Criteria For Fibromyalgia Research Articles

Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

Pain is a common symptom of chronic fatigue syndrome (CFS). We investigated the effects of the treatments used in the PACE trial [cognitive behavioural therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT) and specialist medical care (SMC)] on pain in CFS. We compared pain outcomes including individual painful symptoms, taken from the CDC criteria for CFS and co-morbid fibromyalgia. We modelled outcomes adjusting for baseline variables with multiple linear regression. Significantly less frequent muscle pain was reported by patients following treatment with CBT compared to SMC (mean difference = 0.38 unit change in frequency, p = 0.02), GET versus SMC (0.42, p = 0.01) and GET versus APT (0.37, p = 0.01). Significantly less joint pain was reported following CBT versus APT (0.35, p = 0.02) and GET versus APT (0.36, p = 0.02). Co-morbid fibromyalgia was less frequent following GET versus SMC (0.03, p = 0.03). The effect sizes of these differences varied between 0.25 and 0.31 for muscle pain and 0.24 and 0.26 for joint pain. Treatment effects on pain were independent of 'change in fatigue'. CBT and GET were more effective in reducing the frequency of both muscle and joint pain than APT and SMC. When compared to SMC, GET also reduced the frequency of co-morbid fibromyalgia; the size of this effect on pain was small.

Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care

To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia (FM), and to analyze the cost-utility of the intervention from health care and societal perspectives. Twelve-month randomized controlled trial. A total of 216 primary care patients meeting the American College of Rheumatology criteria for FM participated in the study. The intervention included 9, 2-hour sessions of psychoeducation (5 sessions of education about the illness+4 sessions of autogenic relaxation) added to usual care provided by a multidisciplinary group in general practice was compared to usual care in the public health system. At 12-month follow-up, patients who received psychoeducation showed greater improvement in global functional status (Cohen d=0.36; -2.49 to 3.81), physical functioning (Cohen d=0.56; 0.08 to 1.00), days feeling well (Cohen d=0.40; -0.16 to 1.02), pain (Cohen d= 0.35; -0.04 to 0.80), morning fatigue (Cohen d=0.24; -0.20 to 0.76), stiffness (Cohen d=0.34; -0.10 to 0.87), and depression (Cohen d=0.30; -0.26 to 0.93). Mean incremental cost per person receiving the intervention was &OV0556;-215.49 (-615.13 to 287.81) from the health care perspective, and &OV0556;-197.32 (-785.12 to 395.74) from the societal perspective. The incremental gain in quality-adjusted life-years per person was 0.12 (0.06 to 0.19), yielding a "dominant" intervention from both perspectives. The sensitivity analysis suggested that the intervention was cost-effective even imputing all missing data. Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective. NCT00550966.

Validation of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia in an Iranian population

The aim of this study was to validate the 2010 American College of Rheumatology (ACR) preliminary criteria for fibromyalgia (FM) in an Iranian population. In this multicenter prospective study, we enrolled 168 FM patients and 110 controls. All participants underwent dolorimetry examination by study assessors and completed a questionnaire containing variables of both the ACR 2010 preliminary and ACR 1990 criteria. We compared the performance of the ACR 2010 criteria with the expert diagnosis as well as the ACR 1990 criteria. Receiver operator characteristic analyses and Youden index were used to evaluate the test characteristics of a set of different cutoff points for two subcomponents of ACR 2010 criteria including widespread pain index (WPI) and symptom severity (SS) scale. Considering expert diagnosis as the gold standard, the ACR 2010 criteria showed comparable specificity with ACR 1990 (92.8 vs. 88.3 %, P = 0.073), but lower sensitivity (58.9 vs. 71.4 %, P = 0.003) and a tendency for lower accuracy (72.4 vs. 78.4 %, P = 0.105). Applying the ACR 1990 criteria as the gold standard, we observed a trend toward an increase in overall accuracy (72.4 vs. 79.1 %, P = 0.064). Optimal test characteristics were achieved for WPI ≥6 and SS scale score ≥4 and improved sensitivity and accuracy of ACR 2010 criteria when compared to expert, 76.1 and 81.7, respectively. The preliminary ACR 2010 criteria performed less desirably in terms of sensitivity in our set of Iranian patients. Selecting lower cutoff points as WPI ≥6 and SS scale score ≥4 improved the diagnostic values of the criteria.

