Fibromyalgia Severity Research Articles

Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised.

Fibromyalgia (FM) is a heterogeneous and complex syndrome; different studies have tried to describe subgroups of FM patients, and a 4-cluster classification based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) has been recently validated. This study aims to cross-validate this classification in a large US sample of FM patients. A pooled sample of 6280 patients was used. First, we computed a hierarchical cluster analysis (HCA) using FIQR scores at item level. Then, a latent profile analysis (LPA) served to confirm the accuracy of the taxonomy. Additionally, a cluster calculator was developed to estimate the predicted subgroup using an ordinal regression analysis. Self-reported clinical measures were used to examine the external validity of the subgroups in part of the sample. The HCA yielded a 4-subgroup distribution, which was confirmed by the LPA. Each cluster represented a different level of severity: “Mild–moderate”, “moderate”, “moderate–severe”, and “severe”. Significant differences between clusters were observed in most of the clinical measures (e.g., fatigue, sleep problems, anxiety). Interestingly, lower levels of education were associated with higher FM severity. This study corroborates a 4-cluster distribution based on FIQR scores to classify US adults with FM. The classification may have relevant clinical implications for diagnosis and treatment response.

Associations Among Nitric Oxide and Enkephalinases With Fibromyalgia Symptoms.

Fibromyalgia (FM) is a complex syndrome of uncertain etiology, characterized by the presence of widespread pain. Both nitric oxide and enkephalinases modulate pain perception. The aim of this study was to evaluate the relationships among serum nitric oxide levels, oxytocinase activity, and enkephalin-degrading aminopeptidase (EDA) activity with pain-related clinical manifestations in women with FM. We performed an observational case study in a population of 58 women diagnosed with FM. Serum nitric oxide levels were analyzed by an ozone chemiluminescence-based assay. Both serum oxytocinase and EDA activities were fluorometrically determined. Pain threshold and pain magnitude were evaluated using the PainMatcher. The pressure pain thresholds were measured using a digital pressure algometer. We used a visual analog scale, the Central Sensitization Inventory, the Revised Fibromyalgia Impact Questionnaire, and the Beck Anxiety Inventory to assess the global level of pain, the symptoms associated with the central sensitization syndrome, the severity of FM, and the anxiety level, respectively. Multiple linear regression analysis adjusted by age, body mass index, and menopause status revealed significant associations between nitric oxide levels and dominant occiput pressure pain thresholds, nondominant occiput pressure pain thresholds, and FM effects. Significant associations of oxytocinase activity with the visual analog scale and dominant knee pressure pain thresholds were also found. Moreover, results showed a significant association between high EDA activity levels and dominant second-rib pressure pain thresholds. Our data have shown significant relationships of serum nitric oxide levels and oxytocinase and EDA activities with some body pressure pain thresholds, the daily activity level, and the global intensity of pain in women with FM. These results suggest that pain, which is the main symptom of this syndrome, may be related to alterations in nitric oxide levels and in oxytocinase and EDA activities in patients with FM.

The Frequency of Fibromyalgia in Patients Presenting with Symptoms of Carpal Tunnel Syndrome

