Myofascial trigger point syndromes in the practice of rheumatology

Pain referred from a muscle can mimic both pain from a joint and radicular pain associated with disease of spinal joints, leading to mistakes in diagnosis and in treatment. When articular disease is present, it predisposes to myofascial trigger point (TP) syndromes. With arthritis, TPs in muscles may result from decreased mobility with prolonged shortening of muscles, from abnormal mechanical stress on muscles and from stimuli arising in diseased joints. During examination for signs of myofascial disorders, the numbers of tender points and of local twitch responses in women with rheumatoid arthritis were twice those found in women free of any rheumatic illness. It is important to consider this high frequency of myofascial syndromes in persons with arthritis, when treating pain or weakness which could be due to the muscles rather than the joints. Conversely, it has been proposed, on theoretical and clinical grounds, that muscular TPs can cause joint disease. This hypothesis has important implications for the treatment of arthritis.