| The nine paired red circles are recognized as common tender points associated with fibromyalgia. |
| Given the nature of fibromyalgia, there are no laboratory tests available for diagnosis of it, in fact the results of x-rays, blood tests and muscle biopsies are normal. |
| The clinical diagnosis is established by exclusion of other pathologies and the presence of characteristic symptoms and signs. |
| To diagnose fibromyalgia, rheumatology doctor should assess the patient's clinical history and symptoms, studies and analysis. |
| The differential diagnosis must rule out other conditions with symptoms similar to fibromyalgia. |
| Fibromyalgia is often confused with other rheumatic different, such as lupus erythematosus, rheumatoid arthritis, spondyloarthropathies, osteoarthritis, chronic fatigue syndrome, deficiency of vitamin D or vitamin B12, polymyalgia rheumatica or Sjögren syndrome and neurological disorders (transverse myelitis, multiple sclerosis, peripheral polyneuropathy. |
| Therefore, the differential diagnosis is essential to the patient's future, as both the diagnostic approach and prognosis and even therapy are different for each condition. |
| It is therefore essential to make tomography, magnetic resonance, electrical study members (conduction velocity and EMG), evoked potentials, blood tests (VCR, CRP, rheumatoid factor, antinuclear antibody). |
| After ruling out other diseases, it verifies the existence of so-called tender points, which is not the same as trigger points or myofascial trigger points syndrome. |
| There are a total of 18 points  |
| can be considered to have fibromyalgia if, by applying a pressure of nine pounds on those points The patient reported pain in 11 or more of them. This technique was developed by American College of Rheumatology . |
| These points are distributed throughout the body: knees, shoulders, neck, buttocks, elbows, hips, etc.. |
| However, this approach was initially adopted as a form of "case definition", which is why the diagnosis requires a thorough evaluation by a physician who specializes in rheumatic disease (rheumatologist). |
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