FIBROSITIS

From Big Medical Encyclopedia

FIBROZYT [lat. (textus) of fibrosus fibrous fabric 4--itis] — the clinical syndrome which is characterized by diffusion or local pains in soft tissues out of joints, existence in certain zones of the painful points revealed at a palpation and also increased fatigue, a specific sleep disorder and neurologic .narusheniye.

T., as well as the miositis (see), a feather arthritis (see), a tendovaginitis (see), etc., belongs to rheumatic diseases of soft tissues out of joints («rheumatism of soft tissues»).

Distinguish primary and secondary F.

The term «fibrositis» is offered by U. Gavers (1904). However to a crust, there is no time of the conventional interpretation of this term. In literature the N y y with and m and t about m an eye of m and l e to with about about z is specified and and - it is hoped differently: fibromyalgia,

fibralgiya, myofascial pain, etc. In a number of classifications of rheumatic diseases and diseases of a musculoskeletal system the term «fibrositis» does not appear.

Prevalence F. it is studied insufficiently. Wolf (F. Woife, 1984) revealed F. at 14,6% from 1473 patients who addressed for consultation in revmatol. clinic within

2 1/2 years (including primary F. — at 3,7% of patients). According to Yunus (M. of Junus, 1981) and sotr., F is the most frequent. it is noted at the age of 26 — 35 years, at women by 6 times more often than at men.

Etiology and pathogeny primary F. are not known. Point out possible value of a mechanical overload, microtraumatization, dystrophic changes of soft tissues.

Secondary F. it is observed at nek-ry rheumatic diseases (a pseudorheumatism, a system lupus erythematosus), tumoral and infectious processes, metabolic frustration.

Patients complain of the constant pricking, dull or arching aches in soft tissues of a trunk and extremities, constraint in the mornings, fatigue. The state worsens in morning and evening hours, after exercise and mental stresses, at a weather changing, cooling. Analgetic means are usually not effective. Pains decrease under the influence of heat, massage or rest.

At a palpation specific painful points (fig.) come to light, to-rye differ in constancy. During the pressing on these points of pain happen so strong that the patient is discharged of the doctor, jumps from a chair, etc. In a zone of the increased painful sensitivity sometimes it is possible to reveal a hyperemia and a hyperesthesia of skin, consolidation of soft tissues. The atrophy of muscles is absent. The passive movements are not limited. According to Smythe (H. A. Smythe, 1972), an electroencephalography (see) at F. reveals specific disturbances of staging of a dream; at the same time stratifications of a bystry alpha rhythm on slow type of waves are registered. Patients after a dream do not feel like holidaymakers. They sleep like «the princess on a pea». After stressful situations there comes long sleeplessness. The frequent painless urination by small portions, is quite often noted especially at night. Urine at the same time is not changed. Patients F. are sensitive, vulnerable, mn you iteit l of a na, at di r chi in y.

The diagnosis is established on the basis of existence of a typical symptom complex. At laboratory, tool and morphological researches of any changes from muscles, periferiche-


Fig. The diagrammatic representation of specific painful points at a fibrositis (and — an anterior aspect, 6 — the back view): 1 — area of front intervertebral cracks Civ — Cvi; 2 — the place of a joint of the II edge with a cartilage; 3 — area of a medial fold of hypodermic cellulose of a knee joint; 4 — the middle of the upper edge of a trapezoid muscle; 5 — the point which is located above an awn of a shovel; 6 — the point which is located distalny an ectocondyle of an ulna, 7 — area of interspinal sheaves Liv — Si; 8 — the point which is located in a verkhnenaruzhny quadrant of a rump; (in the drawing symmetrically located painful points are not shown).

sky nerves and other fabrics at primary F. do not find. At the same time it is necessary to exclude other diseases of soft tissues having similar a wedge, a picture (a tendovaginitis, a periarthritis, a miositis, etc.). Additional researches are necessary for an exception of diseases, at to-rykh perhaps development secondary

F. Smythe (1972, 1981) offered the following criteria of the diagnosis F.: 1)

existence of generalized musculoskeletal pains within

not less than 3 months; 2) morbidity at a palpation not less than in 12 specific points; 3) morbidity at capture of skin pleated over an upper part of a shovel; 4) sleep disorder and feelings of constraint and fatigue in the mornings.

The differential diagnosis is carried out first of all with so-called psychogenic rheumatism, for to-rogo the fancy, emotionally brightly painted pain of uncertain localization is characteristic, it is frequent with senestopaticheskpm a shade; disturbances of mentality of patients. However characteristic for F. distribution of painful points is absent, pains do not change under the influence of external factors.

Treatment. Success of treatment depends on ability of the doctor to come into contact with the patient, to show consideration for his numerous complaints, to convince of the favorable forecast. Appoint massage (see), warmly (see. Thermal treatment), balneoprotsedura (see Balneoterapiya), LFK (see. Physiotherapy exercises). It is necessary to eliminate mechanical overloads, a nerve strain, to watch the correct position of a body in operating time and a dream. Apply anti-inflammatory drugs (acetilsalicylic to - that, an ibuprofen, etc.). To night appoint sedatives (Tazepamum, Seduxenum, etc.) or antidepressants (amitriptyline), generally during the greatest frustration of a dream. Barbiturates are a little effective. At the exhausting pains locally repeatedly enter a hydrocortisone, Kenalogum or novocaine, lidocaine. Are shown also local irrigation by Aether chloratus (ethyl chloride) and reflexotherapy

{see).

The forecast for life favorable. V. N. Anokhin.

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