Fibromyalgia

If you want to learn more about fibromyalgia tests, you're in the right place! Find out what you should know about the types of fibromyalgia symptoms, causes, treatments, tests, and more here.


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Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE. 

Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge.


Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor abosrption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency.

 Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.


If the Tissue Transglutaminase IgA is positive,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.


A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.


See individual tests

Test for myocardial infarction and skeletal muscle damage. Elevated results may be due to: myocarditis, myocardial infarction (heart attack), muscular dystrophy, muscle trauma or excessive exercise

A synthetic circular peptide containing citrulline called CCP IgG (cyclic citrullinated peptide) has been found to be better at discriminating Rheumatoid Arthritis patients from other patients than either the perinuclear autoantibody test or the test for rheumatoid factor. Approximately 70% of patients with Rheumatoid Arthritis are positive for Anti-CCP IgG, while only about 2% of random blood donors and disease controls subjects are positive.

Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor absorption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency. While this assay will produce accurate Vitamin D results on patients of any age, it is specifically indicated for infants less than 3 years of age.


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Elevated RF is found in collagen vascular diseases such as SLE, rheumatoid arthritis, scleroderma, Sjögren's Syndrome, and in other conditions such as leprosy, tuberculosis, syphilis, malignancy, thyroid disease and in a significant percentage of otherwise normal elderly patients.

Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. However, rheumatoid factor can also be present in individuals with other conditions such as lupus, infectious hepatitis, syphilis, mononucleosis, tuberculosis, liver disease, and sarcoidosis. Rheumatoid factor is an antibody that is detectable in the blood of 80% of adults with rheumatoid arthritis. Rheumatoid can be detected in the blood of normal individuals and of those with other autoimmune diseases that are not rheumatoid arthritis. In people with rheumatoid arthritis, high levels of rheumatoid factor can indicate a tendency toward more aggressive disease and/or a tendency to develop rheumatoid nodules and rheumatoid lung disease. Rheumatoid factor is actually an antibody that can bind to other antibodies. Antibodies are normal proteins in our blood that are important parts of our immune system. Rheumatoid factor is an antibody that is not usually present in the normal individual. Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. Rheumatoid factor is present in about 80% of adults (but a much lower proportion of children) with rheumatoid arthritis.

Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. However, rheumatoid factor can also be present in individuals with other conditions such as lupus, infectious hepatitis, syphilis, mononucleosis, tuberculosis, liver disease, and sarcoidosis. Rheumatoid factor is an antibody that is detectable in the blood of 80% of adults with rheumatoid arthritis. Rheumatoid can be detected in the blood of normal individuals and of those with other autoimmune diseases that are not rheumatoid arthritis. In people with rheumatoid arthritis, high levels of rheumatoid factor can indicate a tendency toward more aggressive disease and/or a tendency to develop rheumatoid nodules and rheumatoid lung disease. Rheumatoid factor is actually an antibody that can bind to other antibodies. Antibodies are normal proteins in our blood that are important parts of our immune system. Rheumatoid factor is an antibody that is not usually present in the normal individual. Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. Rheumatoid factor is present in about 80% of adults (but a much lower proportion of children) with rheumatoid arthritis.

Useful in differentiating inflammatory and neoplastic diseases and as an index of disease severity. CRP is also useful in monitoring inflammatory disease states.

Anti-skeletal muscle antibody titers of >1: 80 have been reported to be present in the serum of 30% of patients with Myasthenia Gravis, 95% of patients with Myasthenia Gravis and thymoma, and 25% of patients with thymoma.

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The assay may be useful in the diagnosis of nonthyroidal illness (NTI). Patients with NTI have low T3 concentrations and increased concentrations of rT3. RT3 may be useful in neonates to distinguish euthyroid sick syndrome from central hypothyroidism.

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Total T3 measurements are used to diagnose and monitor treatment of hyperthyroidism and are essential for recognizing T3 toxicosis

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This test is used to diagnose hyperthyroidism and to clarify thyroid status in the presence of a possible protein binding abnormality.

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For diagnosis of hypothyroidism and hyperthyroidism.

