Background

Generally, the forensic scientist does not raise diagnostic suspicions, and his work is limited to the evaluation of pathological pictures that are already well framed and supported by clinical certificates drawn up by other specialists in the field at an earlier time. However, there are cases in which the medico-legal assessment allows a diagnostic suspicion to be raised which may have repercussions on the quantification of - among other things - civil invalidity and handicap.

Case description

In the context of a collegial examination to ascertain her fitness for work as provided in the 2008 interdepartmental collective agreement, a 53-year-old female patient requested exemption from her current employment due to chronic widespread pain. The patient was employed as an assistant teacher at a kindergarten, she had a graduate in pedagogy and she was unmarried and without children. In her medical history there was a septic arthritis of the newborn on the left hip, which was treated surgically by multiple accesses, as well as a depressive disorder with a history of admission to a psychosomatic clinic. The patient was being treated with acetaminophen, metamizole, citalopram and quetiapine. Radiological imaging showed only arthritis in the hips, but no problems in other body districts. Symptomatically, however, she complained of pain in both hips, the spine and both shoulders. These symptoms were progressive and did not respond to the medication. The patient also reported insomnia, sometimes needing to take sleep-inducing drugs.  Objectivity reported BMI of 25.21, possible walking with lameness, inability to raise the upper limbs beyond the shoulder line, pain in all tender points (TPs). Due to the presented symptoms, as well as the absence of radiological data justifying pain in the spine and shoulders, the diagnostic suspicion of FMS was raised, and the patient was advised to consult a rheumatologist or a specialist in pain medicine who could make a definite diagnosis and set up the correct therapy. Subsequently, on the basis of the clinical-radiological picture and the symptomatology, a judgement was made of 'unsuitability for the job of the professional profile for a period of six months', effectively exempting the patient from work and allowing her a change of job that was more suited to her needs.

Discussion

In our opinion, this case is emblematic of how FMS and chronic pain can affect a patient's work activity. From this perspective, will be necessary to implement the dissemination of awareness and knowledge of the FMS also among medical personnel dedicated to the evaluation of invalidating states in order to guarantee the best protection of FMS sufferers also from the medical-legal point of view.

References

• Interdepartmental Collective Agreement, 2008, Italy
• Schweiger V, Del Balzo G, et Al. Current trends in disability claims due to fibromyalgia syndrome. Clin Exp Rheumatol. 2017 May-Jun;35 Suppl 105(3):119-126.