FIBROMYALGIE Diagnostic

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87
Diagnostic*
*
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Critères*du*Collège*américain*de*rhumatologie*
9-:7;(+#_(-:7.-7;6/::+'+;/#+0<76-:7$6>:7;0>(/44-<#7/;;-$#=:70<#7=#=7=6/30(=:7-<78``I7$/(76-7P066_1-7
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Symptômes*
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6/7f0>(<[email protected]/7:-4/+<-@7.>740+:@7.-76B/<<=-)79-7$/#+-<#7'+3(045/61+A>-7/7#0>#70>7$/(#+-7.-:7:54$#K4-:7
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Pathophysiologie*
Hypothèse*de*l'anomalie*d'alignement*des*dents*du*fibromyalgique*
9-:7'+3(045/61+A>-:7:-7$6/+1<-<#7:0>?-<#7.-7#(0>36-:70;;6>:/>F@7;B-:#WHW.+(-7A>Q+6:7=$(0>?-<#7><-7
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Anomalies*du*liquide*cérébro@spinal*
9/7.=;0>?-(#-76/7$6>:7:5:#=4/#+A>-4-<#7(-$(0.>+#-7-<76/30(/#0+(-7-:#7><-7;0<;-<#(/#+0<7"/>#-@7;"-T76-:7
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Imagerie*du*cerveau*
Hyperactivité*et*hypoactivité*de*certaines*zones*
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Concentrations*en*neurotransmetteurs*
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Od740+<:7.+:$0<+36-@7:$=;+'+A>-4-<#7./<:76-7$>#/4-<7.(0+#)7
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<->(0#(/<:4-##->(:7-#76/7'+3(045/61+-)7
Troubles*du*sommeil*décelés*par*un*électro@encéphalogramme*
9-:7$(-4+_(-:7.=;0>?-(#-:703f-;#+?-:7/::0;+=-:7H76/74/6/.+-70<#7=#=7(/$$0(#=-:7-<78`sh70E7/7=#=7
.=40<#(=-76/7$(=:-<;-7.B0<.-:7/6$"/7L/::0;+=-:7>:>-66-4-<#7H7.-:7$"/:-:7.-7:044-+676=1-(N7/<0(4/6-:7
-<7$"/:-7g7L:044-+67$(0'0<.N7.>(/<#76Bt6-;#(0W-<;=$"/601(/44-7.-7$/#+-<#:7'+3(045/61+A>-:)7
G<7'/+#@7-<7+<#-((04$/<#76-7:044-+67.-7$"/:-7g7;0<:#/44-<#7:>(7.-:7:>f-#:7f-><-:7-#7-<730<<-7:/<#=@7
^06.0':,57-#7:0<7=A>+$-70<#7=#=7;/$/36-:7.-7(-$(0.>+(-7><-7#-<:+0<74>:;>6/+(-7:>$$0:=-7;04$/(/36-7H7
;-66-7.-:7$/#+-<#:7'+3(045/61+A>-:)7P-$-<./<#7;-:7:-<:/#+0<:70<#7.+:$/(>760(:A>-76-:7:>f-#:70<#7$>7
(-#(0>?-(7><7:044-+67<0(4/6)7
O-$>+:7;-##-7=#>[email protected]<043(->:-:7=#>.-:7;0<'+(4-<#7.-:7/<04/6+-:7.>7:044-+67?/(+=-:7./<:7.-:7:0>:W
1(0>$-:7.-7$/#+-<#:7'+3(045/61+A>-:)7
Sensibilité*polymodale*
i6>:+->(:7=#>.-:7(=:>6#/<#7.-7:#+4>6/#+0<7-F$=(+4-<#/6-70<#7.=40<#(=7A>-76-:7$/#+-<#:7'+3(045/61+A>-:7
.=40<#(-<#7><-7:-<:+3+6+#=7/;;(>-7H76/7$(-::+0<@7/>F7:-<:/#+0<:7.-7;"/6->(7-#7.-7'(0+.@7H7.-:7:#+4>6/#+0<:7
=6-;#(+A>-:7-#7;"+4+A>-:)7O-:7-F$=(+4-<#/#+0<:7:>(76-:7:5:#_4-:7(=1>6/#->(:7.-76/7.0>6->(70<#740<#(=7A>-7
