FIBROSITIS
Eugene F. Traut from Chicago, EUA
Doctor Traut starts with the following question: “Fibrositis, are we talking about something that does not exist?” (Personal note: even by then some clinicians had doubts about the existence of the entity fibrositis) He defines fibrositis as muscular or nonarticular rheumatism that presents as a painful and stiffness syndrome, and that is real.
In some patients it presents as a subjective collection of complaints about pain and disability, in other patients there is the presence of disabling contractures and nodules.
Traut mentions Gowers and Stockman as the first ones to mention the “fibrositis” entity. They attributed to fibrositis 70% of the admissions to rheumatism centers.
Hench and co-workers suggest that some of the patients had a psychosomatic disorder called “psychogenic rheumatism”.
Traut defines as primary fibrositis what it is now known as fibromyalgia syndrome.
Diagnostic symptoms of primary fibrositis syndrome ACCORDING to TRAUT
Patients with primary fibrositis complain of generalized aching and stiffness unassociated with any acute febrile episode and without any joint disease. The syndrome is practically limited to females, usually in climacteric years. They are tense women, single or with no more than one child. They work in offices, schools or factories and they do their domestic work. They admit being “worry-warts” and they ache “all over”. Headaches are related or unrelated to neck pain. There is a history of colitis. During vacation or sick leave, the manifold of complaints may temporarily vanish. These women are “always tired” and usually they are poor sleepers. Generalized deep tenderness over the muscles and a worried expression. Laboratory test remains normal. The patients complain of “arthritis”, yet there are no symptoms or signs related to the articulations. The patients designate the seat of pain in some muscle group. Masseuses describes INDURATIONS OR NODULES in the painful muscle masses (Stockman studied these indurations and nodules and points out certain “congestions” that did not have further substantiation by other authors).
In men, the symptoms and signs are more often associated to some RECENT, SUDDEN, UNUSUAL or CONTINUED FATIGUING EXERTION with often a COLD AND DAMP environment.
Pain is often localized in the neck, shoulder girdle, lumbosacral area, or rib cage. There may be LOCALIZED AREAS of DEEP TENDERNESS called “trigger zones”.
The deep tenderness exists just lateral to the vertebra corresponding to the root of the nerve serving the involved area.
NODULES and INDURATIONS are felt in some cases.
Prominent herniated fatty nodules (Personal note: what we call back mice) are frequently present in the sacroiliac area of obese patients with backache.
Secondary fibrositis
Many clinicians relate the involvement of the soft tissues concomitant with the joint disease. Then this entity is classified as SECONDARY FIBROSITIS (as in rheumatoid arthritis, Traut, 1952). Other entities also present nodules like the granulomas in rheumatic fever or the Aschoff bodies. And there are histological changes in the Dupuytre’s contracture or the periarticular changes in the shoulder syndromes.Location of the fibrositis
–Fibrositis of the neck: This entity can host a group of complaints that engage the attention of NEUROLOGIC or ORTHOPEDIC surgeons, RHEUMATOLOGISTS and PSYCHIATRISTS, OPHTHALMOLOGISTS or OTORHINOLARYNGOLOGISTS to treat a “nonexistent sinus disease”. It may be diagnosed as a “scalenus-anticus” syndrome. It may cause precordial pain of cervical origin. The X-RAY examinations may show common vertebral deformities that often are used to INCORRECTLY explain the pains and, subsequently, to a disappointing therapy. Traut recommends cervical traction, strectching exercises and correction of posture. A “Queen Anne collar” may also help. –FIBROSITIS OF THE LOW BACK (also called LUMBAGO): common in muscular men. Classically, it recurs. The pain was characterized by the German term “HEXENSCHUSS” or “witches shot” and it can be agonizing. The usual effective treatment is rest on a firm mattress with heat applied by a lamp. Also the use of opiates and strapping. And later diathermy, massage and stretching.
OTHER localized FIBROSITIS:
-Fibrositis of the shoulder
-Tennis elbow
-The carpal tunnel
-Dupuytren’s contracture
GENERALIZED FIBROSITIS or PRIMARY FIBROSITIS (Personal note: an old name of fibromyalgia): It is a generalized condition. It requires mental and physical hygiene. Rest and relaxation. Careless postural habits should be corrected.
Indications for PROCAINE INFILTRATION (preferable procaine amide) AND ADRENOCORTICAL STEROIDS CAN BE USED TO TREAT THE LOCAL FIBROSITIS (Traut, 1952).
Extra-articular pain in the buttocks can be treated by injecting the epidural space.
All cases of fibrositis need applications of heat, massage and exercise.
Published in March 2019 By Marta Cañis Parera 