Karpal tünel sendromu (KTS), en sık görülen tuzak nöropatisidir. Ellerde ağrı, uyuşma ve kuvvetsizlik gibi yakınmalarla karakterizedir. Fibromiyalji (FM) ise yaygın ağrının eşlik ettiği kronik kas iskelet sistemi hastalığıdır. Geniş semptom yelpazesi içinde parestezi yakınması sık görülmekte olup KTS ile karışabilmektedir. FM’li hastalarda KTS sıklığını araştıran az sayıda çalışma olup sonuçlar çelişkili bulunmuş-tur. Bu çalışmada amaç, klinik olarak KTS ile uyumlu yakınmaları olup sinir ileti çalışmalarında KTS saptanan ve saptanmayan iki grup arasında FM açısından farlılık olup olmadığını araştırmaktır. Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran ve KTS ön tanısı ile elektrofizyoloji laboratuvarına yönlendirilen kadın hastalar çalışmaya dahil edilmiştir. Tüm hastalara FM 2016 ACR tanı kriterleri uygulan-mış ve Yaygın Ağrı İndeksi (YAİ), Semptom Şiddet Skalası (SSS), Fibromiyalji Şiddet Skoru (FŞS) kaydedilmiştir. Hastalar elektrofizyolo-jik olarak KTS saptanan ve saptanmayan iki gruba ayrılarak sonuçlar karşılaştırılmıştır. Çalışmaya ellerde uyuşma yakınması olan ve sinir ileti çalışması sonucunda 30 KTS pozitif, 25 KTS negatif hasta alındı. İki grup arasında yaşa ve beden kitle indeksine göre farklılık saptan-madı. KTS saptananların %26,7’sinde, saptanmayanların %24’ünde ACR 2016 kriterlerine göre FM saptanmış olup, iki grup arasında istatis-tiksel olarak anlamlı fark bulunmamıştır. YAİ, SSS ve FŞS incelendiğinde de gruplar arasında istatistiksel fark saptanmamıştır. Diğer yandan FM saptanan ve saptanmayan iki grup karşılaştırıldığında FM saptanmayan grupta median sinir ileti hızları anlamlı olarak daha yavaş bulun-du. Sonuç olarak, KTS hastalarında FM prevalansı yüksek bulunmuştur. FM olan ve olmayan KTS hastalarının median sinir iletim hızların-da anlamlı farklılıklar olduğundan, FM hastalarında KTS tanısı için elektrofizyolojik doğrulama önerilebilir.

Correlation Between Central Sensitization and Remote Muscle Performance in Individuals With Chronic Low Back Pain

ObjectiveThe purpose of this study was to examine associations between the degree of central sensitization (CS) and remote muscle performance in people with chronic low back pain (CLBP). MethodsThe 2011 fibromyalgia (FM) criteria and severity scales (2011 FM survey) were used as a surrogate measure of CS to divide the participants into 2 groups: FM-positive CLBP and FM-negative CLBP. Measures related to central sensitization included the 2011 FM survey and pressure pain threshold of the thumbnail. Measures related to muscle performance included neck flexor muscle strength and endurance and plantar flexor muscle strength. Between-groups and correlation analyses were performed. ResultsSixty people with CLBP were enrolled (30 FM-positive, 30 FM-negative). There was no significant difference between the subgroups in age, sex, or pain duration (P > .05). The FM-positive CLBP group showed poorer neck flexor muscle endurance (P = .01) and plantar flexor muscle strength (P = .002) than the FM-negative CLBP group, whereas neck flexor muscle strength was not different between the groups (P = .175). Scores for FM and values for pressure pain thresholds of the thumbnail were associated with neck flexor muscle strength (respectively, r = −0.320, P = .013, and r = 0.467, P < .001), endurance (r = −0.242, P < .001, and r = 0.335, P = .009), and plantar flexor muscle strength (r = −0.469, P < .001, and r = 0.500, P < .001). ConclusionWe found associations between the degree of CS and remote muscle strength and endurance, suggesting that poor remote muscle performance is possibly a clinical sign of CS in people with CLBP.

Is fibromyalgia accompanying Behçet's disease more severe than primary fibromyalgia?

Objectives: Although there are studies in the literature about how Behçet's disease is affected in the presence of fibromyalgia, there is no information about how the severity of fibromyalgia is in the presence of Behçet's disease. This study aims to evaluate the severity of fibromyalgia by comparing the impact of fibromyalgia and pain thresholds between fibromyalgia patients with and without Behçet's disease. Methods: Twenty-five fibromyalgia patients with Behçet's disease and 34 primary fibromyalgia patients were included in this cross-sectional study. All participants completed the fibromyalgia impact questionnaire, and pain thresholds were measured at 18 tender points using algometry. Results: The mean fibromyalgia impact questionnaire scores in fibromyalgia patients with and without Behçet's disease were 66.6 ± 18.4 and 60.4 ± 14.5, respectively (p = 0.157). Pain thresholds were not different between the groups in 15 of the 18 tender points (TP). In fibromyalgia patients with Behçet's disease, pain thresholds in TP-15, TP-16 and TP-17 were 11.44 ± 4.84, 11.92 ± 5.00 and 15.16 ± 4.89 pounds, respectively, while in primary fibromyalgia patients those were 8.41 ± 2.68, 8.14 ± 2.76 and 12.14 ± 4.06 pounds respectively. Pain thresholds in TP-15, TP-16 and TP-17 were significantly different between the groups (p = 0.003, p = 0.003, p = 0.014, respectively). Conclusions: According to the literature data, although fibromyalgia has an effect on Behçet's disease, especially in cases associated with central sensitization syndromes, the severity of fibromyalgia was not found to be different in fibromyalgia patients with and without Behçet's disease in this study. There may be a relationship between Behçet's disease and fibromyalgia due to non-inflammatory causes such as central sensitization.

Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective.

Given the scarcity of studies regarding perfectionism from a contextual perspective, this study aims to analyze its role in the relationship between pain and activity avoidance and its differential effect among patients with different fibromyalgia severity. A cross-sectional study with 228 women with fibromyalgia classified into two disease severity groups (low/moderate vs. high) was carried out. Moderation analyses were conducted; perfectionism was used as moderator, pain (in high and low pain situations) as independent variable, and activity avoidance as the outcome. Among the high disease severity group, analyses showed direct contributions of perfectionism (p < 0.001) but not of pain (p > 0.05); moderation effects were found in high pain situations (p = 0.002) (for low levels of perfectionism, a positive association was found between pain intensity and avoidance). Among the low severity group, direct effects of perfectionism (p < 0.05) and pain intensity (p = 0.04) were found (although the latter only for high pain situations); moderation effects were found in high pain situations (p = 0.018) (for high levels of perfectionism a positive and significant association was found between pain intensity and avoidance). Perfectionism has been found to be a key variable in the differential relationship between pain intensity (in high pain situations) and activity avoidance in groups with high and low disease severity.

Fibromyalgia in patients with psoriatic arthritis: Impact on disease activity indices, fatigue and health-related quality of life.

To assess the frequency of fibromyalgia (FM) in patients with psoriatic arthritis (PsA) and its impact on disease activity indices, fatigue and health-related quality of life (QOL). This cross-sectional study randomly recruited patients with PsA attending an outpatient clinic between June 2017 and December 2018. Disease activity, functional ability, fatigue, and QOL were assessed for all patients. The recruited PsA patients were screened for concomitant FM, then classified into group Ι, patients with PsA only, and group ΙI, patients with FM-PsA. The severity and impact of FM were assessed for group II patients. A total of 60 patients with PsA were assessed with a mean age of 49.30±11.69years, of which 43.3% were female. A total of 23 PsA patients had concomitant FM (38.3%). Patients with FM-PsA showed a statistically higher disease activity in all aspects of PsA except for C-reactive protein, swollen joint count (SJC) and dactylitis count. Patients in both groups had similar functional levels, while fatigue and QOL were statistically worse in patients with FM-PsA than in patients with PsA only. These results might highlight the importance of considering FM as a contextual factor in disease activity assessment in patients with PsA, especially in those with discrepancies in tender joint count/patient-reported outcomes vs SJC/inflammatory markers and those with persistently high disease activity indices.

Association between vitamin D serum levels and fibromyalgia disease activity

Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread, long-term pain and multiple tender points revealed in physical examination. Previous studies about the relationship between serum vitamin D level and FM have reported paradoxical results. This cross-sectional study aimed to evaluate levels of vitamin D and its relationship with the severity of FM. Based on the American College of Rheumatology (ACS) criteria, 100 female patients with FM were enrolled in this study, and their serum vitamin D levels were screened. Vitamin D deficiency is defined as a level less than 12 ng/mL; insufficiency is defined as a level between 12–29 ng/mL, and sufficiency is a level equal to or greater than 30 ng/mL. Disease severity was evaluated by symptom severity scale (SSS) score and documented using designed questionnaires. Among the 100 female FM patients enrolled in this study, the mean patient age was 35.60 years; 47% of them had vitamin D deficiency, 36% had vitamin D insufficiency, and only 17% had normal vitamin D serum levels. Vitamin D deficiency was reported among 50% of patients with an SSS score between 9 and 12, 49% of patients with an SSS score between 5 and 8, and 14.3% of patients with an SSS score between 1 and 4. There was no significant correlation between patient age and vitamin D level (p-value=0.12). Moreover, no significant correlation was found between patient age and SSS score (p-value=0.36). The current study demonstrated that there was no statistically significant relationship between FM disease activity and vitamin Dserum level.