6-:7$/#+-<#:7/##-+<#:7.-7'+3(045/61+-740<#(-<#7/>::+7><-7.=(=1>6/#+0<7.-7.+''=(-<#:74=;/<+:4-:7
+<"+3+#->(:7.-76/7.0>6->()7G66-:7.=40<#(-<#7=1/6-4-<#7><-7(=/;#+0<7-F/1=(=-7H7><7:#+4>6+7(=$=#=@7-#76/7
.+4+<>#+0<70>76B/3:-<;-7.-76/7(=/;#+0<7/</61=:+A>-7+<.>+#-7$/(76B-''0(#7$"5:+A>-)7G<:-436-@7;-:7(=:>6#/#:7
$0+<#-<#7?-(:7><7.=(_16-4-<#7.>7:5:#_4-7<-(?->F7;-<#(/6)7
Perturbation*neuroendocrinienne*
9-:7=#>.-:7.-7$/#+-<#:7/##-+<#:7.-7'+3(045/61+-70<#7.=40<#(=7.-:7/<04/6+-:7./<:76-:7'0<;#+0<:7
<->(0-<.0;(+<+-<<-:7>:>-66-:7;044-7><-7"5$0;0(#+:06=4+-@7><-7:=;(=#+0<7-F;-::+?-7.-76B"0(40<-7
;0(#+;0#(0$-7-<7(=$0<:-7H7><-7:#+4>6/#+0<@7-#7><-7(=:+:#/<;-7/>7'--.3/;,716>;0;0(#+;0j.-)7]<-7(=.>;#+0<7
$(01(-::+?-7.-76/7$(=:-<;-7.B"0(40<-7.-7;(0+::/<;-7">4/+<-7/7/>::+7=#=7.=40<#(=-7:>(7;-(#/+<:71(0>$-:7
.-7$/#+-<#:@7/60(:7A>-76/7$6>$/(#7.=40<#(-<#7.-:7:=;(=#+0<:7"0(40</6-:7.+4+<>=-:7'/;-7H7.-:7-''0(#:7
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(=$0<:-7(=.>+#7.-76/7#"5(=0:#+4>6+<-7-#7.-:7"0(40<-:7#"5(0j.+-<<-:760(:7.-7:#+4>6/#+0<:7"0(40</6-:)7]<-7
"/>::-7(-6/#+?-4-<#7=6-?=-7.-:7<+?-/>F7.-7$(06/;#+<-@7/?-;7><-7.=:+<"+3+#+0<7.-76/7:=;(=#+0<7.-7$(06/;#+<-7
60(:7.-7:#+4>6/#+0<:7"0(40</6-:7-#7><-7:=;(=#+0<7+<:>''+:/<#-7.-:7"0(40<-:7$(0.>+#-:7$/(76-:716/<.-:7
:>((=</6-:70<#7=1/6-4-<#7=#=7;0<:#/#=-:)7
P-:7;"/<1-4-<#:7$0>((/+-<#7c#(-7/##(+3>=:7/>F7-''-#:7.>7:#(-::7;"(0<+A>-7A>-7;/>:-76/74/6/.+-@7A>+7/$(_:7
/?0+(7=#=7(-q>7-#7#(/+#=7$/(76-7:5:#_4-7<-(?->F7;-<#(/6@7/;#+?-<#76/7:=;(=#+0<7.B"0(40<-:7<->(0</6-:7
;0(#+;0#(0$"+<-:7"5$0#/6/4+A>-:)7P-6/7(=:>6#-(/+#7-<7><-7$-(#>(3/#+0<7.-76/7;044><+;/#+0<7\5$0$"5:-W
o6/<.-7V>((=</6-@7-#7-<7><7-F;_:7-<7:04/#0:#/#+<-7"5$0#"/6/4+A>-@7A>+7-<7(-#0>(@7+<"+3-<#76/7:=;(=#+0<7
.B><7;-(#/+<7<043(-7.B/>#(-:7"0(40<-:)7
Hyperactivité*du*système*nerveux*sympathique*
]<-7/</65:-7/7.=40<#(=7><-7/;#+?+#=7$-(#>(3=-7-#7-F;-::+?-7.>7:5:#_4-7<-(?->F7:54$/#"+A>-)7/?-;7><-7
(=/;#+?+#=7.-:716/<.-:7:54$/#"+A>-:7(=.>+#-7H7.+''=(-<#:7'/;#->(:7.-7:#(-::@7A>B+6:7:0+-<#7$"5:+A>-:70>7
4-<#/>F)79-:7$/#+-<#:7/##-+<#:7.-7'+3(045/61+-70<#7><-7?/(+/3+6+#=7.-76->(7(5#"4-7;/(.+/A>-73/:@7;-#7+<.-F7
.-76B=A>+6+3(-7:54$/#"+A>-&$/(/:54$/#"+A>-7+<.+A>/<#7><-7"5$-(/;#+?+#=7:54$/#"+A>-7:0>#-<>-@7-<7
$/(#+;>6+-(7.-7<>+#)7O-7$6>:@76-:7<+?-/>F7-<7<->(0$-$#+.-7u7LniuN7./<:76-7$6/:4/7:/<1>+<7:0<#73/:7;"-T76-:7
4/6/.-:@7;-7<->(0$-$#+.-7=#/<#760;/6+:=7/?-;76/7<0(/.(=</6+<-7./<:76-7:5:#_4-7<-(?->F7:54$/#"+A>-)7v7
6B+<?-(:-76-:7<+?-/>F7;+(;>6/#0+(-:7.B/.(-</6+<-7-#7.-7<0(/.(=</6+<-70<#7=#=7$/('0+:7.=;(+#:7;044-7"/>#:@7
