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Fibromyalgia classified as spectrum disorder; affects 2.1% of German population
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Fibromyalgia is a spectrum or dimensional disorder, according to evidence from a recent study, in which researchers determined its prevalence in 2.1% of the general population in Germany.
“The new [American College of Rheumatology (ACR) 2010 preliminary diagnostic fibromyalgia] criteria gave us an opportunity to study the characteristics in the general population, thereby giving an unbiased picture of the illness, something that the usual ‘tip-of-the-iceberg’ clinical studies cannot do,” researcher Frederick Wolfe, MD, of the National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, told Healio.com.
Frederick Wolfe
Researchers studied 2,445 people (mean age, 50.2 years; 53.5% women) randomly selected from the German general population, with data collected between May and June 2012. The 2010 ACR criteria for fibromyalgia (FM), modified for survey research, identified patients with the disorder. Researchers investigated whether FM was a categorical or dimensional disorder via the polysymptomatic distress scale (PSD). The Patient Health Questionnaire (PHQ) assessed anxiety, depression and somatic symptom severity; symptoms and quality of life were measured by the European Organization for Research and Treatment of Cancer questionnaire.
Overall FM prevalence was 2.1% (95% CI, 1.6%-2.7%) — 2.4% among women (95% CI, 1.5%-3.2%) and 1.8% in men (95% CI, 1.1%-2.6%). Prevalence rose with age, and patients with FM had abnormal scores for all covariates.
The PSD and PHQ somatic symptom severity scale showed a strong correlation (r=.0.790). Physical symptom disorder was met by 38.5% of people with FM, based on proposed criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
“The prevalence of fibromyalgia is primarily of interest to researchers because of the self-report method of the new fibromyalgia criteria,” Wolfe said. “However, there are two other results that should be of considerable interest. We found strong evidence that fibromyalgia is not a discrete (yes or no) disorder. Rather the symptoms … exist in a continuum from none to very severe across all people in the population.
“In those with fibromyalgia, there is overwhelming polysymptomatic distress — severe pain and severe symptoms of all sorts. One doesn’t either have fibromyalgia or not have it. There is a gradual transition from the mild to the severe. The point at which we classify an individual as having fibromyalgia is arbitrary, but reasonable. Fibromyalgia, therefore, is a convenient shorthand, not a disease.”
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