Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals
Abstract
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.
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The tender point count was rarely performed in primary care where most fibromyalgia diagnoses occurred, and when performed, was performed incorrectly.
“the tender point count was rarely performed in primary care where most fibromyalgia diagnoses occurred, and when performed, was performed incorrectly (2)”
From The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity (2010) · cites this paper as [2]
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- Authors
- Fitzcharles, M.-A.
- Affiliations
- Montreal General Hospital (CA)
- Corresponding author
- Fitzcharles, M.-A.
- Venue
- Rheumatology
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-02-01
- Volume
- 42
- Issue
- 2
- Pages
- 263-267
- ISSN
- 0263-7103 (ISSN-L)
- 1460-2172
- OpenAlex
- W2013813107
- Cited by
- 153
- References
- 16
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 7 · 2020: 6 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 8 · 2014: 14 · 2013: 12 · 2012: 14
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British journal of rheumatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- fibromyalgia, diagnostic accuracy, overdiagnosis, rheumatology referral, tender points, fatigue, morning stiffness, health care utilization
- MeSH terms
- Adolescent, Adult, Aged, Clinical Competence, Diagnosis, Differential, Female, Fibromyalgia, Humans, Male, Middle Aged, Pain Measurement, Physical Examination, Prospective Studies, Quebec, Referral and Consultation, Rheumatic Diseases, Syndrome
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