Isokinetic evaluation of the trunk muscle strength in housewives with fibromyalgia: a cross-sectional study

BackgroundIt is known that physical activity and muscular performance are reduced in fibromyalgia (FM) syndrome. This study aims to compare the performance of trunk muscles in women with FM and healthy controls and evaluate the correlation between trunk muscle strength and FM severity.MethodsForty-six patients with FM and 42 age- and body mass index-matched healthy housewives without FM were included in the FM and control groups, respectively. The Fibromyalgia Impact Questionnaire (FIQ) was used for the assessment of FM severity. The pain intensity was evaluated using the visual analogical scale (VAS). An isokinetic dynamometer was used to measure the isokinetic trunk muscle strength. The peak torque (PT) values were recorded. The psychological status of the patients was evaluated using the Beck Depression Inventory.ResultsThere was no statistically significant difference in terms of age, BMI, and BDI scores in two groups (p > 0.05, for all). The isokinetic trunk extensor PT values were significantly lower in the FM group (p = 0.002 for 60°/s, and p < 0.001 for 90°/s and 120°/s) than control group. There was a statistically significant negative correlation between FIQ score and isokinetic extensor muscle parameters.ConclusionThe results indicate that trunk extensor muscles were significantly weaker in FM patients. Trunk extensor muscle strength decreased as FM severity increased in FM patients.

Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients.

To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'-which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th-75th percentiles) were respectively 61.16 (41.16-77.00), 27.00 (19.00-32.00) and 19.0 (13.00-24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0-23 for remission, 24-40 for mild disease, 41-63 for moderate disease, 64-82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0-12 for remission, 13-20 for mild disease, 21-28 for moderate disease, 29-33 for severe disease and >33 for very severe disease; PDS: 0-5 for remission, 6-15 for mild disease, 16-20 for moderate disease, 21-25 for severe disease and >25 for very severe disease. Disease severity cut-offs can represent an important improvement in interpreting FM.

Diagnostic Accuracy of ACR 2010 Preliminary Diagnostic Criteria in the Diagnosis of Fibromyalgia Among Chronic Backache Patients.

Chronic backache remains among common causes of attendance in orthopaedic, pain and neurology clinics and requires a detailed workup for the management of these patients. As per literature, fibromyalgia contributes to a significant number of chronic backache patients but in clinical practice, it remains a diagnosis of exclusion in the absence of definitive diagnostic workup. We need to evaluate the diagnostic accuracy of ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia among chronic backache patients for use in primary and speciality care. The patients with chronic backache (> 3months) attending the orthopaedic OPD were screened by the principal investigator by ACR 1990 tender point and ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia. Symptoms severity assessment was done by the Fibromyalgia severity score by the principal investigator or resident doctors trained by the principal investigator. Approximately 47% of patients didn't satisfy the American College of Rheumatology 1990 criteria but could be diagnosed as a case of fibromyalgia by ACR 2010 new case definition: (WPI ≥ 7 and SS ≥ 5) or (WPI ≥ 3-6 and SS ≥ 9). The patients with chronic back pain along with marked symptoms variability need consideration of Fibromyalgia for possible diagnosis especially in the absence of secondary cause for these symptoms. ACR 2010 diagnostic criteria seem compelling and effective for the diagnosis of fibromyalgia among patients with chronic back pain.

