Fibromyalgia is frequently misdiagnosed, finds study

DELHI: A study comparing clinician diagnosis with published criteria to identify possible diagnostic misclassification of fibromyalgia has found that there is considerable disagreement between ICD (International Classification of Diseases) diagnosis and criteria‐based diagnosis of fibromyalgia. The study published in the journal Arthritis Care & Research calls into question ICD‐based studies.

Fibromyalgia also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body.

As well as widespread pain, people with fibromyalgia may also have:

• increased sensitivity to pain


• extreme tiredness (fatigue)


• muscle stiffness


• difficulty sleeping


• problems with mental processes (known as "fibro-fog"), such as problems with memory and concentration


• headaches


• irritable bowel syndrome (IBS) – a digestive condition that causes stomach pain and bloating

Recent studies have suggested the inaccurate diagnosis of fibromyalgia in the community is common. Also, ~75% of persons reporting a physician diagnosis of fibromyalgia would not satisfy published criteria. Frederick Wolfe, Arthritis Diseases Center, University of Wichita School of Medicine, Wichita, Kansas, and colleagues conducted the study to investigate possible diagnostic misclassification, they compared expert physician diagnosis with published criteria.

In a university clinic, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology (ACR) preliminary diagnostic criteria for fibromyalgia questionnaire. Patients were then evaluated by rheumatology staff.

Key findings of the study include:

• Of the 497 patients, 121 (24.3%) satisfied the fibromyalgia criteria, while 104 (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia.


• The agreement between clinicians and criteria was 79.2%.


• Agreement beyond chance was only fair (κ = 0.41).


• Physicians failed to identify 60 criteria‐positive patients (49.6%) and incorrectly identified 43 criteria‐negative patients (11.4%).


• In a subset of 88 patients with rheumatoid arthritis (RA), the kappa value was 0.32, indicating slight to fair agreement.


• Women and patients with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to satisfy fibromyalgia criteria.


• More abnormal MD-HAQ scores were associated with higher polysymptomatic distress scores and criteria-based diagnosis.

“Fibromyalgia criteria were easy to use, but problems regarding clinician bias, the meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial," concluded the authors.

For further reference log on to https://doi.org/10.1002/acr.23731