Pathology

Fibromyalgia Defined



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Fibromyalgia is the name developed for a common syndrome, which seems to be quite uniform among members of the human race, but it seems to have arrived on the medical scene during the last 20 years especially. In medical texts it was called fibrocitis, fibromyositis, and myositis in decades past. There has never been any specific pathology or anatomy known, simply that patients hurt, are tender, and there seem to be other systemic symptoms such as fatigue, depression, etc. It is my idea that the wide spread pain is what was termed "rheumatism" years ago, and it became less and less meaningful as a malady during the 40's, 50's, 60's, 70's and 80's. The medical community and the laity more or less forgot the concept of rheumatism over those years. Even medical books of late never mention the word rheumatism in their indexes, but they did 20 years ago. Rheumatism as a malady was thought to be a wide spread condition and patients had aches and pains all over the body. I, as a physician for nearly thirty years, recognized that the onset of the malady of fibromyalgia coincided with the apparent up-swing in the occurrence of rheumatic fever during the early 1980s.

As a medical fact, more young people under 30 died of rheumatic fever than any other infectious disease until 1965. The disease never really disappeared and there is no immunization available. The malady became much less meaningful with the increased food supply and less crowded housing during the 1950's and 1960's, so by the late 60's and 70's it was apparent in modern societies that it had nearly disappeared.

During WW II over 120,000 Naval personnel were known to have contracted rheumatic fever or scarlet fever (nearly synonymous terms). However, in various countries and in parts of our country which are less economically advanced or the climate is such that Streptococcus pyogenes thrives at a high level (ie., such as Mexico, the Far East, Russia and the Rocky Mountain region of the United States) it is still common. Also, it is my idea that with the increased immigration from poorer countries such as Mexico, with the development of the great class of working poor in America, with the decreased use of antibiotics (just simple penicillin by injection or by oral dosing), with the advent of mass transportation, large schools, air conditioning, large commercial structures such as shopping centers, causes many persons to be enclosed in relatively tight spaces and facilitates the transfer of bacteria between the individuals in the population.

Rheumatism was a word coined by Galen, a famous Greek physician about 200 A.D. He named it for the disease patients developed due to damp seasons, climates, and perhaps it reflects cough, and congestion. The acute disease created, over time, a chronic painful condition. The word was used meaningfully for nearly 1500 years, but slowly lost its meaning for the laity and physicians alike. During the 1600's and later, at least, it was known that rheumatic fever, then termed acute rheumatism, set the stage for the condition known as chronic rheumatism, a systemic disease process. During the 1500's to 1700's it was known that the heart was affected especially, that patients with rheumatism had arteriosclerosis, that patients had lumbago (neurological back pain), that patients had arthritis, and that patients had seizures. Also, it was known that rheumatic fever caused coronary artery disease early in the last century. The prior data has been forgotten, really, even though it was recorded, as part of the rheumatism concept.

With the advent of specialty medicine, over the last 60 years wherein physicians become focused on procedures and not on determining, usually, the causes of medical problems, the systemic concept of rheumatism was further forgotten.

The word-root "rhem" has been maintained in: rheumatic diseases, rheumatologist, polymyalgia rheumatica, rheumatoid arthritis, etc. however none of the diseases treated by rheumatologists have a known cause,ie., they are idiopathic, and so the treatments are empirical and attempt to make symptoms less meaningful, but not treat the cause of the problem.

Surprisingly, even in texts such as "Harrison's Principles of Internal Medicine" it mentions under the chapter on rheumatoid arthritis that it is a systemic disease and those with it commonly have vasculitis and neuropathy and even myocardial infarctions, pericarditis and other problems of the internal organs.

Even though the words are so close: that is rheumatic fever, and chronic rheumatism are so close to rheumatoid arthritis and the rheumatic diseases, somehow medical personnel have missed the connection that Streptococcal pyogenes bacteria and the autoimmune response to repeated infections can cause, when high grade, the clinical presentation of rheumatic fever, but over time the same autoimmune response can cause chronic autoimmune diseases such as rheumatoid disease, with arthritis, lupus erythematosus, dermatomyositis, myositis, scleroderma, Wegener's granulomatosis,and that those syndromes are just manifestations of the same disease process. Certain cases are even called mixed connective tissue disease.

Fibromyalgia is simply systemic autoimmune vasculitis and it affects the peripheral nerves all over the body, but especially the brachial plexus bilaterally and the lumbosacral plexus bilaterally in its distal portions. " Nerve pain " or neuropathy is difficult for patients to localize and often the brachial plexus pain is felt in the shoulders, the scapula of the upper back and into the neck due to the referred pain patterns of the peripheral nervous system. Surprisingly sciatica, carpal tunnel syndrome, femoral neuropathy, meralgia paresthetica,ulnar neuropathy, pain and neuropathy thought to be secondary to herniated discs of the cervical and lumbar spine, are all caused by rheumatoid autoimmune vasculitis, the vasculitis secondary to repeated Streptococcal pyogenes infections. Please see the 14 page paper on this site: Rheumatism, Rheumatoid Autoimmune Vasculitis.

No doubt groups of patients with fibromyalgia will have more frequent coronary artery disease, thyroid abnormalities such as Hashimoto's thyroiditis, Addison's disease, ulcerative colitis, Crohn's disease, heartburn (surprisingly, caused by this systemic disease), and will be identified, often with one or another of the rheumatic diseases. Many other diseases, so called, which are idiopathic, are caused by this disease, including cancer of all types. No doubt if a large group of fibromyalgia (rheumatism) patients are followed they will develop cancer of various types at a high frequency. The same underlying condition causes arteriosclerosis (including aneurysms) and many other conditions identified during the later ages in life. This is because human tissues are exposed to the autoantibodies stimulated by Streptococcal pyogenes infection for a longer period by our upper years and there is more autoimmune damage which we often term: aging. During our aging period, of course humans experience more frequent arteriosclerosis (especially coronary arteriosclerosis), cancer, gall bladder disease, rheumatoid diseases, especially the arthritis, and of course experience the various skin presentations consistent with aging: seborrheic keratosis, thinning skin, facial erythema (solar dermatitis), formation of nevi, etc.

This concept would be easy to test: simply test all fibromyalgia patients for ASO titer, Anti-DNase B, and AntiHyaluronidase. These are specific tests for Streptococcus pyogenes antibodies. Also, they will present with frequent elevated Sedimentation Rates, RA factors, C-Reactive Protein, and C-Reactive Protein Cardiac (or high sensitivity)tests. There will be a relatively high frequency of positive tests in those with severe fibromyalgia.

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