Fibromyalgia – assessment by a rheumatologist at Charlottenlund Privathospital
Rheumatologists assess patients for fibromyalgia and rule out conditions that can cause similar symptoms.
Fibromyalgi (fibromyalgisyndrom) er en kronisk smertetilstand med udbredte smerter i muskler og bindevæv, træthed, søvnforstyrrelser og ofte koncentrationsbesvær. Tilstanden skyldes en ændret smertebearbejdning i nervesystemet – ikke betændelse eller skade i led og muskler – og der findes ingen blodprøve eller scanning, der kan påvise den. Diagnosen stilles derfor på symptomer og kriterier, efter at andre sygdomme er udelukket. På Charlottenlund Privathospital udredes fibromyalgi af speciallæger i reumatologi på Jægersborg Allé 4 i Charlottenlund.
What are the symptoms of fibromyalgia?
The main symptom is pain in several areas of the body for more than three months – most often in the neck, shoulders, back, hips, arms and legs – which can change location and intensity from day to day. Other symptoms include severe fatigue, unrefreshing sleep, morning stiffness, difficulty concentrating and remembering, and increased sensitivity to touch, cold, light and sound. Many people also experience headaches, irritable bowel syndrome, bladder irritation, and tingling or pins and needles in their hands and feet.
What causes fibromyalgia?
The cause is not fully understood. According to Ugeskrift for Læger, the most likely explanation is an interplay between genetic predisposition, hormonal factors and stressors such as prolonged stress, sleep deprivation, infections or physical trauma, which together alter how the nervous system processes pain. Fibromyalgia can occur on its own or as a secondary condition in patients with another rheumatic disease. The condition does not endanger joints or organs and does not cause joint damage, but it affects function and quality of life.
How is fibromyalgia assessed by a rheumatologist?
Smerternes udbredelse, varighed og døgnvariation, søvn, træthed og øvrige symptomer.
Led, muskler, sener og bevægelighed undersøges for hævelse, varme og bevægeindskrænkning.
Inflammation, stofskifte, D-vitamin og gigtprøver; ultralydsscanning ved mistanke om ledbetændelse.
Vurdering efter ACR-kriterierne, samtale om diagnosen og plan for behandling og opfølgning.
The assessment has two purposes: to rule out conditions that can cause similar symptoms and to determine whether the criteria for fibromyalgia are met. The initial consultation begins with a thorough review of the location, duration and daily pattern of the pain, sleep, fatigue and other symptoms. The joints, muscles, tendons and range of movement are then examined for signs of swelling, warmth or restricted movement that could point to inflammatory arthritis or another joint condition.
Blood tests are taken to rule out inflammation, thyroid disorders, vitamin D deficiency and rheumatic diseases. Ultrasound scans of the joints are used if joint inflammation is suspected. If all tests are normal and the symptoms meet the current international criteria from the American College of Rheumatology (ACR 2016), a diagnosis is made. The previous examination of 18 “tender points” is no longer required by the criteria.
The criteria are based on three elements: widespread pain in at least four of five body regions, symptoms lasting at least three months, and an overall assessment of the extent of pain and the severity of fatigue, sleep disturbance and cognitive symptoms. Another diagnosis does not rule out fibromyalgia – both conditions can be present at the same time.
How is fibromyalgia treated?
Fibromyalgia cannot be cured with a single treatment, but symptoms can be reduced and function improved. According to EULAR, treatment should begin with information about the condition and a gradual programme of physical exercise, which has the strongest evidence of effectiveness. This is supplemented by sleep advice, pain management and, where needed, psychological treatment. Medication has a limited role and is only used for selected symptoms following medical assessment; standard arthritis medicines and corticosteroids do not affect fibromyalgia, as there is no inflammation to reduce.
At Charlottenlund Privathospital, treatment includes medical assessment, a discussion of the diagnosis and its implications, advice on exercise and sleep, and treatment of any accompanying conditions identified during the assessment. If a multidisciplinary pain programme is needed, you will be referred onward with the completed assessment.
When should I see a rheumatologist?
A rheumatology assessment is recommended when pain in several areas of the body has lasted for more than three months without a clear cause, when it is accompanied by fatigue and sleep problems, or when blood tests taken by your GP have not identified a cause. It is also recommended if you have swollen joints, morning stiffness lasting more than half an hour or raised inflammatory markers at the same time – signs that may point to a rheumatic disease requiring different treatment. The sooner other causes are ruled out, the sooner the right treatment can begin.
Fibromyalgia assessment at Charlottenlund Privathospital
The assessment is carried out by specialist rheumatologists and is outpatient. The initial consultation typically lasts between half an hour and an hour, and blood tests and an ultrasound scan can often be done on the same day. Results and diagnosis are provided at a follow-up appointment or by phone, by arrangement.
Most patients come through health insurance; insurers typically require a referral from your GP and prior authorisation before an appointment can be booked. No referral is needed if you are paying for your treatment yourself, and prices are listed in the price list. Appointments can be booked online around the clock or by phone on 44 98 19 21 Monday to Friday, 08:00–14:00. Outside phone hours, the digital phone assistant Anna can book, cancel and reschedule appointments.
Frequently asked questions
Can fibromyalgia be detected in a blood test?
No. There is no blood test, scan or other test that can detect fibromyalgia. Blood tests are used to rule out other conditions, such as inflammatory arthritis or an underactive thyroid.
Is there a test for fibromyalgia?
Not a single test. The diagnosis is made using international criteria (ACR 2016), which assess the extent and duration of pain and accompanying symptoms, after other conditions have been ruled out. Online tests can give you an idea, but they cannot provide a diagnosis.
Who diagnoses fibromyalgia?
Your GP or a rheumatologist. A rheumatologist is involved when other rheumatic or connective tissue diseases need to be ruled out, or when the diagnosis is unclear.
Is fibromyalgia a rheumatic disease?
No. Fibromyalgia is a chronic pain condition without inflammation in the joints. However, it can occur alongside a rheumatic disease, and the assessment needs to clarify both.
Is fibromyalgia an autoimmune disease?
No. No autoimmune mechanism has been identified. Research points to altered pain processing in the nervous system.
Is fibromyalgia a recognised diagnosis?
Yes. Fibromyalgia is classified by the WHO in the International Classification of Diseases (ICD), and both American (ACR) and European (EULAR) rheumatology organisations have criteria and treatment recommendations for the condition.
Are tender points still used?
The 18 tender points were part of the 1990 criteria and are still used by some doctors, but they are not required under the current ACR criteria from 2016.
What is the most effective treatment for fibromyalgia?
According to EULAR, gradual physical exercise has the strongest evidence of effectiveness. Information, sleep advice and pain management are also important. Medication is only used for selected symptoms.
How long does the assessment take?
The initial consultation typically lasts between half an hour and an hour. Blood tests and, if necessary, an ultrasound scan can often be done on the same day, with results provided at a follow-up appointment or by phone.
Do I need a referral to be assessed for fibromyalgia at Charlottenlund Privathospital?
If you are using health insurance, your insurer will typically require a referral from your GP and prior authorisation. No referral is needed if you are paying for your treatment yourself.