3/:7-#7<0(4/>F)7

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h7
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$(0?0A>-7><-7"/>::-7'0(#-7.-:7<+?-/>F7;+(;>6/#0+(-:7.-7<0(/.(=</6+<-@7-#7><-7"/>::-7.>7(5#"4-7
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Facteurs*aggravants*
9-:7:54$#K4-:7.-76/7'+3(045/61+-7:-(/+-<#7<0#0+(-4-<#7./<:76-:7;0<.+#+0<:7:>+?/<#-:@76+=:7/>7:#(-::@7-#7
$->?-<#7.=;6-<;"-(7.-:7(=/;#+0<:7/>7<+?-/>7.-:7<->(0#(/<:4-##->(:70>7.-:7"0(40<-:7%7
• #(/>4/#+:4-@7:#(-::7-#7;"0;7=40#+0<<-6Y7
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• A>/<#+#=7.-7<0>((+#>(-7+<:>''+:/<#-7Y7
• 4/>?/+:-71-:#+0<7.>7:044-+67LA>/<#+#=7+<:>''+:/<#-70>7-F;-::+?-NY7
• '/#+1>-70>7-''0(#7$"5:+A>-7#(0$7+4$0(#/<#7Y7
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• ><-7"51(0:-<:+3+6+#=7W7(=/;#+0<7/>7#/>F7.B">4+.+#=7Y7
• ><-7#"-(40:-<:+3+6+#=7W7(=/;#+0<7H76/7#-4$=(/#>(-)7
x<7$/(6-71603/6-4-<#7.B"5$-(:-<:+3+6+#=)7
i/(7/+66->(:@7A>-6A>-:7;/:7.-7'+3(045/61+-:7:0<#7/::0;+=:7H7.-:7+4$6/<#:74/44/+(-:7.='-;#>->F7-<71-67.-7
:+6+;0<-7L4/(A>-7i065WZ4$6/<#7i(0#"_:-N)7O/<:76B><7.-7;-:7;/:@76-7(-#(/+#7.-76B+4$6/<#7.=#=(+0(=7/7$-(4+:7.-7
;0<:#/#-(7><-7.+4+<>#+0<7+4$0(#/<#-7.-:7:0>''(/<;-:7$-(q>-:7$/(76/7$/#+-<#-)7
Fatigue*chronique*
X>F7:54$#K4-:7;0>(/<#:7:B/::0;+-7:0>?-<#7><-7'/#+1>-7.+#-7C7;"(0<+A>-7D7(=/;#+0<<-66-7LH7<-7$/:7
;0<'0<.(-7/?-;76-7:5<.(04-7.-7'/#+1>-7;"(0<+A>-@7A>-7$->?-<#7/?0+(7-<7$6>:7;-(#/+<:7'+3(045/61+A>-:N)7
P-##-7'/#+1>-7-:#7.=;(+#-7;044-7(=/;#+0<<-66-7;/(7'6>;#>/<#-7:-60<76B-<?+(0<<-4-<#7-#76-:7;+(;0<:#/<;-:@7
$0>?/<#7.+:$/(/S#(-7#0#/6-4-<#7$>+:7(=/$$/(/S#(-)7
9-7:5<.(04-7.-7'/#+1>-7;"(0<+A>-7<B-:#7$/:76+=7H7><7-F;_:7.-7:>3:#/<;-7i)79-:74=;/<+:4-:7(-:$0<:/36-:7
.-76/7.0>6->(7:0<#7.0<;7$(03/36-4-<#7.+''=(-<#:7$0>(7;-:7.->F7;0<.+#+0<:)7
Variabilité*des*symptômes*
Z67-F+:#-7.+?-(:-:7'0(4-:7.-7:=?=(+#=:7H76/7'+3(045/61+-@7$0>?/<#7=?-<#>-66-4-<#7;0((-:$0<.(-7H7.+?-(:-:7
;/>:-:@70>7H7.+''=(-<#-:7?/(+/<#-:7.-76/74/6/.+-)79/7$(036=4/#+A>-7=#/<#7.-7#(0>?-(7><-7=;"-66-7L><7
4/(A>->(N7.-7:=?=(+#=7'+/36-@7+<-F+:#/<#7.>7'/+#7A>B/>;><74/(A>->(7<B/7-<;0(-7=#=74+:7H7f0>()7P-$-<./<#7
;-(#/+<:7#(/?/>F7.-7(-;"-(;"-:7#-<.(/+-<#7H7$(0>?-(7A>B+67-F+:#-7><-7;0((=6/#+0<7-<#(-76-:7<+?-/>F7-<7
:>3:#/<;-7i7-#76/7:=?=(+#=7.-:7:54$#K4-:)7
t#/<#7.0<<=76B+4$6+;/#+0<7.-:7<->(0#(/<:4-##->(:7./<:76/74/6/.+-@7;"/A>-7'+3(045/61+A>-7/7:-:7;5;6-:@7:-:7
:54$#K4-:@7.B+<#-<:+#=:7-#7.-7.>(=-:7?/(+/36-:)79-:7?/(+/<#-:7.B/##-+<#-:7.-7'+3(045/61+-:7:0<#7#(_:76/(1-:@7