The overdiagnosis of fibromyalgia (FM) syndrome

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PURPOSE: As fibromyalgia syndrome (FM) has gained greater acceptance
and awareness in both the medical and the lay community, the
possibility of overdiagnosis exists. Diffuse body pain in a
woman is likely to suggest this diagnosis. We report the
diagnosis of FM in 11 female patients whose primary cause for
musculoskeletal symptoms was spondyloarthritis rather than
only FM.

PATIENTS AND METHODS: Of a total of 321 new
rheumatology referrals in a 1-year period, 35 (11%) were
diagnosed with FM. A further 11 (3%) were referred with either
a previous diagnosis of FM or a presumed diagnosis of FM in
whom the musculoskeletal syndrome could be attributed to
previously unrecognized spondyloarthropathy.

RESULTS: The 11 female patients had mostly experienced
 musculoskeletal symptoms for prolonged periods of time ranging
from 1 to 40 years. Symptoms included prominent spinal pain
involving at least 2 locations in the spine (n = 10), night pain that
disturbed sleep (n = 10), and prolonged morning stiffness (n =
9). A previous history of enthesopathy, or history in the
patient or first-degree relative of one of the seronegative
associated diseases, such as psoriasis or ulcerative colitis,
occurred in nine patients. Most patients had already undergone
extensive investigations by various specialists in
musculoskeletal medicine, but spondyloarthritis had only
infrequently been considered a diagnostic possibility.

CONCLUSION: Spondyloarthropathy in women may present subtly
and have considerable overlap in symptomalogy with FM. A
diagnosis of spondyloarthropathy should be considered in women
with an ill-defined pain syndrome with prominent spinal pain
and associated enthesopathy, or history or family history of
seronegative-associated disease. It is possible that a primary
diagnosis of FM is being made too freely, without
consideration of other diagnoses, in the setting of
ill-defined musculoskeletal pain.

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