Fibromyalgia: The Long and Winding Road

Key points
• The majority of patients with primary fibromyalgia continue to have symptoms that fluctuate for years and even decades after diagnosis.

• Even though most patients with fibromyalgia do not realize a cure per se, they may have long periods without symptoms.

• Physical activity helps with symptoms of fibromyalgia but does not often lead to complete remission.

Background
Primary fibromyalgia is characterized by a long fluctuating clinical course. Isomeri and colleagues¹ in Finland point out that long-term studies of the course and outcomes of primary fibromyalgia are not plentiful.

In limited long-term studies, it has been shown that while fibromyalgia symptoms often persist, remissions may be seen. Coping with pain seems to be the most common long-term strategy among patients with primary fibromyalgia.

The researchers sought to describe the outcomes of 28 patients with primary fibromyalgia over 26 years. Recently, they presented their findings in Clinical Rheumatology.

The study
Twenty-eight patients with primary fibromyalgia filled out structured questionnaires and were monitored prospectively for 26 years of follow-up.

The results
• 23% of patients reported symptomless periods of more than 1 year.

• 11% of those with symptomless periods stated that they were healed of their fibromyalgia.

• 48% of patients reported restless leg syndrome symptoms weekly.

• Of 21 fibromyalgia symptoms reported, the sum scores did not change significantly during follow-up (P = .75).

• At follow-up, patients reported less nighttime pain (P = .035), more abdominal irregularities (P = .035), and more sleeplessness (P = .0034).

• Common persistent symptoms included morning stiffness, weather-related symptoms, pain during movement, numbness and tightness in muscles, and general fatigue.

• 88% of subjects reported regular exercise, and 45% exercised at least 3 times a week.

• 31% of patients reduced their use of pain medication, while 8% stayed the same and 61% increased their use.

Implications for clinicians
• Counsel patients with fibromyalgia that symptoms may persist indefinitely but that symptom reduction and remission are possible for extended periods.

• Patients should expect fluctuations in their symptoms and talk to their health care providers about changes.

• Exercise is beneficial for patients with fibromyalgia to increase mobility and prevent comorbidities but is unlikely to lead to remission or cessation of the disease.

References:

1. Isomeri R, Mikkelsson M, Partinen M, Kauppi MJ. Severity of symptoms persists for decades in fibromyalgia-a 26-year follow-up study. Clin Rheumatol. 2018 Jan 9. doi: 10.1007/s10067-017-3967-0. [Epub ahead of print]