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Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias
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PURPOSE: Multiple clinical and epidemiological studies have provided estimates of fibromyalgia prevalence and sex ratio, but different criteria sets and methodology, as well as bias, have led to widely varying (0.4%->11%) estimates of prevalence and female predominance (>90% to <61%). In general, studies have failed to distinguish Criteria based fibromyalgia (CritFM) from Clinical fibromyalgia (ClinFM). In the current study we compare CritFM with ClinFM to investigate gender and other biases in the diagnosis of fibromyalgia. METHODS: We used a rheumatic disease databank and 2016 fibromyalgia criteria to study prevalence and sex ratios in a selection biased sample of 1761 referred and diagnosed fibromyalgia patients and in an unbiased sample of 4342 patients with no diagnosis with respect to fibromyalgia. We compared diagnostic and clinical variables according to gender, and we reanalyzed a German population study (GPS) (n = 2435) using revised 2016 criteria for fibromyalgia. RESULTS: In the selection-biased sample of referred patients with fibromyalgia, more than 90% were women. However, when an unselected sample of rheumatoid arthritis (RA) patients was studied for the presence of fibromyalgia, women represented 58.7% of fibromyalgia cases. Women had slightly more symptoms than men, including generalized pain (36.8% vs. 32.4%), count of 37 symptoms (4.7 vs. 3.7) and mean polysymptomatic distress scores (10.2 vs. 8.2). We also found a linear relation between the probability of being females and fibromyalgia and fibromyalgia severity. Women in the GPS represented 59.2% of cases. DISCUSSION: The perception of fibromyalgia as almost exclusively (≥90%) a women's disorder is not supported by data in unbiased studies. Using validated self-report criteria and unbiased selection, the female proportion of fibromyalgia cases was ≤60% in the unbiased studies, and the observed CritFM prevalence of fibromyalgia in the GPS was ~2%. ClinFM is the public face of fibromyalgia, but is severely affected by selection and confirmation bias in the clinic and publications, underestimating men with fibromyalgia and overestimating women. We recommend the use of 2016 fibromyalgia criteria for clinical diagnosis and epidemiology because of its updated scoring and generalized pain requirement. Fibromyalgia and generalized pain positivity, widespread pain (WPI), symptom severity scale (SSS) and polysymptomatic distress (PSD) scale should always be reported.
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“Notably, the authors showed a greater impact of pain on male patients with FMS in terms of stronger experience and more catastrophizing thoughts about pain than in women with FMS.”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [55]
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“In a few studies, characteristics of FMS pain were investigated in both sexes, and a higher symptom load including more cases with generalized pain was reported in women than in men.38,55”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [55]
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“Earlier studies38,55 also showed high FIQ scores in male patients with FMS indicating a great impact on pain, which is in line with our results.”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [55]
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(1992) · PubMed · Cited by 33,716
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033
The american college of rheumatology 1990 criteria for the classification of fibromyalgia
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., Tugwell, P., Campbell, S. M., Abeles, M., Clark, P., et al. (1990) · Arthritis & Rheumatism · doi:10.1002/art.1780330203 · Cited by 9,563
Self-citationVandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040297 · Cited by 8,613
Confirmation Bias: A Ubiquitous Phenomenon in Many Guises
Nickerson, R. S. (1998) · Review of General Psychology · doi:10.1037/1089-2680.2.2.175 · Cited by 7,267
Wolfe, F., Clauw, D. J., Fitzcharles, M., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Winfield, J. B., & Yunus, M. B. (2010) · Arthritis Care & Research · doi:10.1002/acr.20140 · Cited by 3,952
Self-citationVandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010-w1 · Cited by 3,543
2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria
Wolfe, F., Clauw, D. J., Fitzcharles, M.-A., Goldenberg, D. L., Häuser, W., Katz, R. L., Mease, P. J., Russell, A. S., Russell, I. J., & Walitt, B. (2016) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2016.08.012 · Cited by 2,232
Self-citationWOLFE, F., CLAUW, D. J., FITZCHARLES, M.-A., GOLDENBERG, D. L., HÄUSER, W., KATZ, R. S., MEASE, P., RUSSELL, A. S., RUSSELL, I. J., & WINFIELD, J. B. (2011) · The Journal of Rheumatology · doi:10.3899/jrheum.100594 · Cited by 1,499
Self-citationThe dimensions of health outcomes: the health assessment questionnaire, disability and pain scales.
