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Progression of fibromyalgia: results from a 2-year observational fibromyalgia and chronic pain study in the US

Authors Adams E, McElroy H, Udall M, Masters ET, Mann R, Schaefer C, Cappelleri J, Clair A, Hopps M, Daniel S, Mease P, Silverman S, Staud R

Received 7 November 2015

Accepted for publication 5 February 2016

Published 1 June 2016 Volume 2016:9 Pages 325—336


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Minal Joshi

Peer reviewer comments 5

Editor who approved publication: Dr Michael E Schatman

Edgar H Adams,1 Heather J McElroy,2 Margarita Udall,3 Elizabeth T Masters,3 Rachael M Mann,4 Caroline P Schaefer,1 Joseph C Cappelleri,5 Andrew G Clair,3 Markay Hopps,3 Shoshana R Daniel,6 Philip Mease,7,8 Stuart L Silverman,9,10 Roland Staud11

1Covance Market Access Services Inc, Gaithersburg, MD, USA; 2Covance (Asia) Pte Ltd, Singapore, Singapore; 3Pfizer Inc, New York, NY, 4Covance Market Access Services Inc, San Diego, CA, 5Pfizer Inc, Groton, CT, 6Covance Market Access Services Inc, Conshohocken, PA, 7Division of Rheumatology Research, Swedish Medical Center, Seattle, WA, 8Department of Rheumatology, University of Washington, Seattle, WA, 9Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 10Department of Medicine, University of California, Los Angeles, CA,11Department of Medicine, University of Florida, Gainesville, FL, USA

Background: A previous fibromyalgia (FM) research reports that 20%–47% of diagnosed patients may not meet the study definition of FM 1–2 years after diagnosis. The aim of this study was to gain a better understanding of the progression of FM in a geographically diverse cohort over a 2-year time period.
Methods: This cohort study followed 226 subjects recruited online to assess FM and chronic widespread pain (CWP) diagnosis stability over time. At enrollment (baseline), subjects provided informed consent, completed an online questionnaire consisting of the London Fibromyalgia Epidemiology Study Screening Questionnaire to screen for CWP (bilateral pain above/below waist lasting ≥1 week in the past 3 months), visited a site for physician evaluation for FM, and completed a questionnaire with validated patient-reported outcome instruments. Subjects were classified into mutually exclusive groups: FM+CWP+ (screened positive for CWP and received physician diagnosis of FM), FM-CWP+ (screened positive for CWP but did not receive physician diagnosis of FM), and FM-CWP- (screened negative for CWP). Approximately 2 years later (follow-up), subjects were reassessed at the same study site and completed a questionnaire with the same patient-reported outcomes.
Results: Seventy-six FM+CWP+ subjects completed assessments at both time points; 56 (73.7%) met the FM study definition at follow-up. Twenty subjects no longer met the FM study definition (eleven became FM-CWP- and nine became FM-CWP+). Ten subjects (two from FM-CWP- and eight from FM-CWP+) transitioned into the FM+CWP+ group at follow-up; they reported more tender points and pain interference with sleep and worse physical function at baseline compared with subjects who did not transition to FM+CWP+. Most (76.7%) of the subjects who transitioned into/out of FM+CWP+ experienced changes in CWP, number of positive tender points, or both.
Conclusion: The results suggest that some FM+CWP+ patients experience fluctuation in symptoms over time, which may reflect the waxing and waning nature of FM and affect diagnosis and treatment.

Keywords: fibromyalgia, chronic widespread pain, physician assessment

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