skip to main content

Fibromyalgia HSD Overlap — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSoft Tissue RheumatologyFibromyalgia HSD OverlapSCE Rheumatology

A 40-year-old woman has an established diagnosis of generalised hypermobility spectrum disorder, with recurrent ankle sprains and symptomatic joint instability. For 6 months she has also had pain in four of five body regions, fatigue, unrefreshing sleep and impaired concentration. Her widespread pain index is 12 and symptom severity score is 8. Examination shows generalised joint hypermobility but no synovitis, muscle weakness or neurological deficit; full blood count, C-reactive protein, thyroid function and creatine kinase are normal. Which is the most appropriate diagnostic interpretation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Diagnose fibromyalgia in addition to HSD and address the manifestations of both conditions

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

The correct answer is C. Her recurrent sprains and joint instability remain attributable to HSD, while pain in at least four of five regions for more than 3 months, together with WPI 12 and SSS 8, supports an additional diagnosis of fibromyalgia. Fibromyalgia can be diagnosed in the presence of another clinically important disorder; HSD is neither an exclusion criterion nor an alternative name for fibromyalgia. The conditions have substantial symptomatic overlap and commonly coexist, but identifying both permits a more complete formulation addressing joint stability, proprioception and graded rehabilitation alongside fibromyalgia education, sleep, activity and pain-management strategies. A and E incorrectly treat HSD as an exclusion. B would discard genuine hypermobility-related pathology. D is incorrect because failure of HSD-directed treatment is not a prerequisite for diagnosing fibromyalgia.

Reference: Alsiri N, Alhadhoud M, Alkatefi T, Palmer S. The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review. Seminars in Arthritis and Rheumatism. 2023;58:152127. https://pubmed.ncbi.nlm.nih.gov/36462303/