Schaefer Caroline P, Adams Edgar H, Udall Margarita, Masters Elizabeth T, Mann Rachael M, Daniel Shoshana R, McElroy Heather J, Cappelleri Joseph C, Clair Andrew G, Hopps Markay, Staud Roland, Mease Philip, Silverman Stuart L
Covance Market Access Services Inc., Gaithersburg, MD, USA.
Pfizer Inc., New York, NY, USA.
Open Rheumatol J. 2016 Nov 30;10:109-121. doi: 10.2174/1874312901610010109. eCollection 2016.
Longitudinal research on outcomes of patients with fibromyalgia is limited.
To assess clinician and patient-reported outcomes over time among fibromyalgia patients.
At enrollment (Baseline) and follow-up (approximately 2 years later), consented patients were screened for chronic widespread pain (CWP), attended a physician site visit to determine fibromyalgia status, and completed an online questionnaire assessing pain, sleep, function, health status, productivity, medications, and healthcare resource use.
Seventy-six fibromyalgia patients participated at both time points (at Baseline: 86.8% white, 89.5% female, mean age 50.9 years, and mean duration of fibromyalgia 4.1 years). Mean number of tender points at each physician visit was 14.1 and 13.5, respectively; 11 patients no longer screened positive for CWP at follow-up. A majority reported medication use for pain (59.2% at Baseline, 62.0% at Follow-up). The most common medication classes were opioids (32.4%), SSRIs (16.9%), and tramadol (14.1%) at Follow-up. Significant mean changes over time were observed for fibromyalgia symptoms (modified American College of Rheumatology 2010 criteria: 18.4 to 16.9; =0.004), pain interference with function (Brief Pain Inventory-Short Form: 5.9 to 5.3; =0.013), and sleep (Medical Outcomes Study-Sleep Scale: 58.3 to 52.7; =0.004). Patients achieving ≥2 point improvement in pain (14.5%) experienced greater changes in pain interference with function (6.8 to 3.4; =0.001) and sleep (62.4 to 51.0; =0.061).
Fibromyalgia patients reported high levels of burden at both time points, with few significant changes observed over time. Outcomes were variable among patients over time and were better among those with greater pain improvement.
关于纤维肌痛患者预后的纵向研究有限。
评估纤维肌痛患者随时间推移临床医生和患者报告的预后情况。
在入组时(基线)和随访时(约2年后),对同意参与的患者进行慢性广泛性疼痛(CWP)筛查,到医生处就诊以确定纤维肌痛状态,并完成一份在线问卷,评估疼痛、睡眠、功能、健康状况、生产力、用药情况及医疗资源使用情况。
76名纤维肌痛患者在两个时间点均参与研究(基线时:86.8%为白人,89.5%为女性,平均年龄50.9岁,纤维肌痛平均病程4.1年)。每次医生就诊时的平均压痛点数量分别为14.1和13.5;11名患者在随访时不再筛查出CWP阳性。大多数患者报告使用药物止痛(基线时为59.2%,随访时为62.0%)。随访时最常用的药物类别为阿片类药物(32.4%)、选择性5-羟色胺再摄取抑制剂(SSRIs,16.9%)和曲马多(14.1%)。纤维肌痛症状(根据2010年美国风湿病学会修订标准:从18.4降至16.;P = 0.004)、疼痛对功能的干扰(简明疼痛量表简表:从5.9降至5.3;P = 0.013)以及睡眠(医学结局研究睡眠量表:从58.3降至52.7;P = 0.004)随时间有显著的平均变化。疼痛改善≥2分的患者(14.5%)在疼痛对功能的干扰(从6.8降至3.4;P = 0.001)和睡眠(从62.4降至51.0;P = 0.061)方面有更大变化。
纤维肌痛患者在两个时间点均报告负担水平较高,随时间观察到的显著变化较少。患者的预后随时间变化不定,疼痛改善较大的患者预后较好。