Note: Free T4 Index (T7) will only be calculated and reported if test code code 861 (T3 Uptake) is ordered as well.


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The free T4 are tests thelps evaluate thyroid function. The free T4 test is used to help diagnose hyperthyroidism and hypothyroidism. Free T4 is the active form of thyroxine and is usually ordered along with or following a TSH test. This helps the doctor to determine whether the thyroid hormone feedback system is functioning as it should, and the results of the tests help to distinguish between different causes of hyperthyroidism and hypothyroidism.

Thyroid Peroxidase Antibodies (TPO) and Thyroglobulin Antibodies

Measurement of thyroglobulin antibodies and thyroid peroxidase antibodies (TPO) is useful in the diagnosis and management of a variety of thyroid disorders including autoimmune thyroiditis, Hashimoto's Disease, Graves Disease and certain types of goiter.

 "IMPORTANT - Please note that Quest returns values up to 900 for the Thyroid Peroxidase Antibodies test.  If tracking requires values above 900 for the Thyroid Peroxidase Antibodies, then order test TPO Antibody Endpoint (Test Code # 15116).


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The Thyroid-stimulating Hormone (TSH) Blood Test is for differential diagnosis of primary, secondary, and tertiary hypothyroidism. The TSH test is also useful in screening for hyperthyroidism. This assay allows adjustment of exogenous thyroxine dosage in hypothyroid patients and in patients on suppressive thyroxine therapy for thyroid neoplasia.


TSI stands for thyroid stimulating immunoglobulin. TSI tells the thyroid gland to swell and release excess amounts of thyroid hormone into the blood.

Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor absorption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia.


Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor absorption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency.


Fibromyalgia is a disease about which much is not yet known. Because of the nature of the symptoms, it is often misdiagnosed as other conditions. For this reason, fibromyalgia tests can be a good idea for those who suspect they may be suffering from this condition.

If you suspect that you may have this disorder, you will want to learn more about some of the fibromyalgia lab tests that are available to you. Read on to find out about the symptoms, causes, management, and diagnosis of this disease.

Fibromyalgia Lab Tests

For some time, there was no known way to test specifically for fibromyalgia. For this reason, diagnosis often consists of testing to rule out other diseases. Doctors most often identify a condition as fibromyalgia by process of elimination.

Some of the diseases that have similar symptoms to fibromyalgia include hypothyroidism, chronic fatigue syndrome, lupus, rheumatoid arthritis. Often, doctors will perform blood tests to rule out these conditions. This includes testing such as a complete blood count test, an antinuclear antibody test to rule out rheumatoid arthritis, and thyroid hormone tests to rule out hypothyroidism.

Recently, there has been promising evidence to suggest that something called an FM/a test may be effective in diagnosing fibromyalgia. This test focuses on the level of cytokines within a blood sample. Abnormal levels of cytokines have been linked to fibromyalgia.

However, more clinical trials are needed to confirm the efficacy of this method of testing. The process of elimination is still a widely used method of a fibromyalgia diagnosis. 

What Is Fibromyalgia?

Fibromyalgia is a disease that affects the central nervous system. It is characterized by widespread pain throughout the body. People with fibromyalgia may be more physically sensitive. This is due to abnormalities in how the nervous system processes pain.

Fibromyalgia typically manifests itself in adults between the ages of 30 and 50. It is estimated that around 4 million adults (or 2% of the population) in the US suffer from this condition.

Risk Factors for Fibromyalgia

Although much is still not known about this disease and its causes, there are some things that can put you at a higher risk. Women, for example, are around 7 times more likely to have fibromyalgia than men. It is more common in adults, although children and elderly people can also develop it.

Certain diseases, such as lupus and rheumatoid arthritis can put patients at a higher risk of developing fibromyalgia. It is now believed that in many cases, family history may also have a part to play.

Causes of Fibromyalgia

The exact causes of fibromyalgia are still unknown. However, there are certain situations or conditions that can be triggers for the development of fibromyalgia.

Going through a stressful or traumatic event can precipitate the development of fibromyalgia. This could be a death of a loved one, an abusive relationship, a car accident, or any other type of physically or mentally stressful situation. Post-traumatic stress disorder has been linked to the development of fibromyalgia.

