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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Di Carlo M, Muto P, Benfaremo D, Luchetti MM, Atzeni F, Salaffi F. The Neuropathic Pain Features in Psoriatic Arthritis: A Cross-sectional Evaluation of Prevalence and Associated Factors. J Rheumatol 2019; 47:1198-1203. [PMID: 31787602 DOI: 10.3899/jrheum.190906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA). METHODS A cross-sectional evaluation was conducted in consecutive patients having PsA with prevalent peripheral joint involvement, referred to 3 rheumatological centers. For each patient, a comprehensive assessment of disease activity, physical function, and disease effect was carried out. The presence of comorbid fibromyalgia syndrome (FMS) was evaluated. Acute-phase reactants were also recorded. The neuropathic pain features were investigated through the PainDETECT Questionnaire (PDQ). A logistic regression analysis was therefore conducted using the PDQ as the dependent variable. RESULTS The final evaluation included 118 patients. A comorbid FMS was detectable in 30 of the 118 patients with PsA (25.4%). Probable characteristics of neuropathic pain (PDQ ≥ 19) were found in 30 (25.4%) patients overall, ambiguous (PDQ > 12 and < 19) in 21 (17.8%) patients, and unlikely (PDQ ≤ 12) in 67 (56.8%) patients. Using logistic regression analysis, the only independent variable among those investigated that could explain the neuropathic pain features was the presence of a comorbid FMS (p = 0.0127). Excluding patients with comorbid FMS, an association with disability (measured by Health Assessment Questionnaire-Disability Index) emerges (p = 0.0489). In patients with PsA and comorbid FMS, PDQ scores were significantly higher than in patients without comorbid FMS. CONCLUSION Neuropathic pain features are common in patients with PsA, and the presence of pain sensitization (comorbid FMS) seems to be its main predictor.
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Affiliation(s)
- Marco Di Carlo
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy. .,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Pietro Muto
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Devis Benfaremo
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Michele Maria Luchetti
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Fabiola Atzeni
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Fausto Salaffi
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
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Gibson KA, Castrejon I, Descallar J, Pincus T. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol 2019; 47:761-769. [PMID: 31474596 DOI: 10.3899/jrheum.190277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied. METHODS All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST). RESULTS In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria. CONCLUSION FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.
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Affiliation(s)
- Kathryn A Gibson
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia. .,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center.
| | - Isabel Castrejon
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Joseph Descallar
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Theodore Pincus
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
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Wolfe F, Ablin J, Guymer EK, Littlejohn GO, Rasker JJ. The Relation of Physical Comorbidity and Multimorbidity to Fibromyalgia, Widespread Pain, and Fibromyalgia-related Variables. J Rheumatol 2019; 47:624-631. [PMID: 31371651 DOI: 10.3899/jrheum.190149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the relation of physical (non-psychological) comorbidity and multimorbidity to quantitative measures of fibromyalgia (FM) and musculoskeletal pain. METHODS We studied 12,215 patients in a research databank with quantitative measures of FM-related variables (FMV) that included binary determinations of FM and widespread pain (WSP), and constituent variables of FM diagnosis that included the WSP index (WPI), the symptom severity score (SSS), and the polysymptomatic distress scale (PSD). We assessed self-reported comorbid conditions and covariates that included age, sex, body mass index, hypertension, smoking history, and total household income. We used nearest-neighbor matching and regression adjustment treatment effects models to measure the effect of comorbidities on FMV. RESULTS We found a positive association between FMV and the probability of having each comorbid condition. Patients with ≥ 1 comorbidities had PSD, WPI, and SSS increases of 3.0 (95% CI 2.7-3.3), 1.8 (95% CI 1.6-2.0), and 1.2 (95% CI 1.1-1.3) units, respectively, and an increase in FM prevalence from 20.4% to 32.6%. As the number of comorbid conditions present increased from 1 to 4 or more, PSD, WPI, SSS, and FM percent increased stepwise. For patients with ≥ 4 conditions, the predicted prevalence of FM was 55.2%. CONCLUSION FM and FMV are associated with an increase in the number of comorbidities, and the association can be measured quantitatively. However, the association of WSP and FM may be an effect of definitions of WSP and FM, because comorbidity increases are also present with subsyndromal levels of both conditions.
