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Teachable Moment
Less Is More
September 2017

Antinuclear Antibody and Subserology Testing in the Evaluation of Fibromyalgia: A Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 2Division of Rheumatology, Dallas VA Medical Center, Dallas, Texas
JAMA Intern Med. 2017;177(9):1369-1370. doi:10.1001/jamainternmed.2017.2776

A man in his 40s with gastroesophageal reflux disease presented to his primary care physician with an 8-month history of “pain all over.” He reported an insidious onset of waxing and waning diffuse pain in and around the neck, elbows, shoulder blades, hips and knees, along with fatigue, unrefreshing sleep, and depressed mood. He denied morning stiffness, trauma, weight loss, joint swelling or redness, or personal or family history of rheumatological conditions. His only medications were ranitidine, and as needed naproxen and topical menthol with minimal relief of pain.

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