Discord Found in Clinician-, Criteria-Based Fibromyalgia Diagnosis
THURSDAY, Feb. 7, 2019 -- There is disagreement between clinical diagnosis and criteria-based diagnosis of fibromyalgia, according to a study published online Feb. 6 in Arthritis Care & Research.
Frederick Wolfe, M.D., from the National Data Bank for Rheumatic Diseases in Wichita, Kansas, and colleagues examined possible diagnostic misclassification among fibromyalgia patients. During their ordinary medical visits, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology preliminary diagnostic criteria modified for self-administration.
The researchers found that 24.3 and 20.9 percent of patients satisfied the fibromyalgia criteria and received a clinician International Classification of Diseases diagnosis of fibromyalgia, respectively. There was 79.2 percent agreement between clinicians and criteria; agreement beyond chance was only fair (κ = 0.41). Physicians incorrectly identified 43 criteria-negative patients (11.4 percent) and failed to identify 60 criteria-positive patients (49.6 percent). The kappa value was 0.32 in a subset of 88 patients with rheumatoid arthritis, indicating slight to fair agreement. More abnormal MD-HAQ clinical scores were seen in association with higher polysymptomatic distress scores and criteria-based diagnosis. Compared with satisfying fibromyalgia criteria, the likelihood of receiving a clinician's diagnosis was higher for women and patients with more symptoms but fewer pain areas.
"It is likely that misdiagnosis is a public health problem and one that can lead to overdiagnosis and overtreatment, as well as to inappropriate treatment of individuals not recognized to have fibromyalgia symptoms," the authors write.
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Posted: February 2019