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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0095" class="elsevierStylePara elsevierViewall">I joined the world of Rheumatology in the Orwellian year of 1984&#44; when I started my residency&#46; At that time&#44; the word fibromyalgia hardly existed&#59; it was mentioned timidly in the English-speaking literature under the misleading term of fibrositis&#46; Phillip Sholwater Hench&#44; discoverer of glucocorticoids and Nobel Prize winner in Medicine&#44; was one of the first to coin this term&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Here&#44; in our country&#44; the terms psychogenic rheumatism and cellulitis were used&#44; among others&#46; In this sense&#44; a search in Pubmed with the term fibromyalgia will reveal that in 1984 there were 23 citations&#44; nothing like the more than 549 citations of 2018&#44; and a historical accumulation of 11&#44;000 citations to date&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">You will already be wondering where on earth people with fibromyalgia were in the last century&#46; Rot&#233;s Querol&#44; the key figure in Catalan and Spanish rheumatology - used the expression psychogenic rheumatism&#46; He referred to it as a syndrome of the locomotor system that was poorly structured and debatable&#46; However&#44; he stressed that the painful disorders of this entity were as frequent as other psychogenic functional disorders&#44; such as those affecting the digestive system&#58; irritable bowel&#46; Note that there is no anatomopathological substrate or specific laboratory test for either entity&#46; Likewise&#44; he highlighted that psychogenic rheumatism was one of the most frequent disorders in general practitioner and rheumatologist consultations&#46; He defined it as any painful manifestation of the locomotor system in whose onset mental illness is a determining condition&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Boland established certain criteria in 1960&#58; a&#41; absence of organic disease or insufficient presence of organic disease&#59; b&#41; functional character of the disorders and c&#41; positive diagnosis of mental illness&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">I would add to Boland&#39;s criteria the absence of a characteristic anatomopathological result or any determining laboratory test&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A recent study by the Catalan Society of Rheumatology described the number of consultations in specific areas of interest in hospitals in Catalonia&#46; There were all kinds&#44; namely&#58; early arthritis&#44; gestation and arthropathies&#44; lupus&#44; ultrasound&#44; paediatric rheumatology&#44; among others&#46; In the survey of rheumatologists in Catalonia&#44; fibromyalgia was an area of specific interest for only 10&#37; of rheumatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> In my opinion&#44; fibromyalgia lacks scientific appeal today&#46; It is a &#8220;must&#8221; of the specialty and of the practitioners dedicated to this specific area&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with psychogenic rheumatism were subdivided into primary and secondary&#46; Until recently&#44; this terminology was also applied to fibromyalgia&#46; The overlap of psychogenic rheumatism with other functional disorders of other organs or systems was also highlighted&#46; Rot&#233;s Querol pointed out some clinical data that characterised these patients&#44; which apply to patients currently &#8220;baptised&#8221; as having fibromyalgia&#46; They presented to their doctor with a series of signs which&#44; taken together&#44; would constitute a setting which should alert the doctor to the possibility of this entity&#58; a&#41; inexorable and unjustified urgency in requesting a visit&#59; b&#41; <span class="elsevierStyleItalic">maladies du petit papier</span>&#44; i&#46;e&#46; a written list of questions&#44; often exhaustive&#59; c&#41; a large bag with imaging tests and other explorations&#59; d&#41; concern for future disability&#59; e&#41; 2 types of accompanying persons&#58; accomplice type &#40;sharing the suffering&#41; or released type &#40;absent from the interview&#41;&#59; f&#41; lack of correlation in the physical examination&#44; presence of the sign of the airplane and abundant facial expressions&#59; and g&#41; often holding the hand of the doctor during the physical examination as a way of preventing or avoiding pain&#46; As you can see&#44; these characteristics&#44; formerly described as typical of psychogenic rheumatism&#44; are seen in patients with fibromyalgia&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As you know&#44; physical examination attaches considerable importance to painful or trigger points&#46; Rot&#233;s Querol referred to these points as&#58; a&#41; nothing more imprecise than where to press&#44; b&#41; nothing more subjective than the intensity with which one presses&#44; and c&#41; nothing more decisive than the patient&#39;s mood&#46; He ended by