Fries, J. F., Spitz, P. W., & Young, D. Y. (1982) · PubMed · Cited by 1,312
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Items 301–347 of 347
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Garrido‐Cumbrera, M., Marzo‐Ortega, H., Correa-Fernández, J., Christen, L., & Navarro‐Compán, V. (2025) · Musculoskeletal Care · doi:10.1002/msc.70094
Myers, M., & Pugh, M. J. (2025) · Springer eBooks · doi:10.1007/978-3-031-87228-0_10
Percepción de dolor en la calidad de vida poblacional desde la psicología de la salud
Campo, E. S. (2025) · International Journal of Developmental and Educational Psychology Revista INFAD de psicología · doi:10.17060/ijodaep.2025.n1.v1.2845
Stevens, M., Locock, L., Doebl, S., Skea, Z. C., Dulake, D., Macfarlane, G. J., & Hollick, R. J. (2025) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2025.100577 · Cited by 1
Solouki, L., Sharini, H., Mohammadi, H., Jafari, S., & Mahaki, B. (2025) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2025.111561
Atenas-Núñez, E., Muñoz-Yánez, M. J., Lizama-Lefno, A., Roco-Videla, Á., Serrat, M., & Flores-Carrasco, S. V. (2025) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2025.103423
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Plata, I. C., Ortíz‐Rubio, A., Pérez-Gisbert, L., Torres‐Sánchez, I., Mateo, A. C., Valenza, M. C., & Ciuró, A. H. (2025) · Healthcare · doi:10.3390/healthcare13222948
Jetter, E. M., & Lucke-Wold, B. P. (2025) · World Journal of Clinical Cases · doi:10.12998/wjcc.v13.i31.109020
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Pontes-Silva, A., de Sousa, A. P., Dibai-Filho, A. V., de Souza, M. C., DeSantana, J. M., & Avila, M. A. (2023) · Figshare · doi:10.6084/m9.figshare.23354304
Pedauyé-Rueda, B., Cimadevilla-Fernández-Pola, E., Hussein, H., Ojedo‐Martín, C., Fernández-Aceñero, M. J., Hernández-Lougedo, J., Mayoral-Gonzalo, N., Hervás-Pérez, J. P., & Úbeda-D’Ocasar, E. (2025) · Diagnostics · doi:10.3390/diagnostics16010062
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Wittenkeller, L. M., Gudelsky, G. G., Winhusen, T. M., & Amato, D. (2026) · Research Square · doi:10.21203/rs.3.rs-8544354/v1
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Albay, S., Salar, S., & Ekici, G. (2026) · American Journal of Occupational Therapy · doi:10.5014/ajot.2026.051431
da Silva, M. A., & Wendt, G. W. (2026) · Brain Sciences · doi:10.3390/brainsci16040381
Toussaint, L. L., Skalski‐Bednarz, S. B., Peck, T. L., Montesó‐Curto, P., & Mohabbat, A. B. (2026) · Pastoral Psychology · doi:10.1007/s11089-026-01320-z
AlAujan, S. S., Almazrou, S. H., AlNahedh, H., AlFalih, L., & Alqahtani, A. (2026) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s578039
Allen, J., Göebel, A., & Fallon, N. B. (2026) · British Journal of Pain · doi:10.1177/20494637261447443
Ganesh, A. (2026) · Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine · doi:10.1177/13634593261446986
Cangelosi, M., Cavicchioli, M., Mesce, M., Torelli, A., Benfante, A., Romeo, A., Nimbi, F. M., Castelli, L., Ghiotto, N., Sances, G., et al. (2026) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.70304 · Cited by 1
Adamowicz, J. L., Lund, B. C., Garvin, L. A., Driscoll, M., & Hadlandsmyth, K. (2026) · Pain Medicine · doi:10.1093/pm/pnag069
Gajda, R., & Jeżewska-Zychowicz, M. (2026) · Nutrients · doi:10.3390/nu18132081
Microglial CX3CR1 signaling mediates stress-induced pain behavior in mice
Fülöp, B., Király, Á., Petrák, R., Müller, J., Biró-Sütő, T., Kormos, V., Tékus, V., Rozmer, K., Dénes, Á., Borbély, É., et al. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1869876
Tenti, M., Suzzi, B., Bugli, C., Albanesi, S. T., Lombardi, E., Lovecchio, L., Ghedini, C., & Raffaeli, W. (2026) · Medicina · doi:10.3390/medicina62071319
