FIBROMIALGIA

FIBROMIALGIA

Dr. Luis Carlos Manzato, médico Reumatologista e também ex-diretor da Faculdade de Medicina de Passo Fundo RS.

A fibromialgia (FM) é uma causa comum de dor músculo-esquelética crônica generalizada, muitas vezes acompanhada de fadiga, distúrbio cognitivo, sintomas psiquiátricos e vários sintomas somáticos. A etiologia do síndrome é desconhecida, e a fisiopatologia é incerta. Apesar dos sintomas de dor nos músculos, tendões e ligamentos, não há nenhuma evidência de inflamacão  destes tecidos (1,2). Assim, o papel de doença orgânica foi bastante questionada e a FM muitas vezes tem sido considerada psicogênica vs psicossomática (3). No entanto, os estudos sugerem que esta doença é um distúrbio da regulação da dor, muitas vezes classificada como uma forma de sensibilização central (1,2).

A fibromialgia (FM) é uma causa comum de dor crônica e é a causa mais comum de dor músculo-esquelética generalizada em mulheres entre as idades de 20 e 55 anos; nos Estados Unidos e em outros países, a prevalência é de aproximadamente 2 a 3% e aumenta com a idade, é mais comum em mulheres do que homens e também pode acometer as crianças (4,5).

Inicialmente denominado fibrositis, a FM foi descrito na França e na Inglaterra em meados do século 19, até o final do século 20, muitos reumatologistas reconheciam a FM como uma síndrome distinta, foram propostos critérios de classificação e de diagnóstico, avaliada, e então validada. Usando esses critérios, a FM tem sido reconhecida em todo o mundo; os relatórios encontram uma prevalência de 1,6% na França, de 2,5% no Brasil, e 3,6% em Bangladesh (6,7,8). Pelo menos 10% da população em geral tem dores crônicas generalizadas, e a maioria destes indivíduos não tem doença específica ou qualquer anormalidade estrutural para explicar a dor; muitos destes pacientes têm sintomas e achados compatíveis com FM.

Alguns pesquisadores têm defendido a não utilização de pontos dolorosos (ACR 1990), como parte dos critérios de diagnóstico de FM e confiado apenas nos sintomas; na prática, a contagem de pontos dolorosos muitas vezes é complexa, o que tem levantado preocupações sobre a precisão do diagnóstico por não especialistas (9). Os critérios diagnósticos do ACR 2010 fornecem uma abordagem alternativa para o diagnóstico e a sua classificação, já que não requer um exame de pontos dolorosos, mas fornece uma escala para medir a gravidade dos sintomas que são característicos de FM (10). Esses critérios também reconhecem a importância de problemas cognitivos e sintomas somáticos em pacientes com FM que não foram considerados no critério de classificação ACR 1990. Os critérios de 2010 podem ser utilizados em pacientes com sintomas durante pelo menos três meses, e nenhum outro transtorno que possa explicar a dor. Eles combinam um índice de dor generalizada (WPI) e uma escala de gravidade dos sintomas (SS). Os critérios de 2010 mostrou boa correlação com os critérios do ACR 1990, e uma vez que podem ser auto administrados, esses novos critérios são mais práticos para estudos de base populacional e de dor crônica generalizada.

A abordagem inicial do tratamento da FM deve incluir a educação do paciente sobre a doença, bem como a importância de comorbidades que pode contribuir para os sintomas, incluindo transtornos de humor ou de sono.  Um programa de exercícios, incluindo o condicionamento aeróbico, alongamento e fortalecimento deve ser obrigatório. O uso de drogas como a amitriptilina, a duloxetina, pregabalina deve ser iniciado quando os sintomas não são aliviados por medidas não-farmacológicas, e se necessário deve ser feita a referência para intervenções psicológicas, incluindo a terapia cognitivo comportamental (11). Os benefícios das intervenções não farmacológicas são suportados por revisões sistemáticas e meta-análise de 2009, que descobriram que o exercício cardiovascular, terapia cognitivo-comportamental (TCC), terapias psicológicas, educação do paciente, e intervenções multidisciplinares pode fornecer benefício em pacientes com FM, particularmente com melhorias de curto prazo na dor e na qualidade de vida (12).

O prognóstico da fibromialgia, a longo prazo, conforme Wolfe et al. (2008), com a abordagem das medidas terapêuticas adequadas costuma ser bom, porém a completa remissão e permanente é rara. A maioria das provas aponta para o fato de que pacientes com fibromialgia a terão por um longo período, e possivelmente por toda vida. Ainda não se tem a cura para essa patologia, apenas a administração dos sintomas.

 

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