Objectives: To document possible diurnal variation in the severity of symptoms [pain, fatigue, stiffness and global sense of well-being] and signs [tender point count and sensitivity to pressure] in fibromyalgia. Methods: Seventeen females with fibromyalgia [mean age 49.6 years] were seen in their own homes at 9:00 a.m. and again at 7:00 p.m. Symptoms were assessed using 100 mm VAS scales. All 18 tender points of the 1990 ACR criteria for fibromyalgia were examined using a 0-11 kg/cm2 dolorimeter. Pain elecited at pressures < kg/cm2 denoted a tender point. Results: Pain, fatigue, and global score were worse in the evening in the majority of patients, while a similar proportion felt as stiff in the morning as in the evening. Tender points tended to be more numerous and more sensitive by evening. Most patients said they felt at their best around mid-day. Conclusions: The features of fibromyalgia are more pronounced later in the day. Fatigue and pain contribute more to this deterioration than does stiffness. This diurnal variation should be considered when evaluating results of treatment.
- Soft tissue