Statins and Fibromyalgia

Statin side effects are often misdiagnosed as fibromyalgia. Both conditions have general fatigue and muscle tenderness. Fibromyalgia has a complex of multiple tender points that can often be confused with the generalized tenderness of statin myopathy.

Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized American College of Rheumatology (ACR) criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

Similarly, there are no laboratory tests specific for statin myopathy for all blood tests may be normal. Even the C-reactive protein test for inflammation may not be elevated. The only reason to consider statin causality is that a person with muscle pain is on a statin drug. The nature of the statin or the dose is irrelevant for all of the statins are associated with this tendency for myopathy and any dosage other than the very minor ones has been associated with tender muscles.

Many fibromyalgia symptoms overlap with those of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus or even statin myopathy, does not necessarily rule out a fibromyalgia diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.     

Complicating things even further is that we are seeing many cases of statin induced myopathy with negative laboratory findings, that persist and even intensify even after the statin is stopped.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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