Background Little is known about the impact and prognosis after establishing a diagnosis of fibromyalgia (FM). It is possible that acquiring a ‘FM-label’ may lead to increased illness behaviour, dependence on health care providers, and increased health care costs. On the other hand, a timely and definite diagnosis may lead to a better health related quality of life (HRQoL) and a reduction of health care costs. The fact that timing in diagnosis could be important was one of the reasons for conducting a randomized controlled trial (RCT) on referred patients with symptoms suggestive of FM, in which diagnostic visits performed by a specialized rheumatology nurse (SRN) within 3 weeks (‘early diagnosis’) after referral were compared with diagnostic visits performed by a rheumatologist (RMT) after a regular waiting period of approximately 3 months (‘regular diagnosis’)1.
Objectives To compare in a post-hoc analysis the 9 months prognosis of patients in whom a FM diagnosis was made with patients in whom another diagnosis was made (non-FM) with respect to health outcomes and health care costs and to investigate the effects of an ‘early’ versus a (‘regular’ diagnosis.
Methods All patients were participants in a RCT (n=193) on the feasibility of a nurse-led diagnostic process in making a FM diagnosis, and were referred to the rheumatology outpatient clinic with FM symptoms1. They were allocated to an ‘early’ diagnosis group, and seen by a supervised SRN within 3 weeks or to a (‘regular’ diagnosis group, and seen by a RMT within 3 months. Health outcomes, measured at baseline and after 9 months follow-up, were e.g. HRQoL and functional status. Costs were measured by 2-monthly questionnaires on medical consumption and productivity.
Results Of all patients, 82.4% (n=159) met the American College of Rheumatology criteria for FM and in 33 patients (17.1%) another diagnosis was made. FM patients had a longer duration of complaints (6.3 yrs vs. 4.2 yrs; P=0.029) and indicated more additional health problems (85.5% vs. 66.7%; P=0.01) than non-FM patients. Before the diagnosis was made, FM patients scored consistently worse than non-FM patients. Timing of diagnosis (early vs. regular) did not influence these results. During 9 months follow-up, FM patients showed a stable course in almost all health outcomes, while non-FM patients improved in these outcomes. FM patients created slightly more healthcare costs than non-FM patients (€1498 vs. €1315; Δ €-183, 95% CI €-613 to €255), but costs related to absenteeism from work were slightly higher in non-FM patients (€3031 vs. €3732; Δ €701, 95% CI €-2474 to €5226). An early diagnosis, however, importantly saved both health care and societal costs in non-FM patients (total societal costs early vs. regular diagnosis: €700 vs. €6425; Δ €5725, 95% CI €1985 to €10.988).
Conclusions Patients who got a FM diagnosis had far worse health outcomes at baseline and after 9 months follow-up than non-FM patients. For FM patients, timing of the diagnosis appeared little important.
Kroese M, Schulpen G, Bessems M, Severens J, Nijhuis F, Geusens P, et al. Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: a randomized controlled trial. Arthritis Care Res 2008;59:1299-1305.
Disclosure of Interest None Declared