Raising Fibromyalgia Awareness: Here's to a Proper Diagnosis

Obtaining a timely and accurate diagnosis of this complex, chronic pain disorder can be difficult. Knowing what to expect at the doctor's office may ease the process. Plus: A new blood test offers hope.

 

As we head into National Fibromyalgia Awareness day – May 12 – Practical Pain Management spoke with Dr. David A. McLain, a prominent rheumatologist based in Alabama, and Dr. Chase Spurlock, CEO of IQuity, a data science company that monitors chronic disease, to get a handle on the need for better diagnostic tools. Read the full Q&A below. 

Why is fibromyalgia so commonly misdiagnosed? What other conditions mimic its symptoms?

Dr. McLain: Fibromyalgia syndrome is a diagnosis of exclusion, meaning it is identified only after a number of other diseases are tested for and eliminated as possibilities. With the onset of pain, fatigue, and poor sleep, fibromyalgia presents itself similarly to diseases such as lupus and rheumatoid arthritis, as well as mononucleosis, Hepatitis C, and other chronic infections. Fibromyalgia is also a common secondary diagnosis for patients who suffer primarily from lupus.

Plus, while not as common, it can be a secondary diagnosis in cases of rheumatoid arthritis, hypermobility syndrome, Sjogren’s syndrome, or Hashimoto’s disease, also known as chronic lymphocytic thyroiditis. For example, patients may complain of symptoms matching lupus, such as mouth and nose ulcers, skin rash, breakouts in the sun, joint pain, poor sleep, and fatigue. However, they also often have back, neck and shoulder blade pain that isn’t symptomatic of lupus. Doctors then begin the process of discovering why the patient is experiencing that pain. Because the symptoms overlap, the patient will often be diagnosed with both lupus and fibromyalgia.

 

 

What should a thorough fibromyalgia evaluation include in terms of questionnaires, tests, and timeframes?

Dr. McLain: First, doctors take the patient’s history to learn how long he/she has been suffering from the symptoms and how the symptoms are presented. Sometimes, patients suffer from post-traumatic fibromyalgia after being in an accident or suffering from a fatiguing illness such as chronic mononucleosis or Lyme disease. This is why it’s important to know what the patient has experienced before seeing the rheumatologist. Doctors then examine any tests a patient has already had done, such as MRIs or X-rays.

Because many viral illnesses present the same way as fibromyalgia, doctors look to see whether symptoms have persisted longer than three months. Waiting to make a diagnosis eliminates speculation that the patient’s symptoms are a result of a viral, short-term illness.

The evaluation may include a widespread pain index (WPI) test, with a score of 7 or higher (out of 19) possibly indicating a case of FM. Doctors will also take into account things like sleep patterns, changes in the weather, unaccustomed exercise, stress, trouble thinking, and fatigue. New fibromyalgia diagnostic criteria from the American College of Rheumatology have removed the need for a physical exam – which involves assessing soreness in 18 tender points located in the knees, elbows, chest, upper back and head – and focus mainly on patient history, symptoms and test results. However, many doctors throughout the rheumatology community still use tender points to aid in their diagnosis.

What does IQuity’s RNA fibromyalgia blood test offer that has not been available to physicians and patients before?

Dr. Spurlock: IQuity’s blood test, IsolateFibromyalgia, analyzes the gene expression pattern in a patient’s blood sample and compares it against a specific RNA pattern that indicates the presence of fibromyalgia. With 94% accuracy, providers receive a ‘Yes’ or ‘No’ result within seven days of receiving the sample at the company’s CLIA-certified, COLA-accredited laboratory. We understand that doctors and patients want to have more clarity earlier on in the diagnostic process, and we created IsolateFibromyalgia with that in mind. This new test produces reliable information that can help doctors decide on a course of treatment that starts immediately, rather than months in the future.

Dr. McClain: We’ve always told patients that there is no single X-ray or blood test you can take that clearly shows you have fibromyalgia. And this has been frustrating because an FM diagnosis comes at the end of a long line of doctor visits, tests, and waiting. This test is something that can be done earlier in the diagnostic process.

What can a patient suspecting fibromyalgia do to find the right doctor for diagnosis and treatment?

Dr. McClain: If someone suspects fibromyalgia, he or she can check online for lists of doctors that treat the disease. Also, the National Fibromyalgia Association keeps lists of physicians who treat fibromyalgia in each state and have been recommended by current patients or other medical professionals.

The memory and thinking problems associated with fibromyalgia, often referred to as ‘fibro fog,’ can make conversations with doctors long and arduous. As a result, some patients may find it difficult to locate a doctor willing to devote the time needed for an initial consultation. However, once treatment has begun and is successful, there can be a dramatic change between visits — patients can engage in conversation easier and better explain how they’re doing.

Read more about fibromyalgia on PPM's online Patient Center. 

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David McLain, MD, FACP, FACRis a native of Chicago, received his undergraduate degree from Northwestern University, and then graduated with honors from Tulane Medical School in New Orleans where he won the senior medicine award “The Order of the Gold-Tipped Stethoscope.” He completed a medical internship at the Ochsner Clinic in New Orleans. At Barnes Hospital and Washington University in St. Louis, he was a medical resident and Rheumatology Fellow. He is board certified in internal medicine and rheumatology and is a Fellow of the American College of Physicians and a Fellow of the American College of Rheumatology. He was an instructor in the Department of Medicine at Washington University School of Medicine. From 1983 until 2011, he was Chief of Rheumatology at Brookwood Medical Center. In 1983, Dr. McLain started the Congress of Clinical Rheumatology. Now in its 34th year, it has been attended by physicians from throughout the US, Canada, Europe, and Asia and is considered the second largest rheumatology meeting in the US. Dr. McLain has been President of the Alabama Society for the Rheumatic Diseases (1988-89, 2010-2011, 2011-2012) and is presently Executive Director of ASRD. He is a member of the American Society of Clinical Rheumatologists. He has won the Patient Choice Award multiple times from Vitals.com. He has been awarded the AMA Physicians’ Recognition Award 11 times.

Chase Spurlock, PhD, is a Phi Beta Kappa graduate of The University of the South and received his doctorate in immunology from Vanderbilt, where he also serves on the faculty. Dr. Spurlock is founder and CEO of IQuity. Through his past research and experience growing IQuity, Dr. Spurlock is committed to developing machine learning applications in healthcare that are capable of delivering accurate clinical insights to speed diagnosis and treatment decisions. Dr. Spurlock’s published work explores the molecular basis for autoimmune disease and further examines therapeutic targets in the management of these diseases leveraging a diverse set of genomic and biochemical approaches including gene expression and next-generation sequencing technologies.

Updated on: 05/11/18
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