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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.

All patients seen in initial consultation at The Lyme Disease Center and The Lupus Clinic . . . [Full Text of this Article]

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