Should Rheumatologists Retain Ownership of Fibromyalgia?

Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. .
The Journal of Rheumatology (Impact Factor: 3.17). 05/2009; 36(4):667-70. DOI: 10.3899/jrheum.081073
Source: PubMed
  • The Journal of Rheumatology 09/2013; 40(9):1621. DOI:10.3899/jrheum.130306 · 3.17 Impact Factor
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    ABSTRACT: <⁄span> Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population. <⁄span> To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM. <⁄span> A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice. <⁄span> The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged. <⁄span> The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.
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    ABSTRACT: 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.
    Rheumatology International 07/2013; 33(12). DOI:10.1007/s00296-013-2829-6 · 1.63 Impact Factor