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Fibromyalgia

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Fibromylagia Abstracts Presented at the Annual Meeting American College of Rheumatology
and Association of Rheumatology Health Professionals October 18-22, 1996 - Orlando, Florida

386
FIBROMYALGIA IN SLE M. Petri, J. Steckroth, Johns Hopkins University, Baltimore, MD.
Past studies have suggested that fibrornyalgia (FM) is much more common in SLE than in the general population. We determined the prevalence of FM in a large cohort of SLE patients (pts) and associations with other clinical and laboratory variables. Patients/Methods: 169 SLE pts (93% female, 55% Afro-American, mean age 39.1 plus or minus 13.1 years) were examined for FM, defined using ACR criteria, by one observer. Clinical and laboratory variables were ascertained from a cumulative cohort database. Results: 29.6% had I I or more tender points (TP). The mean # of TP was 4.6 ± 5.8. Tender points increased with age (p= 0.002). Race and gender were not associated with the number of TP. Non-high school graduates had more TP (p = 0.03) as did pts with disability (p = 0.06). The following clinical variables were associated with TP. lack of livedo reticularis (p = 0.08), depression (p = 0.03), lack of anemia (p = 0.01), Sjogren's (p = 0.048), mouth ulcers (p = 0.07), and pancreatitis (p = 0.03). The following laboratoryvariables were associated with the number of TP: normal anti-DNA (p 0.08), normal C3 (p = 0.08), normal C4 (p = 0.006), normal ESR (p = 0.08). FM TP were not associated with myositis or prednisone use, but there was a borderline association with hydroxychloroquine use (p = 0.08).

Conclusion: Fibromyalgia in SLE is extremely common. It is strongly associated with the LACK of serologic or laboratory abnormalities. It does not appear to represent a subdinlical myositis or drug myopathy, although the borderline association with hydroxychloroquine use deserves further study.

387
A RANDOMIZED, CONTROLLED TRIAL OF EXERCISE AND EDUCATION IN FIBROMYALGIA. Susan Gowans, Susan Voss, Amy deHueck, and Mary Richardson, Physiotherapy and Occupational Therapy Departments, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada, M5G 2C4 & The Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.

Fibromyalgia affects 2 to 4% of the population and is associated with significant disability. Although exercise is the leading nonpharmacological treatment for fibromyalgia, evidence for the efficacy of exercise in this population is limited. This study evaluates the effect of an exercise and educational program for fibromyalgia, with 41 patients who met the American College of Rheumatology (1990) criteria for fibromyalgia. The 6 week program consisted of moderately-intense aquafit classes (30 min, 2 times/week) and multidisciplinary group education (2 times/week). The study was divided into 2 phases. In phase 1, subjects were randomly assigned to the fibromyalgia program (n=20) or became wafting list controls for 6 weeks (n=21). Subjects were assessed at baseline and 6 weeks. In phase 2, waiting list controls entered the 6 week program and were assessed post program. In addition, all subjects were assessed 3 or 6 months post program. Outcome was assessed with a 6 minute walk test, the Fibromyalgia Impact Questionnaire (FIQ), the Arthritis Self-Efficacy Scale and a questionnaire on knowledge of fibromyalgia management. The program produced immediate improvements (p < .05) in 6 min walk distance(326 m vs 412 m), knowledge, well-being (a FIQ subscale) and fatigue (another FIQ subscale). These measures were unchanged in waiting list controls. Immediate gains in 6 min walk distance, and well being were maintained at 3 or 6 month follow-up. Thus, short-term exercise and educational programs can improve physical function and a variety of psychometric measures in fibromyalgia. Further studies are in progress to determine the effect of exercise alone on physical function and mood.

394

COSTS INCURRED IN WOMEN WITH FIBROMYALGIA SYNDROME (FMS). Mary Ann Fitzcharles, Helen Assimakopoulos, Hanna Zowall, John M. Esdai1e. and Ann E. Clarke, McGill University, Montreal, Quebec, Canada H3A IA 1.

Background: FMS, one of the commonest reasons for consultation to a rheumatologist, may affect up to 2% of the population. The direct, i.e. all resources consumed in patient care, and indirect costs, i.e. wages loss due to lack of work force participation because of morbidity, have never been evaluated.

Aim: To determine the direct and indirect costs incurred by 82 consecutive FMS patients.

Patients & Methods: Patients reported their health services utilization and employment history over the preceding 6 months. Ambulatory costs included health care providers, diagnostic/laboratory procedures, and emergency room visits and were calculated using fully allocated costs, i.e. a method by which the resources of overhead hospital departments are assigned to the service centre. Indirect costs represent lost income for wage earners and domestic labour wages on days non-wage earners were unable to attend to household responsibilities.

