Rheumatic fibromyalgia

Pain is the main symptom of fibromyalgia and practically an indispensable condition for making the diagnosis. Nowadays, there is increased knowledge of the physiopathological characteristics of osteoarticular pain (peripheral and central sensitisation and inhibition) and the disorders in the process that lead to fibromyalgia. Studies are being carried out on the hypothesis that there is a genetic susceptibility to suffer this complaint based on alterations of pain control mechanisms in the brain, such as a physiological reduction of endorphins. The presence of hyperalgesia implies an alteration of psychological functions and this is the reason why there are secondary psychopathological phenomena such as depression and sleep disorders in patients with fibromyalgia. It is probable that the sustained persistence of mediators such as COX-2 also leads to the appearance of fatigue, but little is yet known about this phenomenon. There are also other types of disorders that could lead indirectly to the production of hyperalgesia and are not related with nociceptive alterations or disorders of the locomotor apparatus. For this reason, the first group is referred to as rheumatic fibromyalgia. This second group has not been so thoroughly studied and specialists other than rheumatologists are required to attend to these patients who do not respond to conventional painkilling treatments. This physiopathological understanding is used to establish a rational treatment for patients with rheumatic fibromyalgia.