017; 18: 773-780
    PubMedGoogle Scholar
  • 37 Macfarlane GJ, Kronisch C. Atzeni et al. EULAR recommendations for management of fibromyalgia. Ann Rheum Dis 2017; 76: e54
    CrossrefPubMedGoogle Scholar
  • 38 Petzke F, Brückle W, Eidmann U. et al. General treatment principles, coordination of care and patient education in fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017; 31: 246-254
    CrossrefPubMedGoogle Scholar
  • 39 Haugmark T, Hagen KB, Smedslund G. et al. Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses. PLoS One 2019; 14: e0221897
    Google Scholar
  • 40 Glombiewski JA, Bernardy K, Häuser W. Efficacy of EMG- and EEG-Biofeedback in Fibromyalgia Syndrome: A Meta-Analysis and a Systematic Review of Randomized Controlled Trials. Evid Based Complement Alternat Med 2013; 2013: 962741
    CrossrefPubMedGoogle Scholar
  • 41 Zech N, Hansen E, Bernardy K. et al. Efficacy, acceptability and safety of guided imagery/hypnosis in fibromyalgia - A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2017; 21: 217-227
    CrossrefPubMedGoogle Scholar
  • 42 Bernardy K, Klose P, Welsch P. et al. Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2018; 22: 242-260
    CrossrefPubMedGoogle Scholar
  • 43 Bernardy K, Klose P, Welsch P. et al. Efficacy, acceptability and safety of Internet-delivered psychological therapies for fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2019; 23: 3-14
    CrossrefPubMedGoogle Scholar
  • 44 Scheidt CE, Waller E, Endorf K. et al. Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. Gen Hosp Psychiatry 2013; 35: 160-167
    CrossrefPubMedGoogle Scholar
  • 45 Lumley MA, Schubiner H, Lockhart NA. et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain 2017; 158: 2354-2363
    CrossrefPubMedGoogle Scholar
  • 46 Thieme K, Meller T, Evermann U. et al. Efficacy of Systolic Extinction Training in Fibromyalgia Patients With Elevated Blood Pressure Response to Stress: A Tailored Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2019; 71: 678-688
    CrossrefPubMedGoogle Scholar
  • 47 Sommer C, Alten R, Bär KJ. et al. Drug therapy of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017; 31: 274-284
    CrossrefPubMedGoogle Scholar
  • 48 Tzadok R, Ablin JN. Current and Emerging Pharmacotherapy for Fibromyalgia. Pain Res Manag 2020; 2020: 6541798
    CrossrefPubMedGoogle Scholar
  • 49 Walitt B, Klose P, Fitzcharles MA. et al. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev 2016; 7: CD011694
    PubMedGoogle Scholar
  • 50 Bialas P, Drescher B, Gottschling S. et al. Cannabis-based medicines for chronic pain: indications, selection of drugs, effectiveness and safety : Experiences of pain physicians in Saarland. Schmerz 2019; 33: 399-406
    CrossrefPubMedGoogle Scholar
  • 51 Salaffi F, Farah S, Di Carlo M. et al. The Italian Fibromyalgia Registry: a new way of using routine real-world data concerning patient-reported disease status in healthcare research and clinical practice. Clin Exp Rheumatol 2020; 123: 65-71
    PubMedGoogle Scholar