National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 288, Wichita, KS 67214, USA.
J Rheumatol. 2011 Oct;38(10):2238-46. doi: 10.3899/jrheum.110026. Epub 2011 Jul 15.
To describe the diagnosis status and outcome of patients diagnosed with fibromyalgia (FM) by US rheumatologists.
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%.
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.
描述美国风湿病学会诊断为纤维肌痛（FM）的患者的诊断现状和结局。
我们在 11006 次半年度观察中，使用详细的结局问卷评估了 1555 例 FM 患者，最长达 11 年。入组时，所有患者均满足美国风湿病学会为调查研究修订的 2010 年初步 FM 标准。我们确定了诊断状态、改善率、应答亚组以及全球健康、疼痛、睡眠问题和健康相关生活质量（QOL）开始和研究完成评分之间的标准化均数差（效应量）。
5 年改善率为疼痛 0.4（95%CI 0.2，0.5）、疲劳 0.4（95%CI 0.2，0.05）和整体 0.0（95%CI -0.1，0.1）。标准化均数差为患者整体 0.03（95%CI -0.02，0.08）、疼痛 0.22（95%CI 0.16，0.28）、睡眠问题 0.20（95%CI 0.14，0.25）、SF-36 简短量表（SF-36）的身体成分摘要 0.11（95%CI -0.14，-0.07）和 SF-36 心理成分摘要 0.03（95%CI -0.07，0.02）。患者在标准阳性和标准阴性状态之间转换，在 4228.5 患者年（7448 次观察）中，716 例患者（44.0%）至少有一次未达到标准。约 10%的患者疼痛有明显改善，约 15%的患者疼痛有中度改善。总体而言，FM 严重程度恶化了 35.9%，疼痛恶化了 38.6%。
尽管我们发现总体上症状严重程度没有平均的临床意义上的改善，但 25%的患者疼痛至少有中度改善。这项纵向研究的结果之一是，大多数患者的自我报告症状和痛苦水平普遍持续较高，但有轻微的改善趋势。
