Three-Quarters of Persons in the US Population Reporting a Clinical Diagnosis of Fibromyalgia Do Not Satisfy Fibromyalgia Criteria: The 2012 National Health Interview Survey

<div><p>Objectives</p><p>Although fibromyalgia criteria have been in effect for decades, little is known about how the fibromyalgia diagnosis is applied and understood by clinicians and patients. We used the National Health Interview Survey (NHIS) to determine the prevalence of self-reported clinician diagnosed fibromyalgia and then compared demographics, symptoms, disability and medical utilization measures of persons with a clinical diagnosis of fibromyalgia that did not meet diagnostic criteria (false-positive or prior [F/P] fibromyalgia) to persons with and without criteria-positive fibromyalgia.</p><p>Methods</p><p>The National Health Interview Survey (NHIS) collected information about both clinical diagnosis and symptoms of fibromyalgia that was appropriately weighted to represent 225,726,257 US adults. Surrogate NHIS diagnostic criteria for fibromyalgia were developed based on the level of polysymptomatic distress (PSD) as characterized in the 2011 modified American College of Rheumatology criteria (ACR) for fibromyalgia. Persons with F/P fibromyalgia were compared with persons who do not have fibromyalgia and those meeting surrogate NHIS fibromyalgia criteria.</p><p>Results</p><p>Of the 1.78% of persons reporting a clinical diagnosis, 73.5% did not meet NHIS fibromyalgia criteria. The prevalence of F/P fibromyalgia is 1.3%. F/P fibromyalgia is associated with a mild degree of polysymptomatic distress (NHIS PSD score 6.2) and characterized by frequent but not widespread pain and insomnia. Measures of work disability and medical utilization in F/P fibromyalgia were equal to that seen with NHIS criteria positive fibromyalgia and were 6-7x greater in F/P fibromyalgia than in non-fibromyalgia persons. F/P fibromyalgia was best predicted by being female (Odds Ratio [OR] 8.81), married (OR 3.27), and white (OR 1.96). In contrast, being a white, married woman was only modestly predictive of NHIS (criteria positive) fibromyalgia (OR 2.1).</p><p>Conclusions</p><p>The majority of clinically diagnosed fibromyalgia cases in the US do not reach levels of severity necessary and sufficient for diagnosis. The clinical diagnosis of fibromyalgia is disproportionally dependent on demographic and social factors rather than the symptoms themselves. Diagnostic criteria for fibromyalgia appear to be used as a vague guide by clinicians and patients, and allow for substantial diagnostic expansion of fibromyalgia.</p></div

Symptoms, the Nature of Fibromyalgia, and <i>Diagnostic and Statistical Manual 5 (DSM-5)</i> Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia

<div><p>Purpose</p><p>To describe and evaluate somatic symptoms in patients with rheumatoid arthritis (RA) and fibromyalgia, determine the relation between somatization syndromes and fibromyalgia, and evaluate symptom data in light of the Diagnostic and Statistical Manual-5 (DSM-5) criteria for somatic symptom disorder.</p><p>Methods</p><p>We administered the Patient Health Questionnaire-15 (PHQ-15), a measure of somatic symptom severity to 6,233 persons with fibromyalgia, RA, and osteoarthritis. PHQ-15 scores of 5, 10, and 15 represent low, medium, and high somatic symptom severity cut-points. A likely somatization syndrome was diagnosed when PHQ-15 score was ≥10. The intensity of fibromyalgia diagnostic symptoms was measured by the polysymptomatic distress (PSD) scale.</p><p>Results</p><p>26.4% of RA patients and 88.9% with fibromyalgia had PHQ-15 scores ≥10 compared with 9.3% in the general population. With each step-wise increase in PHQ-15 category, more abnormal mental and physical health status scores were observed. RA patients satisfying fibromyalgia criteria increased from 1.2% in the PHQ-15 low category to 88.9% in the high category. The sensitivity and specificity of PHQ-15≥10 for fibromyalgia diagnosis was 80.9% and 80.0% (correctly classified = 80.3%) compared with 84.3% and 93.7% (correctly classified = 91.7%) for the PSD scale. 51.4% of fibromyalgia patients and 14.8% with RA had fatigue, sleep or cognitive problems that were severe, continuous, and life-disturbing; and almost all fibromyalgia patients had severe impairments of function and quality of life.</p><p>Conclusions</p><p>All patients with fibromyalgia will satisfy the DSM-5 “A” criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 “B” criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the “B” designation requires special knowledge that symptoms are “disproportionate” or “excessive,” something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.</p></div

Probability of a person being told by a physician that they have fibromyalgia according to gender, ethnicity, and marital status.

<p>Codes are F (Female), M (Married), W (White) and None (Not female, married, or white). Groups are mutually exclusive.</p

Comparison of somatic and psychological symptoms between persons without fibromyalgia, FP fibromyalgia, and those that meet NHIS fibromyalgia criteria.

<p>Comparison of somatic and psychological symptoms between persons without fibromyalgia, FP fibromyalgia, and those that meet NHIS fibromyalgia criteria.</p

Comparison of selected work and health utilization between persons without fibromyalgia, FP fibromyalgia, and those that meet NHIS fibromyalgia criteria.

<p>Comparison of selected work and health utilization between persons without fibromyalgia, FP fibromyalgia, and those that meet NHIS fibromyalgia criteria.</p

Multivariable logistic regression of predictors of physician diagnosis of fibromyalgia: Model predicting persons told by a physician that they that fibromyalgia (including Polysymptomatic Distress Score).

<p>Multivariable logistic regression of predictors of physician diagnosis of fibromyalgia: Model predicting persons told by a physician that they that fibromyalgia (including Polysymptomatic Distress Score).</p

Multivariable logistic regression of predictors of physician diagnosis of fibromyalgia: Model predicting persons meeting 2012 NHIS fibromyalgia criteria (excluding Polysymptomatic Distress Score).

<p>Multivariable logistic regression of predictors of physician diagnosis of fibromyalgia: Model predicting persons meeting 2012 NHIS fibromyalgia criteria (excluding Polysymptomatic Distress Score).</p

The relation of the PHQ-15 and Polysymptomatic Distress (PSD) scales.

<p>The vertical lines at 5, 10 and 15 define the PHQ-15 severity groups (0–4, 5–9, 10–14, ≥15). The horizontal line at 12 roughly separates fibromyalgia negative patients (<12) from mostly fibromyalgia criteria positive patients (≥12). A small amount if random jitter is added to the symbols to make overlapping symbols easier to see.</p

Prevalence of PHQ-15 symptoms in RA, SLE and Fibromyalgia.

<p>PHQ-15– Patient Health Questionnaire-15.</p><p>*Criteria positive patients.</p