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Affiliation(s)
- Frederick Wolfe
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands. .,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente.
| | - Jacob Ablin
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente
| | - Emma K Guymer
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente
| | - Geoffrey O Littlejohn
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente
| | - Johannes J Rasker
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente
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Wolfe F, Walitt B, Rasker JJ, Häuser W. Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress. J Rheumatol 2018; 46:204-212. [PMID: 30008459 DOI: 10.3899/jrheum.180083] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Polysymptomatic distress (PSD) is the underlying metric of fibromyalgia (FM), and levels of PSD can identify criteria-positive FM with > 90% accuracy. We used levels of the PSD scale to test whether symptom levels in primary FM (PFM) and secondary FM (SFM) were the same and whether symptoms were equivalent in persons not meeting FM criteria. METHODS We studied 1525 patients with a clinical diagnosis of FM and 12,037 patients with rheumatoid arthritis (RA). We used regression models to compare patients with potential and actual PFM to RA patients with potential and actual SFM for 17 key clinical variables. RESULTS When controlled for PSD values, the widespread pain index, symptom severity scale, and pain, global, quality of life, and physical and mental component scores were essentially the same or only slightly different in PFM and SFM. Health Assessment Questionnaire-Disability Index scores were slightly higher in SFM (0.21 units), as was the painful joint count (1.6 joints). Overall, higher PSD scores were associated with more severe symptoms or abnormal status. PSD scores in patients not satisfying FM criteria and in patients satisfying criteria operated similarly. CONCLUSION PFM and SFM are equivalent regarding symptom burden. PSD scores are more informative about severity and severity within diagnosis than dichotomization into FM/non-FM. Studies of FM versus "healthy individuals," or FM versus other diseases, are inherently defective, while studies of FM and PSD in RA offer the opportunity to have meaningful comparison groups, because there are no readily available unbiased appropriate controls for PFM.
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Affiliation(s)
- Frederick Wolfe
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas; US National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland, USA; Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. .,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, Wichita, and University of Kansas School of Medicine; B. Walitt, MD, PhD, National Institute of Nursing Research, NIH; J.J. Rasker, MD, Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente; W. Häuser, MD, Department of Internal Medicine 1, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
| | - Brian Walitt
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas; US National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland, USA; Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, Wichita, and University of Kansas School of Medicine; B. Walitt, MD, PhD, National Institute of Nursing Research, NIH; J.J. Rasker, MD, Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente; W. Häuser, MD, Department of Internal Medicine 1, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Johannes J Rasker
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas; US National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland, USA; Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, Wichita, and University of Kansas School of Medicine; B. Walitt, MD, PhD, National Institute of Nursing Research, NIH; J.J. Rasker, MD, Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente; W. Häuser, MD, Department of Internal Medicine 1, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Winfried Häuser
- From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas; US National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland, USA; Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.,F. Wolfe, MD, National Data Bank for Rheumatic Diseases, Wichita, and University of Kansas School of Medicine; B. Walitt, MD, PhD, National Institute of Nursing Research, NIH; J.J. Rasker, MD, Faculty of Behavioral Management and Social Sciences, Psychology, Health and Technology, University of Twente; W. Häuser, MD, Department of Internal Medicine 1, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
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Abstract
OBJECTIVE In 2016, a revised version of the 2010 American College of Rheumatology fibromyalgia (FM) criteria and the 2011 self-report (survey) FM criteria were published. The 2016 criteria preserved the distinction between physician and patient criteria, but made the individual criteria items identical, added a "generalized pain" criterion, and changed ascertainment and scoring methods, among other changes. In this study, we evaluated diagnostic differences relating to 2016 changes. METHODS We used the National Data Bank for Rheumatic Diseases and evaluated 16,987 participants with painful rheumatic disorders using the 2011 and 2016 methodologies. RESULTS There were 4731 patients (27.9%) who satisfied the 2011 criteria and 4077 (24.0%) the 2016 revision. This resulted in agreement in 96.2% of cases and disagreement in 3.9%. All disagreements occurred in the 4731 2011-positive cases who failed to meet the 2016 criteria. This result came about because 654 (13.8%) of the 2011-positive cases failed to meet the new generalized pain requirement. When using the approximate polysymptomatic distress diagnostic method, diagnostic misclassification ranged between 7% and 13%. CONCLUSION The 2016 FM criteria further refined and increased the usefulness of symptom-based diagnosis of FM by excluding patients with regional pain syndromes. However, these changes, useful as they are, underscore the social construction of symptom-based diagnosis and the inherent limitations in reliability and validity associated with FM criteria.
