Fibromyalgia Diagnosis Linked to All-Cause Mortality

Patients with fibromyalgia should be screened for suicidal ideation, the prevention and treatment of infections, and accident prevention, according to a study published in Rheumatic and Musculoskeletal Diseases.¹

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As fibromyalgia often coexists with other health issues, such as neurologic, mental health disorders, and rheumatic diseases, patients with fibromyalgia often experience increased mortality. Previous research has also linked widespread pain with increased mortality rates for all-cause mortality.²

“To date there is no consensus as to whether fibromyalgia is associated with increased mortality,” explained Yulia Treister-Goltzman, PhD, Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, and colleagues. “This is the first study to address the question of excess mortality among patients with clinical fibromyalgia.”

A systematic review of literature was conducted using a search of Web of Science, Scopus, and PubMed electronic databases in August 2022. Results were pooled in a meta-analysis.

Eligible studies were ones that assessed the associations between the two and provided an effect measure, such as a hazard ration (HR), standardized mortality ratio (SMR), or odds ratio (OR), which quantified the relationship between fibromyalgia and mortality. Risk of bias was assessed using the Newcastle-Ottawa scale.

Of the 557 studies identified, of which 150 were duplications. Ultimately, 8 studies were included in the review, all of which were published between 1999 and 2021. Three of these studies had a follow-up period between 16 and 31 years. The total fibromyalgia cohort included 188,751 patients.

Ultimately, an increased HR was observed for all-cause mortality (HR 1.27, 95% confidence interval [CI] 1.04 to 1.51), although it was not seen in patients diagnosed by the 1990 criteria. A borderline increased SMR for accidents (SMR 1.95, 95% CI .97 to 3.92) and an increased risk for mortality from infections (SMR 1.66, 95% CI 1.15 to 2.38) and suicide (SMR 3.37, 95% CI 1.52 to 7.50) was reported in this patient population. However, a decreased mortality rate for cancer was observed (SMR .82, 95% CI .69 to .97). Pooled SMRs for chronic lower respiratory, chronic liver, cerebrovascular, and heart diseases were not statistically significant between studies.

All included studies showed significant heterogeneity. According to the Newcastle-Ottawa risk of bias assessment, all 8 studies were categorized as good quality.

Investigators noted the systematic search of literature used to identify applicable studies, all of which were good quality with a large number of patients, as a strength of the analysis. Additionally, all-cause mortality coupled with specific causes of mortality were included in the analysis.

However, the inclusion of patients with fibromyalgia using different definitions of diagnosis criteria may have limited the study. On the other hand, these studies may be more representative of a real-life population of patients, including patients with both primary and secondary types of fibromyalgia. The study did not evaluate whether the disease itself, or the degree of comorbidity, was linked to mortality. Future research addressing this aspect is critical. An additional limitation was the small number of studies determining each cause of mortality.

“Studies have shown that medical staff are reluctant to accept fibromyalgia as a medical condition, and they face emotional and psychological difficulties interacting with these patients and coping with their disorder,” investigators concluded. “Fibromyalgia is often called an ‘imaginary condition’, with ongoing debates on the legitimacy and clinical usefulness of this diagnosis. Our review provides further proof that fibromyalgia patients should be taken seriously, with particular focus on screening for suicidal ideation, prevention of accidents, and prevention and treatment of infections.”

References

1. ^{Treister-Goltzman, Y., & Peleg, R. (2023). Fibromyalgia and mortality: a systematic review and meta-analysis. Rheumatic & Musculoskeletal Diseases. https://doi.org/10.1136/rmdopen-2023-003005}
2. ^{Wolfe F, Ablin J, Guymer EK, et al. The relation of physical comorbidity and multimorbidity to fibromyalgia, widespread pain, and fibromyalgia-related variables. J Rheumatol 2020;47:624–31.}