Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 15;1(1):43-51.
doi: 10.1002/acr2.1006. eCollection 2019 Mar.

The Problematic Nature of Fibromyalgia Diagnosis in the Community

Sachin Srinivasan  1 , Eamon Maloney  1 , Brynn Wright  1 , Michael Kennedy  2 , K James Kallail  1 , Johannes J Rasker  3 , Winfried Häuser  4 , Frederick Wolfe  5
Affiliations

The Problematic Nature of Fibromyalgia Diagnosis in the Community

Sachin Srinivasan et al. ACR Open Rheumatol. .

Abstract

Background: Recently, some studies suggested that clinical diagnosis of fibromyalgia is inaccurate and does not reflect current definitions. However, this hypothesis has not been tested. We examined whether fibromyalgia was accurately diagnosed in the community.

Methods: We surveyed 3276 primary care patients to determine current fibromyalgia status by criteria (CritFM). We also determined whether the patients had a physician's diagnosis of fibromyalgia (MDFM) and the level of symptom severity as measured by the polysymptomatic distress scale (PSD).

Results: The prevalence of MDFM and CritFM was 6.1% (95% confidence interval [CI] 5.3%, 6.9%) and 5.5% (95% CI 4.8%, 6.3%), respectively. However, only 32.2% with MDFM met 2016 criteria (CritFM), and only 35.4% with CritFM also had MDFM. The kappa statistic for diagnostic agreement was 0.296 (minimal agreement). The mean PSD score was 12.4 and 18.4 in MDFM and CritFM, respectively. The odds ratio for being a woman compared with being a man was 3.2 for MDFM versus 1.9 for CritFM, P = 0.023. Of the patients with MDFM, 68.3% received specific fibromyalgia pharmacotherapy.

Conclusions: There is little agreement between MDFM and CritFM. Only one-third of MDFM satisfy fibromyalgia criteria, and only one-third of patients who meet the criteria have a clinical diagnosis of fibromyalgia. Physician diagnosis is biased and more likely in women. Fibromyalgia treatment is common in MDFM (70.7%). Overall, MDFM appears subjective and unrelated to fibromyalgia criteria. There appears to be no common definition of fibromyalgia in the community.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The distribution of PSD scores in all patients (solid line) and those diagnosed with fibromyalgia by criteria (dashed line) and physician diagnosis (dotted line)
Figure 2
Figure 2
The relation of polysymptomatic distress (PSD) to the probability of treatment in physician‐diagnosed fibromyalgia. The lower curve represents the distribution of PSD scores in this group. Fibromyalgia criteria cannot be satisfied at PSD scores less than 12 (vertical line). FM, fibromyalgia.
See this image and copyright information in PMC

References

    1. Dumit J. Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses. Soc Sci Med 2006;62:577–90. - PubMed
    1. Hazemeijer I, Rasker JJ. Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting. Rheumatology (Oxford) 2003;42:507–15. - PubMed
    1. Häuser W, Ablin J, Fitzcharles M‐A, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nature Reviews Disease Primers 2015;1:15022. - PubMed
    1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160–72. - PubMed
    1. Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Katz RS, Mease P, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62:600–10. - PubMed

LinkOut - more resources