An article titled “Inflammatory Fibromyalgia: Is It Real?” by Metyas et al (see library) took me completely by surprise. At first I read it because I had a flashback to a certain doctor’s reaction to seeing the fibromyalgia diagnosis on my chart. His eyes went blank and his whole demeanor yawned. He no longer took me seriously nor did he intend to. I was in his office because I couldn’t catch my breath, was having sharp shooting pains in my rib cage, and going downhill quickly. He wasn’t too interested in the first place – I was his last patient of the day. But he agreed to do an EKG and take an x-ray of my lungs, neither of which would pick up the massive pulmonary emboli I had in my lungs – blood clots in both lungs, all lobes. Five days later, I woke up on the bathroom floor, spent a night in the ICU with a clot-buster, then five days in hospital, and a year on warfarin. The diagnosis on my chart stopped him in his tracks from regarding me as anything but a psychosomatic whiner. This is what I thought this article was going to be about, the validity of a fibromyalgia diagnosis. My own defense mechanisms were up high enough that it took a little while for me to realize I wasn’t reading an article like that at all.
Metyas et al look at the possibility of a subset of fibromyalgia patients, a fairly substantial subset, actually. Some fibromyalgia patients have elevated inflammatory markers, in particular ESR and CRP, and positive ANA and RF. Yeah, I had to Google… ESR=erythrocyte sedimentation rate; CRP=C-Reactive Protein; ANA=antinuclear antibodies; RF=rheumatoid factor.
One of the major points Metyas et al make is that if there is a substantial subset of patients with abnormal inflammatory markers, then the American College of Rheumatology may need to amend its guidelines for fibromyalgia treatment, since it does not take into account any problems with inflammation.
And here’s where I realize, huh. It never occurred to me that inflammation was NOT a part of the fibromyalgia process. Ever since I can remember, pain was accompanied by inflammation. When my joints hurt the worst, they are stiff and visibly swollen. I can see inflammation in the soft tissue of my hands and feet in particular, again corresponding with the peak pain times. I had no idea it wasn’t considered part of the fibromyalgia experience.
Live and learn! For what it’s worth – I concur wholeheartedly that YES the American College of Rheumatology absolutely needs to take into account inflammation markers, and yes, doctors please consider these as a potential way of treating fibromyalgia. I’ve asked more than one doctor if there was a way to reduce fluids in the joints to ease up pain: steroids, diuretics, etc. None have taken me up on it – with my propensity to side effects, that’s probably good, but it’s still an unanswered question in my head. If I wasn’t so swollen, would I have less pain?