Validity of fibromyalgia survey questionnaire (2016) assessed by telephone interview and cross-cultural adaptation to Brazilian Portuguese language

BackgroundTo verify the validity of the 2016-revised Fibromyalgia Survey Questionnaire (FSQ) by telephone interview compared to self-administration and to produce a valid version of FSQ in Brazilian Portuguese language.MethodsThe Brazilian version of FSQ was produced following the recommendations for cross-cultural adaptation. Validity of Brazilian FSQ self-administration was assessed by checking agreement of its results with fibromyalgia diagnosis according the 1990 American College of Rheumatology (ACR) criteria. Reproducibility and validity of FSQ by telephone were assessed by comparing its results with the previous FSQ self-administration.ResultsA Brazilian Portuguese version (FSQ-Brazil) was produced. FSQ-Brazil had good internal consistency (Cronbach’s alpha between 0.73 and 0.94). Agreement between the results obtained by self-administration of FSQ-Brazil and by telephone interview was substantial or almost perfect for almost all questions about pain sites and all questions about other somatic symptoms (Cohen’s kappa higher than 0.6). There were small but significant bias toward higher scores of widespread pain index and fibromyalgia severity scale in the telephone interview compared to self-administration. Fibromyalgia definition by self-administration and telephone interview with FSQ-Brazil both revealed substantial agreement with the diagnosis based on ACR 1990 criteria (Cohen’s kappa 0.62 and 0.65; respectively).ConclusionsFSQ-Brazil demonstrated good internal consistency, reproducibility and validity both by self-administration and by telephone interview. However, caution must be taken with the interpretation of quantitative scores of widespread pain index and symptoms severity scale, which slightly differed according the method (self-administration or interview) in our study.

Syrian female war refugees: preliminary fibromyalgia and insomnia screening and treatment trends

Background Fibromyalgia (FM) is a chronic disorder characterised by chronic widespread pain, fatigue and sleep disturbances with higher prevalence in females. Psychological factors contribute largely to FM. Although women war refugees represent a fragile population that is prone to psychological distress, FM was not studied in this population. Objective The current study had three objectives: (1) to screen FM and insomnia prevalence and severity, (2) to study the correlation between FM severity and insomnia and (3) to study FM treatment trends and their concordance with the guidelines among female Syrian refugees residing in Jordan. Methods A cross-sectional study design was performed. Data from 384 Syrian female were analysed from four medical centres in Jordan. The Fibromyalgia Impact Questionnaire (FIQ) was used to study FM prevalence. Structured questions were designed to explore FM pharmacotherapeutic trend, and the Insomnia Severity Index (ISI) was used to screen insomnia. Results The prevalence of severe FM was about (30%), with a significant correlation with insomnia. Acetaminophen was used for FM relief in 60% of the study sample. Conclusions Fibromyalgia prevalence is high among female refugees and is associated with insomnia. The treatment is suboptimal. The early screening and raising awareness of FM diagnosis and treatments are highly recommended. Key Points Fibromyalgia is an overlooked disorder especially among female war refugees The prevalence of severe fibromyalgia was about (30%), with a significant correlation with insomnia Fibromyalgia among the Syrian female refugees is mistreated perhaps due to lack of the proper diagnosis

Fibromyalgia 2016 criteria and assessments: comprehensive validation in a Norwegian population.

Background and aims The ACR1990 criteria of fibromyalgia (FM) have been criticized due to poor reliability of tender points counting (TPC), inconsistent definitions of the widespread pain, and by not considering other symptoms than pain in the FM phenotype. Therefore, several newer self-report measures for FM criteria have emerged. The aim of this study was to translate the fibromyalgia survey questionnaire (FSQ) to Norwegian and validate both the 2011 and the 2016 fibromyalgia survey diagnostic criteria (FSDC) against the ACR1990 criteria. Methods One hundred and twenty chronic pain patients formerly diagnosed with fibromyalgia according to the ACR1990 criteria, and 62 controls not diagnosed or where fibromyalgia was not suspected, were enrolled in this study. All responded to a Norwegian version of the FSQ. Also, they had a clinical examination according to ACR1990 fibromyalgia criteria including a counting of significant tender points with an algometer (TPC). The FSQ with the Widespread Pain Index (WPI) and Symptom Severity scale (SSS) subscales, Fibromyalgia Severity (FS) sum score, was examined for correlations with the fibromyalgia impact questionnaire (FIQ) and TPCs. Face-validity, internal consistence, test-retest reliability and construct validity with convergent and divergent approaches were examined and a Receiver Operating Characteristics (ROC) analysis was performed. Results The internal consistency of FS measured by Cronbach's alfa was good (=0.904). The test-retest reliability measures using intra class correlation were respectable for the FS, including WPI and SSS subscales (0.86, 0.84 and 0.87). FS, WPI and SSS correlated significantly with FIQ (0.74, 0.59 and 0.85) and TPC indicating an adequate construct, convergent validity. The medians of FS, WPI and SSS in the fibromyalgia-group were significantly different from the non-fibromyalgia-group indicating good construct, divergent validity. Using the 2011 and 2016 FSDC vs. ACR 1990 as a reference, sensitivity, specificity, positive likelihood ratio (LR +) and negative likelihood ratio (LR-) were identified. The accuracy rate for both 2011 and 2016 FSDC were respectable (84%). ROC analysis using FS revealed a very good Area Under the Curve (AUC) = 0.860. Conclusion The current study revealed that the Norwegian versions of FSQ is a valid tool for assessment of fibromyalgia according to the 2011 and 2016 (FSDC).

