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. 2019 Feb;46(2):204-212.
doi: 10.3899/jrheum.180083. Epub 2018 Jul 15.

Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress

Frederick Wolfe  1   2 , Brian Walitt  3   4 , Johannes J Rasker  3   4 , Winfried Häuser  3   4
Affiliations

Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress

Frederick Wolfe et al. J Rheumatol. 2019 Feb.

Abstract

Objective: Polysymptomatic distress (PSD) is the underlying metric of fibromyalgia (FM), and levels of PSD can identify criteria-positive FM with > 90% accuracy. We used levels of the PSD scale to test whether symptom levels in primary FM (PFM) and secondary FM (SFM) were the same and whether symptoms were equivalent in persons not meeting FM criteria.

Methods: We studied 1525 patients with a clinical diagnosis of FM and 12,037 patients with rheumatoid arthritis (RA). We used regression models to compare patients with potential and actual PFM to RA patients with potential and actual SFM for 17 key clinical variables.

Results: When controlled for PSD values, the widespread pain index, symptom severity scale, and pain, global, quality of life, and physical and mental component scores were essentially the same or only slightly different in PFM and SFM. Health Assessment Questionnaire-Disability Index scores were slightly higher in SFM (0.21 units), as was the painful joint count (1.6 joints). Overall, higher PSD scores were associated with more severe symptoms or abnormal status. PSD scores in patients not satisfying FM criteria and in patients satisfying criteria operated similarly.

Conclusion: PFM and SFM are equivalent regarding symptom burden. PSD scores are more informative about severity and severity within diagnosis than dichotomization into FM/non-FM. Studies of FM versus "healthy individuals," or FM versus other diseases, are inherently defective, while studies of FM and PSD in RA offer the opportunity to have meaningful comparison groups, because there are no readily available unbiased appropriate controls for PFM.

Keywords: FIBROMYALGIA; POLYSYMPTOMATIC DISTRESS; PRIMARY FIBROMYALGIA; RHEUMATOID ARTHRITIS; SECONDARY FIBROMYALGIA.

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Figures

Figure 1.
Figure 1.
Distribution of PSD score in patients referred to National Data Bank for Rheumatic Diseases with RA and FM diagnoses. Vertical line at PSD = 15 most accurately separates 2016 FM criteria–positive subjects from 2016 FM criteria–negative subjects. PSD: polysymptomatic distress; RA: rheumatoid arthritis; FM: fibromyalgia.
Figure 2.
Figure 2.
Plots of pain, HAQ, patient global, and health-related quality of life at levels of the PSD scale. Vertical line at PSD = 15 most accurately separates 2016 FM criteria–positive subjects from 2016 FM criteria–negative subjects. HAQ: Health Assessment Questionnaire; PSD: polysymptomatic distress; FM: fibromyalgia; QOL: quality of life; RA: rheumatoid arthritis.
Figure 3.
Figure 3.
Plots of SSS, WPI, symptom count, and joint count at levels of the PSD scale. Vertical line at PSD = 15 most accurately separates 2016 FM criteria–positive subjects from 2016 FM criteria–negative subjects. SSS: symptom severity scale; WPI: widespread pain index; PSD: polysymptomatic distress; FM: fibromyalgia; RA: rheumatoid arthritis.
Figure 4.
Figure 4.
Plots of opioid use, pregabalin use, prednisone use, and proportion of subjects currently smoking at levels of the PSD scale. Vertical line at PSD = 15 most accurately separates 2016 FM criteria–positive subjects from 2016 FM criteria– negative subjects. PSD: polysymptomatic distress; FM: fibromyalgia; RA: rheumatoid arthritis.
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Comment in

  • Secondary Fibromyalgia.
    Bennett RM, Friend R. Bennett RM, et al. J Rheumatol. 2019 Feb;46(2):127-129. doi: 10.3899/jrheum.180611. J Rheumatol. 2019. PMID: 30710001 No abstract available.

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