Serratrice, G · Revue du rhumatisme et des maladies osteo-articulaires · 1990
Quick Summary
This 1990 editorial questions whether fibromyalgia is a distinct disease, noting that no actual tissue damage (fibrosis) has been found under microscopes. The author argues that fibromyalgia shares symptoms with other conditions like ME/CFS and suggests using the simpler term 'persistent, widespread muscle pain with no recognized organic cause' instead. The author found that only 25% of cases had a clear psychological cause, suggesting most cases have other unexplained factors.
Why It Matters
This historical perspective is relevant to ME/CFS patients because it highlights longstanding confusion about diagnostic categories and disease definitions in post-viral and unexplained fatigue/pain syndromes. The editorial's call for clearer, symptom-based terminology anticipates modern debates about ME/CFS classification and the need to separate descriptive symptoms from mechanistic assumptions. Understanding this conceptual history helps patients and advocates recognize that diagnostic uncertainty is not new and has contributed to underdiagnosis and delayed treatment.
Observed Findings
Psychological etiology was identified in only 25% of fibromyalgia cases examined.
Muscular morphological and functional abnormalities were sometimes detected, though their clinical significance remained unclear.
Fibromyalgia shared symptom profiles with several related syndromes including benign myalgic encephalomyelitis, epidemic neuromyasthenia, and chronic fatigue.
Inferred Conclusions
The term 'fibromyalgia' is nosologically unjustified because no histological fibrosis is present.
A multifactorial vicious cycle model better explains the pathophysiology than single-factor causation.
Descriptive terminology ('persistent, diffuse myalgia with no recognized organic etiology') is more accurate than disease-specific labels without proven organic bases.
Remaining Questions
What are the actual biological mechanisms underlying the muscle pain and fatigue in these conditions?
Why do morphological and functional muscle abnormalities appear in some patients but not others, and what is their clinical significance?
How do the various related syndromes (ME, epidemic neuromyasthenia, chronic fatigue) relate to each other pathophysiologically, and should they be classified as one or separate conditions?
What This Study Does Not Prove
This editorial does not definitively establish the cause of fibromyalgia or related conditions, nor does it prove that psychological factors are unimportant—finding psychological factors in only 25% of cases does not explain the remaining 75%. The editorial's proposed terminology does not establish what the underlying biological mechanism is, only what it is not (fibrosis). As a 1990 editorial without contemporary neuroimaging or biomarker data, it cannot address modern evidence of central sensitization or immune dysfunction.