- Brian Walitt,
- Mary-Ann Fitzcharles,
- Afton L. Hassett,
- Robert S. Katz,
- Winfried Häuser and
- Frederick Wolfe
+ Author Affiliations
- From Georgetown University, Washington Hospital Center, Washington, DC; Montreal General Hospital, Division of Rheumatology, McGill University, Montreal, Quebec, Canada; Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Rush University Medical Center, Chicago, Illinois; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany; and the National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, Kansas, USA.
Dr. Walitt has received consulting feels from Jazz Pharmaceuticals. Dr. Häuser has received honoraria from Eli-Lilly, Janssen-Cilag, Mundipharma, and Pfizer, and travel support from Eli Lilly. Dr. Hassett has received research funding from Bristol-Myers Squibb and Jazz Pharmaceuticals and is a consultant to Jazz Pharmaceuticals and Bristol-Myers Squibb. Dr. Fitzcharles has received consultant fees, speaking fees, and/or honoraria from Boehringer Ingelheim, Eli-Lilly, Paladin, Pfizer, and Purdue.
B. Walitt, MD, MPH, Georgetown University, Washington Hospital Center; M-A. Fitzcharles, MB, ChB, Montreal General Hospital, Division of Rheumatology, McGill University; A.L. Hassett, PsyD, Department of Anesthesiology, University of Michigan Medical School; R.S. Katz, MD, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; F. Wolfe, MD, National Data Bank for Rheumatic Diseases, University of Kansas School of Medicine.
Address correspondence to Dr. F. Wolfe, National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 288, Wichita, KS 67214. E-mail: email@example.com
Accepted for publication May 6, 2011.
Objective To describe the diagnosis status and outcome of patients diagnosed with fibromyalgia (FM) by US rheumatologists.
Methods We assessed 1555 patients with FM with detailed outcome questionnaires during 11,006 semiannual observations for up to 11 years. At entry, all patients satisfied American College of Rheumatology preliminary 2010 FM criteria modified for survey research. We determined diagnosis status, rates of improvement, responder subgroups, and standardized mean differences (effect sizes) between start and study completion scores of global well-being, pain, sleep problems, and health related quality of life. (QOL)
Results The 5-year improvement rates were pain 0.4 (95% CI 0.2, 0.5), fatigue 0.4 (95% CI 0.2, 0.05), and global 0.0 (95% CI –0.1, 0.1). The standardized mean differences were patient global 0.03 (95% CI –0.02, 0.08), pain 0.22 (95% CI 0.16, 0.28), sleep problems 0.20 (95% CI 0.14, 0.25), physical component summary of the Short-form 36 (SF-36) 0.11 (95% CI –0.14, –0.07), and SF-36 mental component summary 0.03 (95% CI –0.07, 0.02). Patients switched between criteria-positive and criteria-negative states, with 716 patients (44.0%) failing to meet criteria at least once during 4228.5 patient-years (7448 observations). About 10% of patients had substantial improvement and about 15% had moderate improvement of pain. Overall, FM severity worsened in 35.9% and pain in 38.6%.
Conclusion Although we found no average clinically meaningful improvement in symptom severity overall, 25% had at least moderate improvement of pain over time. The result that emerged from this longitudinal study was one of generally continuing high levels of self-reported symptoms and distress for most patients, but a slight trend toward improvement.http://jrheum.org/content/early/2011/07/11/jrheum.110026.abstract