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Kaur, S. J., Breidenbach, C., & Üçeyler, N. (2026) · Der Schmerz · doi:10.1007/s00482-026-00957-2
Adler, L., Meyer, B., Betz, L. T., Häuser, W., & Knitza, J. (2026) · doi:10.2196/preprints.107347
Self-citationMounter, D., Rogerson, D., VIVO, M. D., & Thompson, S. W. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-116789
Kim, S.-A., Macfarlane, G. J., & Beasley, M. (2026) · Arthritis Care & Research · doi:10.1002/acr.80131
Jenssen, M. D. K., Fors, E. A., Berntsen, G., Fagerlund, A. J., Bellika, J. G., & Godtliebsen, F. (2026) · Applied Sciences · doi:10.3390/app16168209
Demir, İ., & Aktürk, S. (2026) · Adıyaman Üniversitesi Sağlık Bilimleri Dergisi · doi:10.30569/adiyamansaglik.1929467
Hung, K.-C., Chang, L.-C., Wang, K.-F., & Chen, I. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1889243
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Srinivasan, V. S. V., Lima, S., Mathis, V., & Yalçın, İ. (2026) · Neuromethods · doi:10.1007/978-1-0716-5312-8_14
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Contag, H., Kiselevskaya, V., Schuster, C. M., & Stearns, G. (2026) · Current Bladder Dysfunction Reports · doi:10.1007/s11884-026-00832-x
Resilience and Family Factors in Fibromyalgia: Associations with Disease Severity and Impact
Altuntaş, V., Şahin, Z. D., & Muluk, S. Y. (2026) · Archives of Current Medical Research · doi:10.47482/acmr.1776296
Arias-Álvarez, G., Gomez-Pulido, J. A., Guede-Rojas, F., Pecos‐Martín, D., Osorio-Torres, W., & Carvajal-Parodi, C. (2026) · Virtual Worlds · doi:10.3390/virtualworlds5040049
González-Lara, C., Camacho-Ruiz, J. A., Cortés‐Pérez, I., Obrero‐Gaitán, E., & Galvez-Sánchez, C. M. (2026) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2026.10308
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Attia, M. H., Maaz, I. B., Swanberg, S. M., & Franks, A. S. (2026) · Women · doi:10.3390/women6040068
Strenth, C. R., Jetpuri, Z., & Thakur, B. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.108043
Ouni, S., Ouni, F., & Chebbi, A. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.10.21.753755
Bruce, W. C., Sevalho, F. D. S., & de Fontes, P. A. D. S. (2026) · South American Sciences · doi:10.63330/sasciencesv6n2-264
Metadata
- Authors
- Wolfe, F., Walitt, B., Perrot, S., Rasker, J. J., & Häuser, W.
- Affiliations
- University of Kansas (US)
- Georgetown University (US)
- Hôpital Cochin (FR)
- University of Twente (NL)
- Klinikum Saarbrücken (DE)
- Corresponding author
- Wolfe, Frederick
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-09-13
- Volume
- 13
- Issue
- 9
- Pages
- e0203755
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6136749
- OpenAlex
- W2890457018
- Cited by
- 346
- References
- 51
- Citations by year
- 2026: 45 · 2025: 43 · 2024: 51 · 2023: 58 · 2022: 47 · 2021: 45 · 2020: 39 · 2019: 17 · 2018: 1
- FWCI
- 20.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/publicdomain/zero/1.0/ (vor)
- Locations
- PLoS ONE (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- University of Twente Research Information (submittedVersion, cc-by)
- 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
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- fibromyalgia, sex bias, prevalence, sex ratio, diagnostic criteria, selection bias, confirmation bias, gender differences, rheumatoid arthritis, pain symptoms
- MeSH terms
- Aged, Arthritis, Rheumatoid, Female, Fibromyalgia, Germany, Humans, Longitudinal Studies, Male, Middle Aged, Pain, Severity of Illness Index, Sex Factors, Prevalence, Databases, Factual, Self Report, Sexism
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