commenting that&#44; if we try&#44; we can induce these in almost all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> On trigger points&#44; Hench commented that finger pressure was like &#8220;the finger of faith&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">To paraphrase Skinner&#44; the creator of the behavioural school&#58; &#8220;Give me a fibromyalgia patient and I will make the trigger points positive&#8221;&#46; Time has proved Dr Rot&#233;s right&#58; today the trigger points explored by doctors have disappeared from the new established criteria and instead it is the patient who indicates painful points in a self-questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A clinical sign that I value highly in the physical examination of fibromyalgia or cellulitis &#40;perhaps more than the reviled points&#41; is the pseudo pinching sign&#44; an exploratory manoeuvre to which doctors who deal with this entity have not paid due attention&#46; It is practiced by compressing and at the same time sliding the skin and the subcutaneous tissue between the thumb and the index finger forming a V&#58; not exerting pressure on the fingertips as in a real pinch&#46; The difference between positive and negative pseudo-pinching is clear&#46; The areas where it is applied are the inner side of the thighs&#44; the arms and the calves&#46; Finally&#44; I take the liberty of mentioning a clinical sign added by experts in fibromyalgia&#58; when blood pressure is taken the cuff evokes pain in the patient&#39;s arm&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3&#44;6&#44;8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The entities included in the psychogenic syndrome of the locomotor system should be mentioned&#58; a&#41; benign dorsalgia&#59; b&#41; cervicocranial or cervicocephalic syndrome&#44; which includes frontal or fronto-occipital headache&#44; cervicalgia&#44; sensation of dizziness&#44; tinnitus&#44; pain in the eyeballs&#44; oropharyngeal dryness and dysphonia&#59; c&#41; nocturnal acroparesthesias&#59; d&#41; restless legs&#44; e&#41; coxygodynia and f&#41; diffuse cellulitis&#46; Many of these conditions are present in the patient with fibromyalgia&#44; with different combinations throughout their life&#46; However&#44; the last is the most common entity&#44; termed diffuse or painful cellulitis&#44; which affects perimenopausal women in the main and is characterised by whole body pain &#40;&#8220;my whole body aches&#8221;&#41;&#44; morning asthenia &#40;&#8220;as if I had been beaten up&#8221;&#41;&#46; On physical examination&#44; the pseudo-pinching sign is invariably present&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3&#44;8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Like many rheumatologists of my generation&#44; those of us who have passed the equator of professional life were perplexed to see how psychogenic rheumatism of the locomotor system had disappeared&#44; which until then had flooded our practices&#46; We observed how one entity transformed into another&#44; mutated&#46; Whether due to the lack of structure of psychogenic rheumatism&#44; due to the connotations of the word &#8220;psychogenic&#8221;&#44; due to the quantification of trigger points&#44; or due to the medicalisation of life&#44; the term fibromyalgia banished the term psychogenic rheumatism completely and began to occupy a considerable space in all the rheumatology textbooks&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A condition that once did not occupy 2 paragraphs in texts went on to occupy entire chapters&#44; all due to the new name and the appearance of quantifiable pain points&#46; This is how fibromyalgia was born&#44; a clinical entity that explores the existence of people with generalised&#44; persistent and idiopathic pain that is defined as a chronic and non-inflammatory rheumatic process that affects the soft tissues of the locomotor system&#46; It is characterised by a low pain threshold &#40;hyperalgesia&#41; and pain on harmless stimuli &#40;allodynia&#41; accompanied by fatigue&#44; impaired functional capacity&#44; sleep and bowel rhythm disturbance&#44; rigidity and depression&#46; The same entity with a different name&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">This introduction leads me straight into the section &#8220;it&#39;s the economy&#44; stupid&#8221;&#44; a phrase coined by one of Bill Clinton&#39;s advisors that helped defeat George Bush in the 1992 presidential elections in the United States&#46; James Carville based the campaign on 3 ideas&#58; a&#41; change versus more of the same&#59; b&#41; it&#39;s the economy&#44; stupid&#33; and c&#41; don&#8217;t forget health care&#46; These 3 sentences can be applied to the issue we are discussing today&#46; I will only focus on section b&#46; The macroeconomic figures of fibromyalgia are of great magnitude&#46; On the one hand&#44; there are the direct costs&#58; in 2004 in Europe a patient with fibromyalgia cost 5&#44;240 euros per year &#40;note that the cost of spondyloarthritis per