Publication: Birinci basamakta fibromiyalji yaklaşımı
Abstract
Birinci basamaktaki hekimlerin en sık karşılaştığı beli biri yaygın ağrı yakınmasıdır. Fibromiyalji, bu yakınmaya neden olan hastalıklardan birisidir. Fibromiyalji kadınlarda %0.7-13r erkeklerde ise %0.2-3.9 sıklığında görülmektedir. Birinci basamağa başvuran hastaların %6'sının fibromiyalji hastası olduğu saptanmıştır. Fibromiyalji tanı kriterlerinin 1990rda tanımlanmış olmasına karşın, hastalığa özgün bir laboratuvar ve görüntüleme yönteminin bulunmayışı ve tanının ayırıcı tanıda yer alan hastalıkların dışlanması sonucu konulabilmesi nedeniyle bu hastaların tanınması ortalama beş yıl gecikmektedir. Bu süre boyunca, tanı koyma sırasında istenen gereksiz incelemeler ve denenen tedaviler sağlık sistemine maddi bir yük oluşturmaktadır. Vücudun her kadranında hissedilen, en az üç aydır süren ve herhangi bir nedene bağlanamayan ağrıların varlığı hastalığın tanısı için önemlidir. Bunun dışında, migren tipi baş ağrısı, kronik yorgunluk sendromu, irritabl barsak sendromu ve depresyon gibi tanı ve tedavisinin güç olduğu bilinen pek çok klinik durum fibromiyaljiye eşlik edebilir. Hastalığın tedavisinde kesin bir yöntem yoktur, halen araştırmalar sürmektedir. Literatüre dayandırılmış olan bu derleme birinci basamakta çalışan hekimlere fibromiyalji hastalığını anımsatmak ve günlük uygulamalarında yol göstermek amacıyla hazırlanmıştır
One of the most common symptoms in primary care is disseminated pain. Fibromyalgia is one of the diseases that causes this complaint. Its prevalance is 0.7- 13% in women and 0.2-3.9% in men. It is identified that 6% of the people who visit primary care are diagnosed as fibromyalgia. Although the diagnostic criteria of fibromyalgia were defined in 1990, since there is no specific laboratory test or imagining technique and its diagnosis is possible only by the elimination of the other diseases in the list of differential diagnosis, the diagnosis of the disease is delayed for about 5 years. During this period, ordering irrelevant investigations for diagnosis and the trials for treatment cause extra financial burden for health care management. Presence of pain that is felt in all quadrants of the body and lasts for at least 3 months, is important for diagnosis. Besides, some clinical problems which are known to be difficult to diagnose and to treat, like migraine-type headache, chronic fatigue syndrome, irritable bowel syndrome and depression may accompany fibromyalgia. There is no definite treatment plan; the investigations are still in progress. This literature-based review hasbeen prepared to remind primary care physicians of fibromyalgia and to provide guidance for its management in daily practice.
One of the most common symptoms in primary care is disseminated pain. Fibromyalgia is one of the diseases that causes this complaint. Its prevalance is 0.7- 13% in women and 0.2-3.9% in men. It is identified that 6% of the people who visit primary care are diagnosed as fibromyalgia. Although the diagnostic criteria of fibromyalgia were defined in 1990, since there is no specific laboratory test or imagining technique and its diagnosis is possible only by the elimination of the other diseases in the list of differential diagnosis, the diagnosis of the disease is delayed for about 5 years. During this period, ordering irrelevant investigations for diagnosis and the trials for treatment cause extra financial burden for health care management. Presence of pain that is felt in all quadrants of the body and lasts for at least 3 months, is important for diagnosis. Besides, some clinical problems which are known to be difficult to diagnose and to treat, like migraine-type headache, chronic fatigue syndrome, irritable bowel syndrome and depression may accompany fibromyalgia. There is no definite treatment plan; the investigations are still in progress. This literature-based review hasbeen prepared to remind primary care physicians of fibromyalgia and to provide guidance for its management in daily practice.