A DGReview of:"Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals."
By Anne MacLennan
Referring doctors frequently misdiagnose fibromyalgia, Canadian researchers have found. This common mistake, mostly observed to be over-diagnosis, might help to explain the high rates of fibromyalgia currently reported, suggest investigators from Montreal General Hospital, McGill University Health Centre, in Montreal, Quebec, and St. Joseph's Hospital, McMaster University, in Hamilton, Ontario.
The finding may also alert doctors to the critical need to consider other diagnostic possibilities in patients with diffuse musculoskeletal pain, they point out.
To examine the accuracy of an initial fibromyalgia diagnosis, Drs. M.A. Fitzcharles and P. Boulos prospectively evaluated a series of patients for preceding, current or subsequent diagnosis of fibromyalgia. All of the patients were newly referred for rheumatology consultation over a 6-month period.
Their clinical characteristics, previous and subsequent management and use of health care resources were assessed and, at 6 months, the final diagnosis and its accuracy were determined.
Overall, 76 (12 percent) of all new patients were referred with either a suspected or definite diagnosis of fibromyalgia.
However, at final evaluation, only 34% of patients had been diagnosed accurately by either the referring doctor or the rheumatologist at the initial visit. The remaining patients had other rheumatological diagnoses. As compared with these other patients, those in the fibromyalgia group had more tender points (12.5 versus four) and reported more fatigue. In contrast, the non- fibromyalgia group more commonly reported prolonged early morning stiffness and limitation of lumbar spinal mobility in more than one plane.
Rheumatology 2003 Feb;42:2:263-7 "Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals."
Copyright (c) 1995-2004 Doctor's Guide Publishing Limited. All rights reserved.