A Questionnaire Using the Modified 2010 American College of Rheumatology Criteria for Fibromyalgia: Specificity and Sensitivity in Clinical Practice

To determine the specificity and sensitivity of the Modified 2010 American College of Rheumatology (ACR) Diagnostic Criteria for Fibromyalgia (given as a self-administered questionnaire) in clinical practice. A cohort of patients with widespread pain, referred by primary care physicians to rheumatologists, completed the questionnaire for the Modified ACR 2010 criteria. Prior to completion of the questionnaire, patients were diagnosed by at least 1 rheumatologist as either having fibromyalgia (FM) or not having FM, using the rheumatologist's clinical assessment as the gold standard for diagnosis of FM. The Modified ACR 2010 criteria were then applied to determine whether a diagnosis of FM was satisfied by the criteria. Sensitivity and specificity were determined, using the rheumatologist's clinical assessment as the gold standard. A score ≥ 12 on the Modified ACR 2010 criteria questionnaire was also tested as the criterion to satisfy a diagnosis of FM, and subsequently to determine sensitivity and specificity. We examined the effect of using a cutoff score ≥ 13, as previous research indicated that this may be a more useful cutoff value. A total of 451 subjects completed the questionnaire: 174 with an a priori diagnosis of FM by a rheumatologist and 277 with widespread pain who did not have an a priori clinical diagnosis of FM by a rheumatologist. The Modified ACR 2010 criteria were satisfied by 90.2% of patients with an a priori diagnosis of FM, and by 10.5% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, sensitivity and specificity are 90.2% and 89.5%, respectively, using the Modified ACR 2010 criteria. A score ≥ 12 on the Modified ACR 2010 criteria was observed in 97.4% of patients with an a priori diagnosis of FM, and 14.8% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, the sensitivity and specificity are 97.4% and 85.2%, respectively, using a cutoff score ≥ 12. Using a score of ≥ 13, however, the sensitivity was 93.1% and the specificity was 91.7%. The Modified ACR 2010 criteria questionnaire can be used in primary care as a tool to assist physicians in the diagnosis of FM with high specificity and sensitivity. Calculating the total score on a Modified ACR 2010 criteria questionnaire, and setting the value of ≥ 13 as the cutoff for a diagnosis of FM appears to be the most effective approach. The Modified ACR 2010 criteria may reduce the need for rheumatology referral simply for the diagnosis of FM.

OP0137-PC Number of Painful Regions and their Distribution Predicts Outcome of Pain in the General Population

BackgroundPain reported by a mannequin or predefined figure with body regions is important in evaluation of pain impact and development in general practice. Such reports are also of importance in...

SAT0400 Influence of Multiple Symptom Domains on Disease Impact in Patients Attending a Multidisciplinary Fibromyalgia Clinic

BackgroundPatients with fibromyalgia (FM) have a high prevalence of non-musculoskeletal symptoms including fatigue, psychological comorbidites and other somatic symptoms. Pharmacolgical therapy is widely used to treat pain, but a more...

SAT0409 Multidisciplinary Care in the Management of Fibromyalgia: A Randomized Controlled Trial

BackgroundChronic musculoskeletal pain disorders such as fibromyalgia (FM) have an impact on all aspects of well-being.ObjectivesTo evaluate the effectiveness of a multidisciplinary care setting for the management of FM in...

AB0824-HPR Personality traits in patients with fibromyalgia using projective test

BackgroundFibromyalgia is a chronic pain syndrome in which “pain” is not a single factor in illness. Patients have physical and psychological changes that affect the ability to cope with the...

AB1090 Delay on fibromyalgia diagnosis and its impact on long term outcomes

BackgroundFibromyalgia is a chronic pain syndrome which has a great impact on general health and functional capacity of affected subjects. As it is seen in other painful disorders, we hypothesized...

FRI0573-PC The prevalence of musculoskeletal diseases in emirati’s attending primary health care clinics in dubai

Background: Introduction Musculoskeletal symptoms are frequent complaints seen in primary health care[1]. Indeed, a considerable number of patients may have a long term sequel, including chronic pain and disabilities if...

THU0511 Estimating the Burden of Illness of Fibromyalgia in Taiwan

BackgroundFibromyalgia is a disorder often characterized by chronic musculoskeletal pain over multiple regions of the body not explained by anatomical injury [1]. There are limited treatments for fibromyalgia.ObjectivesTo determine and...

AB0255 The effect of biological and conventional disease-modifying anti-rheumatic drugs on fatigue in fibromyalgic rheumatoid arthritis patients

BackgroundRheumatoid Arthritis (RA) has different clinical phenotypes. RA with co-existing fibromyalgic features has been termed as fibromyalgic- RA (FRA). Fatigue is a common symptom in rheumatological diseases.ObjectivesThe aim of this...