Results: The mean total annual cost per patient, expressed in 1994 dollars, was $6098. Mean annual direct cost was $1435 ($1168 for health care providers, $173 for diagnostic/laboratory procedures, and $94 for emergency room visits). Mean annual indirect cost was $4663. On average, FMS patients made 18 visits to a physician annually, exceeding the known average by 3-fold. Patients had few hospitalizations (2) and outpatient surgeries (6).

Conclusiona The direct and indirect costs of FMS are substantial for both the individual and society.

The London Fibromyalgia Epidemiology Study: The Prevalence of Fibromyalgia (FMS) in London, Ontario. K. White, M. Speechley, M. Harth,T. Ostbve UWO, London, Ontario N6A 5A5

Objective: To estimate the prevalence of FMS among non institutionalized adult males (M) and females (F) in London.

Methods: A random-digit dialing telephone survey was undertaken to screen for chronic widespread pain and fatigue over the previous 3 months, randomly interviewing 1 adult per household, using a prevalidated screening instrument. Subjects with chronic widespread pain were examined by a rheumatologist at University Hospital to confirm or exclude FMS using the 1990 A.C.R. criteria. Results: We contacted 4674 eligible adults; 3395 (72.6%) agreed to be interviewed. Recalling the previous 3 months, 34.8% reported some musculoskeletal pain lasting at least I week, 6.5% chronic widespread pain, 54.5% frequent fatigue, and 21.5% frequent fatigue that significantly limited activities. Of 221 with widespread chronic pain, 176 (79.6%) agreed to be examined. FMS was confirmed in 100 (86 F), who had a mean age of 47.8 years (C.I. 45.0, 50.6). The age-adjusted overall point prevalence of FMS was 4.2% in F and 1.1% In M, for a F:M prevalence ratio of 3.8:1. In both sexes, prevalence steadily increased with age until age 64, peaking at 8.9% in F age 50-64, and at 2.1% in M age 50-64. In both sexes, prevalence decreased sharply after age 64; no M cases over age 64 were identified.

PREVALENCE OF FMS (with 95% confidence intervals [CI])

Age Males Females Combined
8-34 1.1% (0.8, 1.5) 1.5% (1.3, 1.8) 1.3% (1.2, 1.5)
35-49 1.1% (0.6, 1.7) 5.4% (5.1, 5.7) 3.7% (3.5, 3.9)
50-64 2.1% (1.3, 3.4) 8.9% (8.3, 9.5) 6.3% (5.9, 6.7)
65+ 0.0% (0.0, 2.0) 3.6% (3.1, 4.2) 2.6% (2.2, 3.0)
TOTAL 1.1% (0.9, 1.2) 4.2% (4.1, 4.3) 2.7% (2.6, 2.8)

VERY HIGH RATES OF SERVICE UTILIZATION IN FIBROMYALGIA PRE AND
POST DIAGNOSIS. F Wolfe, RM Bennett, X Caro, DL Goldenberg, IJ Russell & MB Yunus. Wichita, Portland, Los Angeles, Boston, San Antonio and Peoria, USA.

It is suspected that utilization of services (UOS) may be increased in fibromyalgia (FIB), be that utilization may fall post diagnosis. Yet almost no data are available. Over a 7 year period we monitored UOS for 1190 fibromyalgia patients from 7 centers by a mailed questionnaire administered at 6 month intervals. Participant number varied by center, and data were inversely weighted by center N so that each center contributed equally to the study results. Data are average utilization over the study period, and reflect utilization after diagnosis by the rheumatology center.

Patients averaged 11.4 outpatient medical visits per year of which 1.9 were to rheumatologists. In addition, there were 2.9 non-traditional medical visits, 1.5 imaging procedures, 3 laboratory tests, and 0.35 hospitalizations per year. 23.2% of hospitalizations were for pain and neuro-musculo-skeletal reasons. The next common causes were GU (11.3%). GI (11.2%), CV (8.6%) and depression (5%). At the Wichita center where a comparison rheumatic disease population was available (N=9,822) lifetime rates of surgical procedures were increased compared to RD controls: odds ratios & 95% CI for back or neck surgery 2.9 (2.3, 3.7), appendectomy 2.7 (1.6, 4.5), carpal tunnel 2.6 (1.5, 4.5), bladder 1.9 (1.5. 2.6), abdominal 1.7 (1.6, 1.9), and tonsillectomy (1.3 (I.2, 1.5).

At study end. 57.8% were taking NSAIDS, 19.2% ASA. and 28.9% acetaminophen. .4% were on narcotics, but for an average of 1.1 months out of the last 6 months. GI medications were used by 22%, tri-cyclics by 35.9%, S2 blockers by 12.8%. Reported lifetime comorbid conditions included depression 55.9%, GI disease 55.9%, GU 53.7%, severe allergies 48.8%, hypertension 39.0%. These data indicate very high rates of current and lifetime utilization of services by fibromyalgia patients, and that utilization continues after diagnosis.