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Affiliation(s)
- Jacob N Ablin
- From the Internal Medicine H and Institute of Rheumatology, Tel Aviv Sourasky Medical Center; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA. .,J.N. Ablin, MD, Internal Medicine H and Institute of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University; F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine.
| | - Frederick Wolfe
- From the Internal Medicine H and Institute of Rheumatology, Tel Aviv Sourasky Medical Center; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA.,J.N. Ablin, MD, Internal Medicine H and Institute of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University; F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine
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7
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Kim S, Slaven JE, Ang DC. Sustained Benefits of Exercise-based Motivational Interviewing, but Only among Nonusers of Opioids in Patients with Fibromyalgia. J Rheumatol 2016; 44:505-511. [PMID: 27909084 DOI: 10.3899/jrheum.161003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Given the known side effects of opioids and their potential effects on cognition, we sought to evaluate the benefits of motivational interviewing (MI) to promote physical activity on 2 subsets of participants with fibromyalgia (FM): nonusers and users of opioids. METHODS This was a secondary data analysis of a 36-week randomized controlled trial to assess the efficacy of MI to promote physical activity among participants with FM. Participants were randomized to 1 of 2 treatment arms: 6 phone-based MI sessions (n = 107) or 6 sessions of FM self-management instructions [attention control (AC), n = 109]. The primary outcomes were changes in physical function (Medical Outcomes Study Short Form-36), pain severity (Brief Pain Inventory), global FM symptom severity (Fibromyalgia Impact Questionnaire), and the amount of light to moderate physical activity (LMPA) from baseline to each followup visit. At study entry, subjects were categorized as opioid nonusers versus users. Repeated measures ANOVA was used to assess treatment effects adjusting for potential confounders. RESULTS Of the 216 participants, 145 (67%) were nonusers and 71 (33%) were opioid users. Among nonusers, MI was associated with improved physical function, reduced pain severity, and global FM severity, and increased LMPA at 6-month followup. Among opioid users, there were no significant differences in any outcome measures between the MI and AC groups. CONCLUSION Exercise-based MI was associated with sustained clinical benefits 6 months after completion of therapy, but only for those who were not taking opioids.
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Affiliation(s)
- Sunghye Kim
- From the Department of Medicine, Division of General Internal Medicine, and Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Biostatistics, Indiana University, Indianapolis, Indiana, USA.,S. Kim, MD, MMSc, Assistant Professor, Department of Medicine, Division of General Internal Medicine, Wake Forest School of Medicine; J.E. Slaven, MS, Biostatistician, Division of Biostatistics, Indiana University; D.C. Ang, MD, MS, Associate Professor, Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine
| | - James E Slaven
- From the Department of Medicine, Division of General Internal Medicine, and Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Biostatistics, Indiana University, Indianapolis, Indiana, USA.,S. Kim, MD, MMSc, Assistant Professor, Department of Medicine, Division of General Internal Medicine, Wake Forest School of Medicine; J.E. Slaven, MS, Biostatistician, Division of Biostatistics, Indiana University; D.C. Ang, MD, MS, Associate Professor, Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine
| | - Dennis C Ang
- From the Department of Medicine, Division of General Internal Medicine, and Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Biostatistics, Indiana University, Indianapolis, Indiana, USA. .,S. Kim, MD, MMSc, Assistant Professor, Department of Medicine, Division of General Internal Medicine, Wake Forest School of Medicine; J.E. Slaven, MS, Biostatistician, Division of Biostatistics, Indiana University; D.C. Ang, MD, MS, Associate Professor, Department of Medicine, Division of Rheumatology, Wake Forest School of Medicine.
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8
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Fitzcharles MA, Ste-Marie PA, Rampakakis E, Sampalis JS, Shir Y. Disability in Fibromyalgia Associates with Symptom Severity and Occupation Characteristics. J Rheumatol 2016; 43:931-6. [PMID: 26980580 DOI: 10.3899/jrheum.151041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE It is intuitive that disability caused by illness should be reflected in illness severity. Because disability rates for fibromyalgia (FM) are high in the developed world, we have examined disease and work characteristics for patients with FM who were working, unemployed, or receiving disability payments for disability as a result of FM. METHODS Of the 248 participants in a tertiary care cohort study of patients with FM, 90 were employed, 81 were not employed and not receiving disability payments, and 77 were not working and currently receiving disability payments awarded for disability caused by FM. Demographic, occupation, and disease characteristics were compared among the groups. RESULTS The prevalence of disability caused by FM was 30.8%. There were no demographic differences among the working, unemployed, or disabled patients. With the exception of measures for anxiety and depression, all measurements for disease severity differed significantly among the groups, with greater severity reported for the disabled group, which used more medications and participated less in physical activity. Disabled patients were more likely previously employed in manual professions or the service industry, whereas employed patients were more commonly working in non-manual jobs that included clerical, managerial, or professional occupations (p = 0.005). CONCLUSION The one-third rate of disability for this Canadian cohort of patients with FM is in line with other reports from the western world. Associations of disability compensation were observed for subjective report of symptom severity, increased use of medications, and previous employment in more physically demanding jobs.