There is also some evidence to suggest that there could be a hereditary element to the condition. Scientists believe people may be more likely to develop fibromyalgia because of genes inherited from their parents.

Signs and Symptoms of Fibromyalgia

Fibromyalgia symptoms are similar to those of many other conditions. This makes it oftentimes difficult to diagnose.

The most common and prominent symptom is pain throughout the entire body. Even the slightest touch can feel painful to someone with fibromyalgia.

Pain can feel like a dull ache or a sharp sensation. For those with fibromyalgia, pain tends to be widespread and long-lasting. Patients may also experience sensitivity to other things such as light, sound, and temperature.

Other symptoms include fatigue, difficulty sleeping, brain fog, and stiffness in the joints. Fibromyalgia sufferers can find themselves experiencing difficulty moving after holding the same position for too long. Brain fog can come in the form of difficulty learning new things, memory loss, and feelings of dizziness.

In some patients, fibromyalgia can cause other conditions such as IBS, anxiety, or depression to develop. In women, it can often cause painful periods.

Fibromyalgia and Fibromyalgia Tests: Frequently Asked Questions

Because we do not know enough about fibromyalgia, it is common for patients not to have heard of it or know how it is diagnosed. Below are some of the most frequently asked questions pertaining to fibromyalgia and fibromyalgia tests.

Is there a Cure for Fibromyalgia?

At the moment, there is no known cure for fibromyalgia. It is a chronic disease, meaning it tends to last a long time in most patients. However, lifestyle changes and medication can help with the symptoms.

How Is Fibromyalgia Treated?

There are many different courses of treatment for fibromyalgia. Often, painkillers are prescribed to help with the pain levels. Doctors often also recommend antidepressants to many patients.

Other treatments, such as cognitive-behavioral therapy and occupational therapy, can have a positive effect. Your doctor may also suggest lifestyle changes such as exercise programs, a special diet, or relaxation techniques.

How Can I Be Tested for Fibromyalgia?

Research is being carried out into FM/a testing for fibromyalgia. However, the most common method of diagnosis remains via the process of elimination.

Tests such as erythrocyte sedimentation ratecyclic citrullinated peptide test, and rheumatoid factor will be carried out to rule out various conditions. Doctors also look for the presence of pain in four of five key areas of the body that has lasted for more than three months.

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Fibromyalgia is a condition that’s associated with widespread, chronic debilitating pain. People with the condition have sore necks, backs, and shoulders, as well as aching muscles. They usually sleep poorly and are stiff when they wake up or move after sitting for prolonged periods. The location and intensity of the pain, as well as the intensity of fatigue, may vary from one day to the next and become worse with stress and excessive exercise. 

It is believed that fibromyalgia affects close to 5 million people in America over 18 years of age. Women are affected most by fibromyalgia at between 80 and 90 percent of cases, but men and children too can be affected. People with certain health conditions affecting bones, muscles, and joints such as lupus and arthritis may also have a higher risk of fibromyalgia. For most rheumatologists (doctors that specialize in rheumatic diseases), fibromyalgia is the second or third most diagnosed condition. 

The fatigue, pain, and many other symptoms associated with the condition can frustrate patients and doctors alike. Fibromyalgia usually makes the affected person miserable but doesn’t cause visible damage or inflammation to the affected tissues. While pain and other symptoms may come and go randomly, they never progress to a disease state or remit over time. While depression is at times associated with the condition, it doesn’t cause fibromyalgia; the prevalence of depression is the same as it is with other chronic conditions. 

Healthcare practitioners that know about fibromyalgia can make a diagnosis using the criteria established by the American College of Rheumatology (ACR) back in 2010. New research into understanding fibromyalgia is mostly centered on how pain is processed in the spinal cord and brain as opposed to the pain receptors in the rest of the body. The change in perspective is hoped to bring forth a new way of diagnosing the condition in the future.  

Currently, there isn’t any cure for fibromyalgia, but treatments are available to manage it. People with the condition may require treatment by a team of professionals, which includes a physical therapist, general practitioner, and perhaps even a rheumatologist. You can usually find such teams at pain clinics that specialize in the treatment of arthritis, along with other rheumatic conditions. 