What high rates of physical and mental comorbidity remind us about fibromyalgia.

This journal recently published a paper by Sleurs et al., entitled"Comorbidities of self-reported fibromyalgia in United-States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). (Sleurs et al., 2020)" While its primary message is that persons reporting a physician diagnosis of fibromyalgia have very high rates of physical and mental comorbidities, this study provides other important information on the nature and validity of fibromyalgia and fibromyalgia diagnosis, as it is likely the most of the reported fibromyalgia patients in the study would not satisfy criteria for fibromyalgia.

Psychometric Validation of the Meaningful Role Functioning Questionnaire in a Sample of 229 Women With Fibromyalgia Syndrome

BackgroundParticipation is one of the most important interdisciplinary outcome variables in biopsychosocial conceptions of health and disability. While the literature surrounding social and community participation in persons with disabilities indicates that participation is a highly subjective construct, there are few known psychometrically validated instruments designed to measure participation in a way that captures the subjective nature of the concept. The present study aimed to develop and test a measure of participation in a way that prioritizes roles that are subjectively meaningful to the individual.ObjectiveTo establish the psychometric properties of the Meaningful Role Functioning Questionnaire (MRFQ) a new life role participation scale intended to measure life role functioning in a way that weighs life roles that are more important to the individual more heavily than those that are less important to the individual.Methods229 women with fibromyalgia took an online survey measuring the following biopsychosocial constructs: meaningful role functioning, participation in society, perceived social support, core self-evaluations, fibromyalgia severity, and life satisfaction.FindingsThe 4-week test-retest reliability coefficient for the MRFQ was .74, indicating acceptable reliability for this measure of life role functioning. The MRFQ was significantly correlated in the expected directions with several external correlates, establishing its construct validity.ConclusionsThe MRFQ is a reliable and valid subjective measure of life role functioning in women with fibromyalgia. Future research should seek to validate the scale in a wider range of disability populations and the general public.

Fibromyalgia in a rheumatology clinic in north-central Nigeria: An audit of the characteristics of the syndrome and the sensitivities of 4 sets of American College of Rheumatology criteria.

To describe the characteristics of fibromyalgia among Nigerian patients and assess the sensitivities of the American College of Rheumatology (ACR) criteria of 1990, 2010, 2011, and 2016 for making the diagnosis of fibromyalgia. Consecutive patients diagnosed clinically with fibromyalgia by a rheumatologist were assessed. ACR criteria for fibromyalgia of 1990, 2010, 2011, and 2016 were applied to each patient. Polysymptomatic distress scores (PSD) were calculated from the Widespread Pain Index and Symptom Severity Scores. Sleep was assessed using the Pittsburgh Sleep Quality Index; fatigue by the Fatigue Severity Scale and the severity of fibromyalgia was determined using the Revised Fibromyalgia Impact Questionnaire (FIQR). A total of 660 new patients were seen out of which a diagnosis of fibromyalgia was made in 114 (17.3%). The mean age of the patients was 44.6±15.6years and females accounted for 84.2%. Twenty-one (18.4%) patients had changed or quit their jobs due to fibromyalgia. Problematic fatigue was present in 80 (70.2%), and sleep disturbance was reported in 83 (72.8%) patients. The severity of fibromyalgia, poor sleep, severe or very severe PSD, and male gender were associated with problematic fatigue, but only moderate/severe fibromyalgia independently predicted problematic fatigue (P=.004). The number of tender points (P=.001) and FIQR score (P=.038) were associated with changing or quitting jobs. The sensitivities of the ACR1990, ACR2010, ACR2011 and ACR2016 were 38.5%, 68.2%, 76.7% and 76.7%, respectively. The ACR1990 had low sensitivity when used to diagnose fibromyalgia in this population and the ACR2010 encounters problems while applying the somatic symptom list.