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Affiliation(s)
- Mary-Ann Fitzcharles
- From the Alan Edwards Pain Management Unit, McGill University Health Centre; Division of Rheumatology, McGill University Health Centre; Jewish General Hospital, McGill University, Montreal; JSS Medical Research, Saint Laurent, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Alan Edwards Pain Management Unit, McGill University Health Centre, and the Division of Rheumatology, McGill University Health Centre; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; J.S. Sampalis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre.
| | - Peter A Ste-Marie
- From the Alan Edwards Pain Management Unit, McGill University Health Centre; Division of Rheumatology, McGill University Health Centre; Jewish General Hospital, McGill University, Montreal; JSS Medical Research, Saint Laurent, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Alan Edwards Pain Management Unit, McGill University Health Centre, and the Division of Rheumatology, McGill University Health Centre; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; J.S. Sampalis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre
| | - Emmanouil Rampakakis
- From the Alan Edwards Pain Management Unit, McGill University Health Centre; Division of Rheumatology, McGill University Health Centre; Jewish General Hospital, McGill University, Montreal; JSS Medical Research, Saint Laurent, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Alan Edwards Pain Management Unit, McGill University Health Centre, and the Division of Rheumatology, McGill University Health Centre; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; J.S. Sampalis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre
| | - John S Sampalis
- From the Alan Edwards Pain Management Unit, McGill University Health Centre; Division of Rheumatology, McGill University Health Centre; Jewish General Hospital, McGill University, Montreal; JSS Medical Research, Saint Laurent, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Alan Edwards Pain Management Unit, McGill University Health Centre, and the Division of Rheumatology, McGill University Health Centre; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; J.S. Sampalis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre
| | - Yoram Shir
- From the Alan Edwards Pain Management Unit, McGill University Health Centre; Division of Rheumatology, McGill University Health Centre; Jewish General Hospital, McGill University, Montreal; JSS Medical Research, Saint Laurent, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Alan Edwards Pain Management Unit, McGill University Health Centre, and the Division of Rheumatology, McGill University Health Centre; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; J.S. Sampalis, PhD, JSS Medical Research, and the Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre
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9
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Cunningham NR, Tran ST, Lynch-Jordan AM, Ting TV, Sil S, Strotman D, Noll JG, Powers SW, Arnold LM, Kashikar-Zuck S. Psychiatric Disorders in Young Adults Diagnosed with Juvenile Fibromyalgia in Adolescence. J Rheumatol 2015; 42:2427-33. [PMID: 26373565 DOI: 10.3899/jrheum.141369] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Adolescents with juvenile-onset fibromyalgia (JFM) have increased rates of psychiatric disorders, but to our knowledge no studies have examined psychiatric disorders in adolescents with JFM when they enter young adulthood. This study examined the prevalence of psychiatric disorders in young adults diagnosed with JFM during adolescence and the relationship between mental health diagnoses and physical functioning. METHODS Ninety-one young adults (mean age 21.60, SD 1.96) with a history of JFM being followed as part of a prospective longitudinal study and 30 matched healthy controls (mean age 21.57, SD 1.55) completed a structured interview of psychiatric diagnoses and a self-report measure of physical impairment. RESULTS Young adults with a history of JFM were more likely to have current and lifetime histories of anxiety disorders (70.3% and 76.9%, respectively) compared with controls (33.3% for both, both p < 0.001). Individuals with JFM were also more likely to have current and lifetime histories of major mood disorders (29.7% and 76.9%, respectively) compared with controls (10% and 40%, p < 0.05). The presence of a current major mood disorder was significantly related to impairment in physical functioning [F (1, 89) = 8.30, p < 0.01] and role limitations attributable to a physical condition [F (1, 89) = 7.09, p < 0.01]. CONCLUSION Psychiatric disorders are prevalent in young adulthood for individuals with a history of JFM, and a current major mood disorder is associated with greater physical impairment. Greater attention to early identification and treatment of mood disorders in patients with JFM is warranted.
