Soft tissue rheumatism is one of the most common and most
misunderstood categories of disorders facing the primary care
physician. Among the more common types are subacromial
bursitis, epicondylitis, trochanteric bursitis, anserine
bursitis, and fibromyalgia.
The keys to the diagnosis of soft-tissue rheumatism are the
history and, more importantly, the physical examination.
Extensive laboratory testing and radiographs are not as
helpful in evaluating patients with these complaints.
Treatment consists of nonsteroidal anti-inflammatory drugs
(NSAIDs) and nonnarcotic analgesics. Especially in patients
with localized disorders, intralesional injections of corticosteroids
are particularly effective and safe and should be part of the
armamentarium of the primary care practitioner.
Fibromyalgia is a particularly challenging form of nonarticular
rheumatism. The clinical presentation is rather characteristic,
with the patient typically being a woman 30-60 years of age who
presents with diffuse somatic pain. Patients often give a history of
sleep disturbance, may be depressed, and show characteristic
tender areas, or trigger points. Laboratory findings are normal.
Management includes reassurance, correction of the underlying
sleep disturbance with low doses of a tricyclic antidepressant,
treatment with muscle relaxants and nonnarcotic analgesics or
NSAIDs, and an exercise program with a strong aerobic component.