Fibromyalgia Impact Reduction Using Online Personal Health Informatics: Longitudinal Observational Study.

BackgroundPersonal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use.ObjectiveThe aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ).MethodsParticipants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program (“SMARTLog”) to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations (“SMARTProfile”) were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ.ResultsA total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=–0.135, P<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=–0.133, P<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop.ConclusionsSignificant inverse associations were found between FIQ scores and both indices of program use, with FIQ scores declining as use increased. Based on established criteria for rating FM severity, the top one-third of users in terms of use had clinically significant reductions from “severe” to “moderate” FM impact. These findings underscore the value of self-management interventions with low burden, high usability, and high perceived relevance to the user.Trial RegistrationClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552

Effects of Monopolar Dielectric Radiofrequency Signals on the Symptoms of Fibromyalgia: A Single-Blind Randomized Controlled Trial.

Monopolar dielectric radiofrequency (MDR) is a non-invasive treatment for pain based on the local application of electromagnetic signals. The study’s goal was to analyze the effects of MDR on the symptoms of fibromyalgia. For this aim, a randomized controlled trial was conducted on 66 female participants (aged 47 ± 17.7) diagnosed with fibromyalgia. Participants were randomly allocated to either an experimental group (n = 23), which received eight 20-minute sessions of MDR; a sham group, which received the same number of sessions of a sham MDR therapy (n = 22); or a control group (n = 21), which received usual care. The outcome variables included pain measured by the visual analogue scale (VAS), score on the hospital anxiety and depression scale (HADS) and quality of life measured by the combined index of fibromyalgia severity (ICAF). A large effect size was observed for the local pain (R2 = 0.46), total ICAF (R2 = 0.42) and ICAF physical factor scores (R2 = 0.38). Significant mean differences were found for the local pain (p = 0.025) and ICAF physical factor (p = 0.031) scores of the experimental group in comparison with the sham group. No statistically significant differences between groups were found in HADS. In conclusion, MDR is more effective than either sham treatment or usual care in the short-term improvement of pain and the physical wellbeing of participants with fibromyalgia.

Pilot Study: Impact of a Gluten-Free Diet on Symptoms and Severity of Fibromyalgia

Fibromyalgia (FM) is a condition of chronic and widespread pain, with several associated symptoms. Previous studies suggested that gluten could influence the severity and frequency of FM symptoms. This work aimed to assess the impact of a gluten-free diet (GFD) in the symptoms and severity of this disease. Fourteen patients with previous FM diagnosis were kept on a gluten-free diet for eight weeks (Phase 1). After that, they were held on the gluten-free diet and received capsules of isolated rice protein (placebo) for seven days, followed by capsules containing 8.4g/day vital gluten for additional seven days (Phase 2). Questionnaires evaluating the number and severity of FM symptoms, the impact of FM on daily routine as well as inflammatory blood markers were assessed in each phase. Results showed that after eight weeks of GFD, we observed a reduction in the impact of FM on daily routine and number of symptoms and sensitive points. However, a seven days challenge with 8.4g of gluten did not worsen these symptoms or the inflammatory markers compared with the placebo challenge. We concluded that the gluten-free diet was associated with the attenuation of main symptoms and improvement of life quality in FM patients. Nonetheless, gluten challenge had no impact on those parameters, suggesting that gluten is not the major dietary component responsible for these improvements. Further studies are needed to elucidate the relationship between gluten intake and fibromyalgia.