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The Enigma of Fibromyalgia

  [ 29 votes ]   [ Discuss This Article ] • August 2, 1995

The article details the history, concept, definition and assessment
of the still enigmatic condition of 'fibrositis' or, as it has
more recently been called, 'fibromyalgia'. The concept and
diagnosis became popular, especially in North America, in the
1970s, after the seminal publications of Hugh Smythe (1972)
and Smythe and Moldofsky (1977). It is noticeable that there
does not appear to be an early case report as there is for
instance for gout, rheumatoid arthritis or certain
vasculitides. This may be one reason why we still lack a
commonly shared clinical image of the 'typical' case.

After Smythe and coworkers, operational definitions
and classification criteria were given by Yunus et al,
Lautenschlager et al (both in 1989) and Wolfe et al in 1990.
The latter received the endorsement of the American College of
Rheumatology and are now the most widely used. They identify
fibromyalgia as a musculoskeletal disorder with spontaneous
widespread pain and exaggerated tenderness as prominent and
distinctive features. The other two criteria sets refer to a
different concept of fibromyalgia as a 'functional' or
'dysfunctional' disorder. These and other nosological
differences pose problems for clinical as well as
epidemiological research. They may be of minor importance if
it is accepted that any present definition is arbitrary and
that a wide range of possible elements are more relevant to
research than a uniform concept of a disease called

Raspe H, Croft P

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