While no single cause of the condition has been identified, it is believed that there are both environmental and genetic components, i.e., something acts as a trigger in those predisposed to the condition. There’s a higher incidence of the condition in some families than in others. Some cases appear to start with a severe illness or physical trauma, while other cases arise without any discernible “event.” 

Some researchers believe that symptoms could be linked to sleep disorders, while others think that the condition could be due to a microorganism. Still, others suspect the cause to be either chronic overreaction of the immune system or altered skeletal muscle metabolism. Current research focuses more on abnormalities in pain processing pathways and neural processes as the cause of fibromyalgia symptoms. Answers to the cause of the condition might be years away, but healthcare practitioners can identify those with the condition and try to help them lead somewhat normal lives. 

Signs and Symptoms 

While there are numerous signs and symptoms associated with the condition, fibromyalgia almost always starts with: 

  • Some degree of chronic fatigue as well as interrupted sleep 
  • Pain upon the application of pressure in specific areas referred to as “tender points.” 
  • Chronic widespread pain 

Other common symptoms of the condition include: 

  • Paresthesia (Tingling and numbness in the feet and hands) 
  • Painful menstruation 
  • Headaches 
  • Memory lapses, difficulty concentrating 
  • Anxiety and depression (may co-exist) 

The people affected may also experience one or more of the following: 

  • Diarrhea 
  • Irregular heartbeat, chest pain, shortness of breath 
  • Painful sexual intercourse 
  • Neurally mediated hypotension, i.e., Blood pressure that lowers when standing 
  • Localized edema 
  • Abdominal pain, cramping, and gas 
  • Dry mouth 
  • Difficulty concentrating, dry eyes 
  • Balance problems, dizziness 
  • Difficulty swallowing 
  • Constipation 
  • Dry, itchy, or blotchy skin 
  • Irritable bowel syndrome 
  • Heartburn 
  • Urinary frequency, irritation, and urge 
  • Temporomandibular joint dysfunction (TMD), pain in jaw joints as well as surrounding muscles 
  • Sensitivity to medications 
  • Sensitivity to sound, light, odors, temperature, and touch 
  • Rhinitis that consists of sinus pain and nasal discharge/congestion (but without an allergic immune response) 
  • Restless legs syndrome as well as periodic limb movement during sleep 

Fibromyalgia is a condition that may and sometimes actually co-exists with numerous other chronic illnesses such as rheumatoid arthritis, chronic fatigue syndrome, Sjögren syndrome, multiple sclerosis, thyroid disease, lupus, and ankylosing spondylitis. The symptoms of these conditions can be mingled with the ones associated with fibromyalgia, which can make diagnosis increasingly challenging. 

Tests 

The condition is typically diagnosed by documenting the medical history of the patient, ruling out diseases and disorders that could be exacerbating or mimicking fibromyalgia, and utilizing the criteria that the American College of Rheumatology (ACR) last updated in 2010. 

The criteria outlined by the ACR evaluates pain severity and location. It also considers the symptoms or how the individual feels. A person would be diagnosed with fibromyalgia if he/she met the following: 

  • Number of painful areas out of 19 parts of the body 
  • Has experienced pain and symptoms over the past week 

Plus, how severe the following symptoms are: 

  • Waking unrefreshed 
  • Fatigue 
  • Cognitive (thought or memory) problems 

Plus, the number of other general physical symptoms:

  • The individual doesn’t suffer from any other condition that might explain the pain 
  • Symptoms have been present at the same level of severity for not less than three months 

Laboratory Tests 

A laboratory test can be incredibly helpful when it comes to diagnosing conditions that have symptoms like fibromyalgia, which include Sjögren syndrome, rheumatoid arthritis, lupus, and thyroid disease. It usually isn’t necessary or effective to do the extensive screening. General test that may be ordered include: 

A healthcare practitioner will usually consider the following when coming up with a diagnosis: 

  • The patient’s history (including risk factors for certain diseases and family history) 
  • Results of general tests 
  • Results of the physical examination 

Based on these findings, additional tests may be ordered.