patient was 2&#44;373 euros per year&#41;&#46; In the United States&#44; in 2006&#44; the cost per patient was &#36;9&#44;573 per year&#44; derived from 7&#44;440 hospitalisations&#44; 2&#46;2 outpatient visits and 1&#46;8 specialist visits&#46; It is estimated that patients with fibromyalgia make 10 visits to the doctor per year&#46; Indirect costs in the United States are &#36;2&#44;573 per patient per year&#44; with a total cost of &#36;1 billion per year&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The magnitude of the tragedy of the cost of fibromyalgia patients is enormous&#44; and therefore it is a problem that the Congress of Deputies and the Parliament of Catalonia have entered the debate&#46; In Catalonia&#44; fibromyalgia also took on political overtones due to the fact that a distinguished person had developed this disease&#44; became an activist &#40;always with elegance&#41; and managed to get Parliament to discuss the subject and issue recommendations&#46; It was a real tidal wave &#40;now called a tsunami&#41;&#44; which put enormous pressure on rheumatology services and ordinary rheumatologists&#46; These facts&#44; the economy and the political nature that fibromyalgia has acquired&#44; are unique in the specialty and have overtaken other perhaps more common and very costly diseases&#44; such as osteoporosis or inflammatory arthropathies&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As the English-speakers say&#44; there is an elephant in the room&#44; that is&#44; there is no denying the obvious&#46; We have to face the problem without awkwardness&#44; avoidance&#44; contempt&#44; denial&#44; ignorance&#44; deviation or silence&#46; The current undertones do the disease no favours&#46; A media dynamic and the interference of politicians&#44; I think&#44; do not serve us well&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">I conclude&#58; a&#41; Psychogenic rheumatism &#40;especially diffuse cellulitis&#41; and fibromyalgia are one and the same entity&#59; b&#41; the absence of a diagnostic test and the lack of appeal is a burden for fibromyalgia&#59; c&#41; nothing is more subjective than trigger points and e&#41; economic data and politics per se have interfered in this entity</p></span>"
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Editorial
Passive Voice of Fibromyalgia
La voz pasiva de la fibromialgia
Alejandro Olivé Marqués
Servicio Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0095" class="elsevierStylePara elsevierViewall">I joined the world of Rheumatology in the Orwellian year of 1984&#44; when I started my residency&#46; At that time&#44; the word fibromyalgia hardly existed&#59; it was mentioned timidly in the English-speaking literature under the misleading term of fibrositis&#46; Phillip Sholwater Hench&#44; discoverer of glucocorticoids and Nobel Prize winner in Medicine&#44; was one of the first to coin this term&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Here&#44; in our country&#44; the terms psychogenic rheumatism and cellulitis were used&#44; among others&#46; In this sense&#44; a search in Pubmed with the term fibromyalgia will reveal that in 1984 there were 23 citations&#44; nothing like the more than 549 citations of 2018&#44; and a historical accumulation of 11&#44;000 citations to date&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">You will already be wondering where on earth people with fibromyalgia were in the last century&#46; Rot&#233;s Querol&#44; the key figure in Catalan and Spanish rheumatology - used the expression psychogenic rheumatism&#46; He referred to it as a syndrome of the locomotor system that was poorly structured and debatable&#46; However&#44; he stressed that the painful disorders of this entity were as frequent as other psychogenic functional disorders&#44; such as those affecting the digestive system&#58; irritable bowel&#46; Note that there is no anatomopathological substrate or specific laboratory test for either entity&#46; Likewise&#44; he highlighted that psychogenic rheumatism was one of the most frequent disorders in general practitioner and rheumatologist consultations&#46; He defined it as any painful manifestation of the locomotor system in whose onset mental illness is a determining condition&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Boland established certain criteria in 1960&#58; a&#41; absence of organic disease or insufficient presence of organic disease&#59; b&#41; functional character of the disorders and c&#41; positive diagnosis of mental illness&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">I would add to Boland&#39;s criteria the absence of a characteristic anatomopathological result or any determining laboratory test&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A recent study by the Catalan Society of Rheumatology described the number of consultations in specific areas of interest in hospitals in Catalonia&#46; There were all kinds&#44; namely&#58; early arthritis&#44; gestation and arthropathies&#44; lupus&#44; ultrasound&#44; paediatric