AB1094 Fibromyalgia in behÇet’s disease is associated with disease activity

BackgroundStudies on the relationship between Fibromyalgia (FM), a generalized pain disorder with up to 2% prevelance and Behcet’s Disease (BD), a systemic, inflammatory vasculitis, is limited.ObjectivesWe conducted the present study...

SAT0099 Application of a Multi-Biomarker Disease Activity (VECTRA™ TA) Score for Assessing Rheumatoid Arthritis Patients with Low Crp or Fibromyalgia

BackgroundClinical assessment of rheumatoid arthritis (RA) patients may be challenging when objective measures, such as C-reactive protein (CRP), do not show elevated disease activity or when patients have concomitant, non-inflammatory...

SAT0398 Diagnosis of Fibromyalgia is Associated with Impaired Health Outcomes and Substantial Health Care Costs After Nine Months of Follow-Up

BackgroundLittle is known about the impact and prognosis after establishing a diagnosis of fibromyalgia (FM). It is possible that acquiring a ‘FM-label’ may lead to increased illness behaviour, dependence on...

FRI0225 Presence of fibromyalgia and fatigue is not increased in patients with takayasu’s arteritis

BackgroundTakayasu’s arteritis (TA) is a chronic inflammatory large-vessel vasculitis of the aorta and its major branches. To our knowledge, there is no data about the frequency of Fibromyalgia Syndrome (FM),...

SAT0057 Fibromyalgia Tender Points in Patients with Rheumatoid Arthritis

BackgroundStudies have shown an increased frequency of fibromyalgia (FM) in patients with rheumatoid arthritis (RA), which according to different authors was between 12-17% 1,2. A recent study found that the...

Fibromyalgia Prevalence, Somatic Symptom Reporting, and the Dimensionality of Polysymptomatic Distress: Results From a Survey of the General Population

To evaluate fibromyalgia in the general population with emphasis on prevalence, dimensionality, and somatic symptom severity. We studied 2,445 subjects randomly selected from the German general population in 2012 using the American College of Rheumatology 2010 preliminary diagnostic criteria for fibromyalgia, as modified for survey research, and the polysymptomatic distress scale (PSD). Anxiety, depression, and somatic symptom severity were assessed with the Patient Health Questionnaire (PHQ) series, and measures of symptoms and quality of life were assessed with the European Organization for Research and Treatment of Cancer questionnaire. The prevalence of fibromyalgia was 2.1% (95% confidence interval [95% CI] 1.6, 2.7), with 2.4% (95% CI 1.5, 3.2) in women and 1.8% (95% CI 1.1, 2.6) in men, but the difference was not statistically significant. Prevalence rose with age. Fibromyalgia subjects had markedly abnormal scores for all covariates. We found smooth, nondisordered relationships between PSD and all predictors, providing additional evidence against the hypothesis that fibromyalgia is a discrete disorder and in support of a dimensional or spectrum disorder. There was a strong correlation (r = 0.790) between the PSD and the PHQ somatic symptom severity scale; 38.5% of persons with fibromyalgia satisfied the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for a physical symptom disorder. The modified 2010 diagnostic criteria do not result in high levels of fibromyalgia. PSD and fibromyalgia are strongly related to somatic symptom severity. There is evidence in support of fibromyalgia as a dimensional or continuum disorder. This has important ramifications for neurobiologic and epidemiology research, and for clinical diagnosis, treatment, and ascertainment of disability.

Use of the 2010 ACR fibromyalgia diagnostic criteria to identify long-term outcomes in patients with juvenile-onset fibromyalgia

Juvenile-onset Fibromyalgia (JFM) is a chronic widespread musculoskeletal pain condition with multiple associated symptoms including sleep difficulty and fatigue. Little is known about the course of JFM and whether symptoms persist into adulthood. In an ongoing longitudinal study of adolescents with JFM, we found that the majority (>70%) of patients reported ongoing pain and associated symptoms in late adolescence (Mage = 19 years). The current study aimed to determine how many JFM patients continued to meet criteria for active fibromyalgia (FM) in their young adult years, and how many experienced sub-clinical symptoms, or were pain-free.

Advancing the screening and diagnosis of fibromyalgia in late-life

We evaluated subjects with 4 sets of criteria for fibromyalgia (FM) screening and classification. The first two sets of criteria are intended for FM classification in clinical trials: 1) ACR 1990 Criteria for the Classification of Fibromyalgia (gold standard), 2) Pope and Hudson supplemental interview for FM. The next two are designed as screening tests: 1) “do you often feel like you hurt all over?” simple screening question, and 2) pain map score. Using a 115 community-dwelling adults at least 60 years old with comorbid depression and chronic low back pain, we assessed the kappa coefficient measuring agreement between criteria and the gold standard diagnostic method.