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A Study of Standard Care in Fibromyalgia Syndrome: A Favorable Outcome
MARY-ANN FITZCHARLES, DEBORAH Da COSTA, and REINO PÖYHIÄ
ABSTRACT. Methods. Eighty-two women with clinical FM were evaluated at baseline and 70 were followed for a mean of 40 months. Patients continued their usual management for FM as prescribed by their own physicians. The primary outcome variable was patient's overall status compared to baseline on a 7 point Likert scale (range 1 = much worse, 7 = much better). Secondary outcome measures included measurements for pain, fatigue, and patient and physician global assessment on a visual analog scale. Additional functional measures were the disease-specific Fibromyalgia Impact Questionnaire (FIQ), and the generic Health Assessment Questionnaire (HAQ). Results. Of 70 (85%) patients who were followed up at 3 years, 33 (47%) reported overall moderate to marked improvement, and the remaining 53% reported either slight improvement, no change, or deterioration. The improved group (n = 33) compared to those that remained the same or worsened (n = 37) showed significant differences for change of score from baseline for tender point count, patient global assessment, sleep disturbance, fatigue, pain, FIQ and HAQ, and were younger, 46 versus 51 years. No other baseline demographic or disease variables discriminated between the 2 groups. The only baseline predictors for a favorable outcome were younger age and less sleep disturbance. Conclusion. The overall outcome in this group was favorable, with almost half the sample reporting clinically meaningful improvement in overall FM status. These findings are discussed in terms of their implications regarding current theory on the pathogenesis of FM. (J Rheumatol 2003;30:154-9) Key Indexing Terms:
FIBROMYALGIA
From the Division of Rheumatology, the Division of Clinical Epidemiology, and the McGill-MGH Pain Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada; and the Department of Anaesthesia, University of Helsinki, Helsinki, Finland. Dr. Pöyhiä was supported by a grant from the Canadian Pain Society (Ronald Melzack Award), the Canadian Anaesthetists' Society, and Astra. M-A. Fitzcharles, MB, ChB, FRCPC, Associate Professor, Division of Rheumatology and McGill-MGH Pain Centre; D. Da Costa, PhD, Assistant Professor, Department of Medicine, McGill University; R. Pöyhiä, MD, PhD, Visiting Assistant Professor, McGill-MGH Pain Centre, Staff Anaesthesiologist, Department of Anaesthesia, University of Helsinki. Address reprint requests to Dr. M-A. Fitzcharles, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca Submitted January 4, 2002; revision accepted July 17, 2002.
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