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Affiliation(s)
- Natoshia Raishevich Cunningham
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Susan T Tran
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Anne M Lynch-Jordan
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Tracy V Ting
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Soumitri Sil
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Daniel Strotman
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Jennie G Noll
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Scott W Powers
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Lesley M Arnold
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Susmita Kashikar-Zuck
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
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Wolfe F, Walitt BT, Rasker JJ, Katz RS, Häuser W. The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity. J Rheumatol 2015; 42:1494-501. [PMID: 26077414 DOI: 10.3899/jrheum.141519] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The polysymptomatic distress (PSD) scale is derived from variables used in the 2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for survey and clinical research. The scale is useful in measuring the effect of PSD over the full range of pain-related clinical symptoms, not just in those who are FM criteria-positive. However, no PSD scale categories have been defined to distinguish severity of illness in FM or in those who do not satisfy the FM criteria. We analyzed the scale and multiple covariates to develop clinical categories and to further validate the scale. METHODS FM was diagnosed according to the research criteria modification of the 2010 ACR FM criteria. We investigated categories in a large database of patients with pain (2732 with rheumatoid arthritis) and developed categories by using germane clinic variables that had been previously studied for severity groupings. By definition, FM cannot be diagnosed unless PSD is at least 12. RESULTS Based on population categories, regression analysis, and inspections of curvilinear relationships, we established PSD severity categories of none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). Categories were statistically distinct, and a generally linear relationship between PSD categories and covariate severity was noted. CONCLUSION PSD categories are clinically relevant and demonstrate FM type symptoms over the full range of clinical illness. Although FM criteria can be clinically useful, there is no clear-cut symptom distinction between FM (+) and FM (-), and PSD categories can aid in more effectively classifying patients.
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Affiliation(s)
- Frederick Wolfe
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
| | - Brian T Walitt
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Johannes J Rasker
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Robert S Katz
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Winfried Häuser
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
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Inanc N, Yilmaz-Oner S, Can M, Sokka T, Direskeneli H. The role of depression, anxiety, fatigue, and fibromyalgia on the evaluation of the remission status in patients with rheumatoid arthritis. J Rheumatol 2014; 41:1755-60. [PMID: 25086073 DOI: 10.3899/jrheum.131171] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the effect of depression, anxiety, fatigue, and fibromyalgia (FM) on the remission status in patients with rheumatoid arthritis (RA), defined according to the 28-joint count Disease Activity Score (DAS28)-erythrocyte sedimentation rate (ESR) and the Boolean-based new American College of Rheumatology/European League Against Rheumatism remission criteria. METHODS The subjects were patients with RA who participated in a hospital-based observational cohort. Patients who met the DAS28-ESR remission criteria at their latest visit were invited to participate in our study. The patient groups fulfilling or not fulfilling the Boolean remission criteria were identified and compared with each other with regard to the presence of depression, anxiety, fatigue (0-50), and FM. The relationship between psychosocial factors and Simplified Disease Activity Index (SDAI) remission, which is the index-based definition of remission in RA, was also investigated. RESULTS A total of 87 out of 428 patients (20%) with RA met the DAS28-ESR remission criteria and 32 (37%) of these also met the Boolean remission criteria, while 55 (63%) did not. Forty patients were also in SDAI remission. In the Boolean remission group, 2 patients had depression and 2 had anxiety (p = 0.004). In the Boolean nonremission group, 19 patients had depression and 13 had anxiety (p = 0.04). Continuous scales of anxiety (3.34 ± 3.76 vs 5.83 ± 4.70, p = 0.012) and depression (2.18 ± 2.75 vs 4.63 ± 4.10, p = 0.001) were also lower in the Boolean remission group in comparison with the nonremission group. Though FM syndrome was detected in only 1 patient of the Boolean remission group and in 7 patients of the Boolean nonremission group (p = 0.249), patients' polysymptomatic distress scores of FM in the Boolean remission group were significantly lower than those of the nonremission group (3.12 ± 3.25 vs 6.27 ± 5.19, p = 0.001). The mean fatigue scores were 9.5 ± 10.6 in the Boolean remission group and 16.8 ± 12.8 in the Boolean nonremission group (p = 0.006). In multivariate analysis, patient's global assessment (PtGA) and depression were found as the independent discriminators of Boolean-based definition. Similar relationships were also observed between psychosocial factors and SDAI remission. CONCLUSION In patients with RA who do not fulfill the Boolean remission criteria, to avoid overtreatment, assessment of anxiety, fatigue, FM, and especially depression must be considered if PtGA scores and disease activity variables are significantly different.
