Résumé
Épidémiologie
La prévalence du trouble sur la vie entière en France est estimée entre 1,4 et 2,2 %. Le sex-ratio est de sept femmes pour un homme, les symptômes apparaissent habituellement entre 30 et 50 ans.
Diagnostic
Le diagnostic de fibromyalgie est aujourd'hui un diagnostic rhumatologique qui repose sur un syndrome cardinal associant des douleurs permanentes diffuses, une fatigabilité et un sommeil vécu comme non réparateur. La fibromyalgie interroge sur son identité nosographique, car il s'agit d'une maladie extrêmement comorbide.
Diagnostic des comorbidités psychiatriques
Il est important pour le clinicien de rechercher les symptômes dépressifs qui ne sont pas classiquement comorbides dans la fibromyalgie : idées suicidaires, anhédonie, autoaccusation, troubles du comportement alimentaire, ralentissement psychomoteur. Un trouble anxieux apparaît fréquemment, secondairement à l'apparition des symptômes, et peut parfois précéder l'apparition du syndrome fibromyalgique. La grande majorité des patients souffrant de fibromyalgie ont un antécédent d'événement de vie traumatique.
Traitements pharmacologiques
La réponse médicale au syndrome fibromyalgique n'est pas forcément médicamenteuse. Le traitement de la fibromyalgie ne fait pas aujourd'hui l'objet d'une AMM en France et en Europe. La duloxétine, la prégabaline et le milnacipran ont reçu l'AMM dans cette indication aux États-Unis mais aucun n'a démontré son efficacité au long cours. La fibromyalgie nécessite donc une prise en charge multidisciplinaire étroite entre les rhumatologues (à qui revient le diagnostic), les médecins généralistes (qui orientent et conseillent les patients), les médecins spécialistes de la douleur et enfin les psychiatres dans le traitement médicamenteux ou psychothérapiques des comorbidités psychiatriques.
Abstract
Epidemiology
The lifetime prevalence of fibromyalgia in France is estimated between 1.4% and 2.2%. The male/female sex ratio is 1:7, and symptoms usually appear between the age of30 and 50 years.
Diagnosis
The diagnosis of fibromyalgia is now a rheumatologic diagnosis, based on symptoms including chronic widespread pain and nonrestorative sleep. As fibromyalgia is a highly comorbid disease, it questions about nosographic identity.
Diagnosing psychiatric comorbidity
It is important for the clinician to look for symptoms of depression that are not traditionally comorbid with fibromyalgia: suicidal ideation, anhedonia, self-blame, eating disorders and psychomotor retardation. An anxiety disorder is often secondary to the onset of symptoms, and can sometimes precede the onset of fibromyalgia syndrome. The vast majority of patients with fibromyalgia have a history of traumatic life events.
Pharmacological treatments
The medical treatment to the fibromyalgia syndrome is not necessarily a drug. Treatment of fibromyalgia is currently not the subject to marketing authorization in France and Europe. Pregabalin, duloxetine and milnacipran received marketing authorization for treatment of fibromyalgia in the US, but none have proven effective in the long term. Fibromyalgia, therefore, requires multidisciplinary support from rheumatologists (who make the diagnosis), general practitioners (who guide and advise patients), medical pain specialists and psychiatrists for the treatment of comorbidities.
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Fond, G., Capdevielle, D., Attal, J. et al. La fibromyalgie est-elle une maladie psychiatrique ?. Psychiatr Sci Hum Neurosci 9, 190–197 (2011). https://doi.org/10.1007/s11836-011-0176-9
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DOI: https://doi.org/10.1007/s11836-011-0176-9
Mots clés
- Fibromyalgie
- Douleurs
- Hystérie
- Antidépresseurs
- Thérapie cognitive et comportementale
- Catastrophisme
- Kinésiophobie
- Épisode dépressif majeur
- Comorbidités
- État de stress post-traumatique