rheumatology&#44; among others&#46; In the survey of rheumatologists in Catalonia&#44; fibromyalgia was an area of specific interest for only 10&#37; of rheumatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> In my opinion&#44; fibromyalgia lacks scientific appeal today&#46; It is a &#8220;must&#8221; of the specialty and of the practitioners dedicated to this specific area&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with psychogenic rheumatism were subdivided into primary and secondary&#46; Until recently&#44; this terminology was also applied to fibromyalgia&#46; The overlap of psychogenic rheumatism with other functional disorders of other organs or systems was also highlighted&#46; Rot&#233;s Querol pointed out some clinical data that characterised these patients&#44; which apply to patients currently &#8220;baptised&#8221; as having fibromyalgia&#46; They presented to their doctor with a series of signs which&#44; taken together&#44; would constitute a setting which should alert the doctor to the possibility of this entity&#58; a&#41; inexorable and unjustified urgency in requesting a visit&#59; b&#41; <span class="elsevierStyleItalic">maladies du petit papier</span>&#44; i&#46;e&#46; a written list of questions&#44; often exhaustive&#59; c&#41; a large bag with imaging tests and other explorations&#59; d&#41; concern for future disability&#59; e&#41; 2 types of accompanying persons&#58; accomplice type &#40;sharing the suffering&#41; or released type &#40;absent from the interview&#41;&#59; f&#41; lack of correlation in the physical examination&#44; presence of the sign of the airplane and abundant facial expressions&#59; and g&#41; often holding the hand of the doctor during the physical examination as a way of preventing or avoiding pain&#46; As you can see&#44; these characteristics&#44; formerly described as typical of psychogenic rheumatism&#44; are seen in patients with fibromyalgia&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As you know&#44; physical examination attaches considerable importance to painful or trigger points&#46; Rot&#233;s Querol referred to these points as&#58; a&#41; nothing more imprecise than where to press&#44; b&#41; nothing more subjective than the intensity with which one presses&#44; and c&#41; nothing more decisive than the patient&#39;s mood&#46; He ended by commenting that&#44; if we try&#44; we can induce these in almost all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> On trigger points&#44; Hench commented that finger pressure was like &#8220;the finger of faith&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">To paraphrase Skinner&#44; the creator of the behavioural school&#58; &#8220;Give me a fibromyalgia patient and I will make the trigger points positive&#8221;&#46; Time has proved Dr Rot&#233;s right&#58; today the trigger points explored by doctors have disappeared from the new established criteria and instead it is the patient who indicates painful points in a self-questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A clinical sign that I value highly in the physical examination of fibromyalgia or cellulitis &#40;perhaps more than the reviled points&#41; is the pseudo pinching sign&#44; an exploratory manoeuvre to which doctors who deal with this entity have not paid due attention&#46; It is practiced by compressing and at the same time sliding the skin and the subcutaneous tissue between the thumb and the index finger forming a V&#58; not exerting pressure on the fingertips as in a real pinch&#46; The difference between positive and negative pseudo-pinching is clear&#46; The areas where it is applied are the inner side of the thighs&#44; the arms and the calves&#46; Finally&#44; I take the liberty of mentioning a clinical sign added by experts in fibromyalgia&#58; when blood pressure is taken the cuff evokes pain in the patient&#39;s arm&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3&#44;6&#44;8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The entities included in the psychogenic syndrome of the locomotor system should be mentioned&#58; a&#41; benign dorsalgia&#59; b&#41; cervicocranial or cervicocephalic syndrome&#44; which includes frontal or fronto-occipital headache&#44; cervicalgia&#44; sensation of dizziness&#44; tinnitus&#44; pain in the eyeballs&#44; oropharyngeal dryness and dysphonia&#59; c&#41; nocturnal acroparesthesias&#59; d&#41; restless legs&#44; e&#41; coxygodynia and f&#41; diffuse cellulitis&#46; Many of these conditions are present in the patient with fibromyalgia&#44; with different combinations throughout their life&#46; However&#44; the last is the most common entity&#44; termed diffuse or painful cellulitis&#44; which affects perimenopausal women in the main and is characterised by whole body pain &#40;&#8220;my whole body aches&#8221;&#41;&#44; morning asthenia &#40;&#8220;as if I had been beaten up&#8221;&#41;&#46; On physical examination&#44; the pseudo-pinching sign is invariably present&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3&#44;8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Like