ACR 2010: Fibromyalgia Not Associated with Increased Mortality Risk

Mortality is not increased in patients with fibromyalgia (FM), but the risk of death from accidents and suicides is increased in patients with this disorder. These data from a large observational study conducted in the US are consistent with a recent study by Dreyer L, Kendall S, Danneskold-Samsoe B, et al. published in Arthritis & Rheumatism reporting no increase in overall mortality but a markedly increased rate of suicide in female patients diagnosed with FM.

“Prior to 2010, mortality in FM patients was unknown. With the publication of the Dreyer study in 2010 [the first study to evaluate this risk], no overall risk of mortality was found but an increased risk of death from suicide, liver cirrhosis/biliary tract disease, and cardiovascular disease was reported in female FM patients ,” said Afton L. Hassett, MD, University of Michigan Medical School, Ann Arbor. Unlike the Dreyer et al. study, the present study did not find an increase in liver disease or cardiovascular disease.

Hassett was standing in for lead author Frederick Wolfe, MD, National Data Base (NDB) for Rheumatic Diseases, Wichita, KS, who was unable to attend the 2010 Annual Scientific Session of the American College of Rheumatology to present his findings.

There are several reasons why mortality might be increased in FM, Hassett told the audience. These include substantial use of painkillers and antidepressants, high levels of somatic symptoms, and high levels of depression.

The study included 8186 patients with FM seen over a period of 35 years in three settings: 1115 consecutive FM patients in a clinical practice; 3482 FM patients seen by US rheumatologists in the NDB longitudinal outcome study; and 3589 patients invited to participate in the NDB study who declined participation.

Standardized mortality ratios (SMRs) were calculated based on age and sex stratified US population data after adjusting for National Death Index non-response. Overall, 539 deaths were recorded, for an overall SMR of 0.90. Among the 1665 clinic patients, the SMR was 0.92; SMR in NDB-enrolled patients was .67; and SMR was 1.1 in non-enrolled patients.

More than 93% of patients were female, 93% were non-Hispanic white, 97% had medical insurance. Mean Body Mass Index (BMI) was 30, mean Health Assessment Questionnaire (HAQ) score range, (0-3) was 1.1; mean pain score (range, 0-10) was 6.4, and global disease severity (range, 0-10) was 5.5. Fibromyalgia was diagnosed according to 2010 ACR criteria in 67.4%; widespread pain was present in 81%.

Compared with the general population in the US, the causes of death that were increased in FM patients were accidents (7.1% versus 5% in the general US population), influenza/pneumonia (5% versus 2.3%, respectively), and septicemia (4.1% versus 1.4%, respectively), and intentional self harm (4.4% versus 1.4%, respectively. The Hazard Ratio for suicide among FM patents compared with the US general population was 3.3, he said.

Predictors for death were BMI >29, smoking, HAQ score, fatigue, pain, mood, and Short Form-36 in separate analyses adjusted for age and sex. “In general, ‘usual’ causes predict mortality in FM,” he stated.