الفهرس 
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Abstract
Introduction: It was thought that fibromyalgia is the most common cause ofgeneralized musculoskeletal pain (GMP). However, it was observed that many other causes may contribute to GMP.
Aim of the study: The aim wasto identify the different causes of GMP among patients attending the Physical Medicine (PM), Rheumatology and Rehabilitation (RR) clinics in Alexandria University (AU) Hospitals.
Subjects: The study was done on 100 patients having GMP among those attending the PMRRclinics in AU Hospitals. The definition of GMP is “pain at more than one body site concurrently and requires the presence of pain: 1) In the axial skeleton; 2) On the left and right side of the body; and 3) Above and below the waist and lasting for at least 3 months”. Exclusion criteria were acute infection.
Methods: All patients were subjected to history taking in addition to both musculoskeletal and neurological examination. The appropriate laboratory investigations and radiological examination were performed to confirm the cause of GMP.
Results: Generalized musculoskeletal pain was more common in females. The female-to-male ratio in this study was 7:1. The results revealed that primary generalized osteoarthritis (GOA) was the most frequent cause (27%). Next in frequency was rheumatoid arthritis (22%). The accidental occurrences of more than one cause of regional pain (mixed causes) were found in 20% of patients. Primary fibromyalgia syndrome was present in 14% of patients; and psychogenic rheumatism was found in 8% of patients. Secondary fibromyalgia syndrome was found in 5% of patients; and myofascial pain syndrome was found in 3% of patients. Multiple sclerosis was found in only one patient (1%). In mixed causes, there was simultaneous occurrence of more than one of the following: Osteoarthritis, rheumatoid arthritis, spondylosis, spondylolithesis, planter fasciitis, epicondylitis, shoulder periarthritis,………… .
Conclusions: 1) Primary GOA was the most frequent cause of GMP. Next to it in frequency was RA, mixed causes, then FMS. 2) Concomitant occurrence of more than one cause of regional pain (mixed causes) can also contribute to GMP. 3) Generalized musculoskeletal pain was more common among women than men.