AMSTERDAM — The diagnosis of fibromyalgia is not followed by a surge in physician office visits, according to Dr. Ernest H.S. Choy, speaking at the annual European Congress of Rheumatology.
A recent study using data from the U.K. General Practice Research Database, led by Dr. Simon Wessely, a King's College psychiatrist, compared health care utilization from 10 years before through 4 years after diagnosis of fibromyalgia in 2,260 patients and a group of age- and gender-matched controls, said Dr. Choy, of King's College London.
The investigators found that the rates of office visits, prescriptions, and medical tests were markedly higher and rising in the years prior to diagnosis in fibromyalgia patients, compared with control patients.
In the year prior to diagnosis, patients averaged 25 office visits and received 11 prescriptions, compared with 12 office visits and 4.5 prescriptions during the same year for controls. The most common reason for prediagnosis office visits by fibromyalgia patients was depression, followed by fatigue, chest pain, headache, and disrupted sleep.
Diagnosis of fibromyalgia was not followed by a surge in illness behavior and health care utilization. In fact, health care utilization declined for 2–3 years following the diagnosis before climbing back up, probably because the patients were not getting effective treatment, according to the investigators (Arthritis Rheum. 2006;54:177–83).
“Patients demand less tests and have less consultations after the diagnosis is made,” Dr. Choy commented.
Fibromyalgia is a high-cost medical condition, he noted. A classic University of Kansas 7-year prospective study determined that the mean annual per-patient cost was $2,274 in 1996 dollars. “These patients are consuming a vast amount of health care resources,” he said at the congress sponsored by the European League Against Rheumatism (EULAR).
Another recent large observational study undercuts claims that fibromyalgia is simply part of a single larger, ill-defined somatization disorder that also includes conditions like chronic fatigue syndrome, irritable bowel syndrome, and regional pain disorders. This study involved 18,122 U.K. patients diagnosed by their primary care physician as having a fatigue syndrome during 1988–2001.
The key finding was that outcomes differed significantly for patients with various diagnostic labels, being best for those with postviral fatigue syndrome, worst for myalgic encephalomyelitis and chronic fatigue syndrome, and intermediate for those with fibromyalgia (Fam. Pract. 2005;22:383–8).
'Patients demand less tests and have less consultations after the diagnosis is made.' DR. CHOY