Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—A common question asked
by rheumatologists of their patients is, "How do you feel in the morning?"
This question may refer to morning stiffness from inflammatory joint disease
or restoration from the night's sleep in fibromyalgia. Fibromyalgia is common
(2% to 5% of the population in a recent study1)
and underdiagnosed as a cause of chronic fatigue, achiness, cognitive dysfunction,
and irritability.2 Approximately 2 years
ago, one of us (L.H.S.) noted that fibromyalgia patients often responded to
this question with the answer, "I feel like I was hit by a Mack truck"; some
did not specify the truck manufacturer, and others substituted bus or train.
We determined the frequency and specificity of this finding, which could be
referred to as the "18-wheeler" sign, as a clue in the diagnosis of fibromyalgia.
Sigal LH, Chang DJ, Sloan V. Intrakines and Blocking HIV Infection. JAMA. 1998;279(6):434. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-6-jac81007