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Affiliation(s)
- Nevsun Inanc
- From the Medical Faculty, and the Department of Rheumatology, Marmara University, Istanbul, Turkey; Jyväskylä Central Hospital, Jyväskylä, Finland.N. Inanc, MD, Associate Professor; S. Yilmaz-Oner, MD; M. Can, MD; H. Direskeneli, MD, Professor, Medical Faculty, Department of Rheumatology, Marmara University; T. Sokka, MD, Professor, Jyväskylä Central Hospital.
| | - Sibel Yilmaz-Oner
- From the Medical Faculty, and the Department of Rheumatology, Marmara University, Istanbul, Turkey; Jyväskylä Central Hospital, Jyväskylä, Finland.N. Inanc, MD, Associate Professor; S. Yilmaz-Oner, MD; M. Can, MD; H. Direskeneli, MD, Professor, Medical Faculty, Department of Rheumatology, Marmara University; T. Sokka, MD, Professor, Jyväskylä Central Hospital
| | - Meryem Can
- From the Medical Faculty, and the Department of Rheumatology, Marmara University, Istanbul, Turkey; Jyväskylä Central Hospital, Jyväskylä, Finland.N. Inanc, MD, Associate Professor; S. Yilmaz-Oner, MD; M. Can, MD; H. Direskeneli, MD, Professor, Medical Faculty, Department of Rheumatology, Marmara University; T. Sokka, MD, Professor, Jyväskylä Central Hospital
| | - Tuulikki Sokka
- From the Medical Faculty, and the Department of Rheumatology, Marmara University, Istanbul, Turkey; Jyväskylä Central Hospital, Jyväskylä, Finland.N. Inanc, MD, Associate Professor; S. Yilmaz-Oner, MD; M. Can, MD; H. Direskeneli, MD, Professor, Medical Faculty, Department of Rheumatology, Marmara University; T. Sokka, MD, Professor, Jyväskylä Central Hospital
| | - Haner Direskeneli
- From the Medical Faculty, and the Department of Rheumatology, Marmara University, Istanbul, Turkey; Jyväskylä Central Hospital, Jyväskylä, Finland.N. Inanc, MD, Associate Professor; S. Yilmaz-Oner, MD; M. Can, MD; H. Direskeneli, MD, Professor, Medical Faculty, Department of Rheumatology, Marmara University; T. Sokka, MD, Professor, Jyväskylä Central Hospital
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Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, Ko G, Moulin DE, Panopalis P, Proulx J, Shir Y. Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia: a summary report. J Rheumatol 2013; 40:1388-93. [PMID: 23818709 DOI: 10.3899/jrheum.130127] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To summarize the development of evidence-based guidelines for the clinical care of persons with fibromyalgia (FM), taking into account advances in understanding of the pathogenesis of FM, new diagnostic criteria, and new treatment options. METHODS Recommendations for diagnosis, treatment, and patient followup were drafted according to the classification system of the Oxford Centre for Evidence-Based Medicine, and following review were endorsed by the Canadian Rheumatology Association and the Canadian Pain Society. RESULTS FM is a polysymptomatic syndrome presenting a spectrum of severity, with a pivotal symptom of body pain. FM is a positive clinical diagnosis, not a diagnosis of exclusion, and not requiring specialist confirmation. There are no confirmatory laboratory tests, although some investigation may be indicated to exclude other conditions. Ideal care is in the primary care setting, incorporating nonpharmacologic and pharmacologic strategies in a multimodal approach with active patient participation. The treatment objective should be reduction of symptoms, but also improved function using a patient-tailored treatment approach that is symptom-based. Self-management strategies combining good lifestyle habits and fostering a strong locus of control are imperative. Medications afford only modest relief, with doses often lower than suggested, and drug combinations used according to clinical judgment. There is a need for continued reassessment of the risk-benefit ratio for any drug treatment. Outcome should be aimed toward functioning within a normal life pattern and any culture of disablement should be discouraged. CONCLUSION These guidelines should provide the health community with reassurance for the global care of patients with FM with the aim of improving patient outcome by reducing symptoms and maintaining function.
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