many rheumatologists of my generation&#44; those of us who have passed the equator of professional life were perplexed to see how psychogenic rheumatism of the locomotor system had disappeared&#44; which until then had flooded our practices&#46; We observed how one entity transformed into another&#44; mutated&#46; Whether due to the lack of structure of psychogenic rheumatism&#44; due to the connotations of the word &#8220;psychogenic&#8221;&#44; due to the quantification of trigger points&#44; or due to the medicalisation of life&#44; the term fibromyalgia banished the term psychogenic rheumatism completely and began to occupy a considerable space in all the rheumatology textbooks&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A condition that once did not occupy 2 paragraphs in texts went on to occupy entire chapters&#44; all due to the new name and the appearance of quantifiable pain points&#46; This is how fibromyalgia was born&#44; a clinical entity that explores the existence of people with generalised&#44; persistent and idiopathic pain that is defined as a chronic and non-inflammatory rheumatic process that affects the soft tissues of the locomotor system&#46; It is characterised by a low pain threshold &#40;hyperalgesia&#41; and pain on harmless stimuli &#40;allodynia&#41; accompanied by fatigue&#44; impaired functional capacity&#44; sleep and bowel rhythm disturbance&#44; rigidity and depression&#46; The same entity with a different name&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">This introduction leads me straight into the section &#8220;it&#39;s the economy&#44; stupid&#8221;&#44; a phrase coined by one of Bill Clinton&#39;s advisors that helped defeat George Bush in the 1992 presidential elections in the United States&#46; James Carville based the campaign on 3 ideas&#58; a&#41; change versus more of the same&#59; b&#41; it&#39;s the economy&#44; stupid&#33; and c&#41; don&#8217;t forget health care&#46; These 3 sentences can be applied to the issue we are discussing today&#46; I will only focus on section b&#46; The macroeconomic figures of fibromyalgia are of great magnitude&#46; On the one hand&#44; there are the direct costs&#58; in 2004 in Europe a patient with fibromyalgia cost 5&#44;240 euros per year &#40;note that the cost of spondyloarthritis per patient was 2&#44;373 euros per year&#41;&#46; In the United States&#44; in 2006&#44; the cost per patient was &#36;9&#44;573 per year&#44; derived from 7&#44;440 hospitalisations&#44; 2&#46;2 outpatient visits and 1&#46;8 specialist visits&#46; It is estimated that patients with fibromyalgia make 10 visits to the doctor per year&#46; Indirect costs in the United States are &#36;2&#44;573 per patient per year&#44; with a total cost of &#36;1 billion per year&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The magnitude of the tragedy of the cost of fibromyalgia patients is enormous&#44; and therefore it is a problem that the Congress of Deputies and the Parliament of Catalonia have entered the debate&#46; In Catalonia&#44; fibromyalgia also took on political overtones due to the fact that a distinguished person had developed this disease&#44; became an activist &#40;always with elegance&#41; and managed to get Parliament to discuss the subject and issue recommendations&#46; It was a real tidal wave &#40;now called a tsunami&#41;&#44; which put enormous pressure on rheumatology services and ordinary rheumatologists&#46; These facts&#44; the economy and the political nature that fibromyalgia has acquired&#44; are unique in the specialty and have overtaken other perhaps more common and very costly diseases&#44; such as osteoporosis or inflammatory arthropathies&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As the English-speakers say&#44; there is an elephant in the room&#44; that is&#44; there is no denying the obvious&#46; We have to face the problem without awkwardness&#44; avoidance&#44; contempt&#44; denial&#44; ignorance&#44; deviation or silence&#46; The current undertones do the disease no favours&#46; A media dynamic and the interference of politicians&#44; I think&#44; do not serve us well&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">I conclude&#58; a&#41; Psychogenic rheumatism &#40;especially diffuse cellulitis&#41; and fibromyalgia are one and the same entity&#59; b&#41; the absence of a diagnostic test and the lack of appeal is a burden for fibromyalgia&#59; c&#41; nothing is more subjective than trigger points and e&#41; economic data and politics per se have interfered in this entity</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Oliv&#233; Marqu&#233;s A&#46; La voz pasiva de la fibromialgia&#46; Reumatol&#46; Cl&#237;n&#46; 2020&#59;16&#58;69&#8211;70&#46;</p>"
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        "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">The author would like to thank Dr Xavier Tena for his critical reading of this editorial&#46;</p>"
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