Srinivasan Sachin, Maloney Eamon, Wright Brynn, Kennedy Michael, Kallail K James, Rasker Johannes J, Häuser Winfried, Wolfe Frederick
Kansas University School of Medicine Wichita.
Kansas University School of Medicine Kansas City.
ACR Open Rheumatol. 2019 Mar 15;1(1):43-51. doi: 10.1002/acr2.1006. eCollection 2019 Mar.
Recently, some studies suggested that clinical diagnosis of fibromyalgia is inaccurate and does not reflect current definitions. However, this hypothesis has not been tested. We examined whether fibromyalgia was accurately diagnosed in the community.
We surveyed 3276 primary care patients to determine current fibromyalgia status by criteria (CritFM). We also determined whether the patients had a physician's diagnosis of fibromyalgia (MDFM) and the level of symptom severity as measured by the polysymptomatic distress scale (PSD).
The prevalence of MDFM and CritFM was 6.1% (95% confidence interval [CI] 5.3%, 6.9%) and 5.5% (95% CI 4.8%, 6.3%), respectively. However, only 32.2% with MDFM met 2016 criteria (CritFM), and only 35.4% with CritFM also had MDFM. The kappa statistic for diagnostic agreement was 0.296 (minimal agreement). The mean PSD score was 12.4 and 18.4 in MDFM and CritFM, respectively. The odds ratio for being a woman compared with being a man was 3.2 for MDFM versus 1.9 for CritFM, = 0.023. Of the patients with MDFM, 68.3% received specific fibromyalgia pharmacotherapy.
There is little agreement between MDFM and CritFM. Only one-third of MDFM satisfy fibromyalgia criteria, and only one-third of patients who meet the criteria have a clinical diagnosis of fibromyalgia. Physician diagnosis is biased and more likely in women. Fibromyalgia treatment is common in MDFM (70.7%). Overall, MDFM appears subjective and unrelated to fibromyalgia criteria. There appears to be no common definition of fibromyalgia in the community.
最近，一些研究表明纤维肌痛的临床诊断不准确，不符合当前的定义。然而，这一假设尚未得到验证。我们调查了社区中纤维肌痛的诊断是否准确。
我们对3276名初级保健患者进行了调查，以根据标准（CritFM）确定当前的纤维肌痛状况。我们还确定了患者是否有医生诊断的纤维肌痛（MDFM）以及通过多症状困扰量表（PSD）测量的症状严重程度。
MDFM和CritFM的患病率分别为6.1%（95%置信区间[CI]5.3%，6.9%）和5.5%（95%CI 4.8%，6.3%）。然而，只有32.2%的MDFM符合2016年标准（CritFM），只有35.4%的CritFM患者也有MDFM。诊断一致性的kappa统计量为0.296（一致性最低）。MDFM和CritFM的PSD平均得分分别为12.4和18.4。MDFM中女性与男性的比值比为3.2，而CritFM为1.9，P = 0.023。在MDFM患者中，68.3%接受了特定的纤维肌痛药物治疗。
MDFM和CritFM之间几乎没有一致性。只有三分之一的MDFM符合纤维肌痛标准，只有三分之一符合标准的患者有纤维肌痛的临床诊断。医生的诊断存在偏差，女性更易被诊断。MDFM中纤维肌痛治疗很常见（70.7%）。总体而言，MDFM似乎是主观的，与纤维肌痛标准无关。社区中似乎没有纤维肌痛的共同定义。
