Fibromyalgia May Be Overdiagnosed

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Fibromyalgia May Be Overdiagnosed

In the past decade, fibromyalgia has become a common diagnosis characterized by reduced pain tolerance, diffuse musculoskeletal pain, sleep disturbances, fatigue and morning stiffness. The estimated prevalence of fibromyalgia has been determined to be around 2%, with 10 times more women affected than men.

Recent information suggests this syndrome may be overreported as a "fashionable diagnosis," however, while other conditions are overlooked. Such overreporting may lead to the administration of improper treatment and create a burden on both the patient and society.
To examine physician diagnostic accuracy of fibromyalgia, researchers evaluated all 76 new patients referred to a rheumatology clinic over a six-month period with either an initial or final diagnosis of fibromyalgia.
At final evaluation, diagnostic accuracy for fibromyalgia by either the referring physician or the rheumatologist at initial visit was correct in only 34% of cases. The 66% of patients initially, but incorrectly, diagnosed with fibromyalgia suffered from conditions such as inflammatory arthropathies; degenerative joint disease; chronic fatigue syndrome; depression; myopathy; radiculopathy; or thoracic outlet syndrome. True fibromyalgia sufferers tended to have more average tender points (12.5 vs. 4) and higher reports of fatigue. Prolonged early-morning stiffness and limited lumbar mobility in multiple planes were more common in non-fibromyalgia sufferers.
The authors conclude that there is a "disturbing inaccuracy," in the diagnosis of fibromyalgia, primarily due to overdiagnosis, which might explain the current high rates of reported fibromyalgia. Additionally, common rheumatological conditions may be overlooked and instead considered fibromyalgia. The authors add, "We recommend caution in simply ascribing the diagnostic label of [fibromyalgia] to patients with diffuse musculoskeletal symptoms and urge physicians to be more rigorous in the evaluation of rheumatological conditions."
Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: Analysis of referrals. Rheumatology 2003:42(2), pp. 263-267.
http://rheumatology.oupjournals.org