Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals
Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals
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DOI：
10.1093/rheumatology/keg075
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发表时间：
2003-02-01
期刊：
影响因子：
5.5
通讯作者：
Boulos, P
中科院分区：
文献类型：
--
作者：
Fitzcharles, MA;Boulos, P
目标。前瞻性检查纤维肌痛(FM)初始诊断的准确性。在为期6个月的时间里，所有新近接受风湿科咨询的患者都被前瞻性地评估了之前、现在或随后诊断为FM的情况。评估了患者的临床特征、既往和后续的管理和卫生保健利用情况。在6个月时对最终诊断进行了验证，并对FM诊断的准确性进行了评估。76例(12%)的新患者要么被转诊为FM问题，要么最终被诊断为FM。在最终评估中，转诊医生或风湿科医生在初次就诊时对FM的诊断准确率为34%。与其他一些风湿病患者相比，FM组有更多的压痛点(12.5vs4)，也更疲倦。相反，清晨僵硬时间延长和腰椎在多个平面的活动受限在非FM组中更为常见。在咨询医生对FM的诊断中，有一个令人不安的不准确，大多数被观察到是过度诊断。这一发现可能有助于解释目前报道的FM的高发生率，并提醒医生在处理弥漫性肌肉骨骼疼痛时考虑其他诊断可能性。
Objective. To examine prospectively the accuracy of an initial diagnosis for fibromyalgia (FM).Methods. All patients newly referred for rheumatology consultation in a 6-month period were evaluated prospectively for either a preceding, current or subsequent diagnosis of FM. Clinical characteristics, previous and subsequent management and health care utilization were assessed. The final diagnosis at 6 months was verified and accuracy regarding the diagnosis of FM was assessed.Results. 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 were 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.Conclusion. There is a disturbing inaccuracy, mostly observed to be overdiagnosis, in the diagnosis of FM by referring physicians. 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.