Inaccuracy in the diagnosis of fibromyalgia

Fitzcharles et al prospectively evaluated all patients newly referred for rheumatology consultation in a 6-month period in order to determine the accuracy of an initial diagnosis for fibromyalgia (FM).The subjects were assessed for either a preceding, current or subsequent diagnosis of FM. Clinical characteristics, previous and subsequent management and health care utilisation were assessed. The final diagnosis at 6 months was verified and accuracy regarding the diagnosis of FM was determined. Seventy-six (12%) of all new patients were either referred with a question of FM or finally diagnosed with FM. At the final evaluation the accuracy of the diagnosis regarding FM by either the referring physician or by the rheumatologist at the time of the initial visit was correct in 34% of patients. The FM group, in comparison with those with some other rheumatological diagnosis, had more tender points (12.5 vs 4) and was more fatigued. In contrast, prolonged early morning stiffness and limitation of lumbar spinal mobility in more than one plane was more common in the non-FM group.The authors conclude that there is a "disturbing inaccuracy", mostly observed to be over diagnosis, in the diagnosis of FM by referring physicians. They suggest that this finding may help explain the current high reported rates of FM and caution physicians to consider other diagnostic possibilities when addressing diffuse musculoskeletal pain. ReferenceFitzcharles, M. Boulos, P. 2003, 'Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals', Rheumatology, vol. 42, pp. 263-267....