Frederick Wolf, MD, describes the diagnosis process as a “negotiation” between patient and physician.
This is especially true with fibromyalgia, he says, because there is no specific test that can be used to determine it. Depending on the outcome of these exchanges, those with the condition can be left frustrated and confused, not to mention abused.
“Fibromyalgia is a type of elective diagnosis,” notes Dr. Wolf, a semi-retired rheumatologist who heads the Forward: National Rheumatic Diseases Data Bank in Wichita, Kansas.
“There is no blood test for fibromyalgia. Diagnosis is based on patient self-report and doctor evaluation. You can go to your doctor and say you are anxious or depressed, you have pain in many places, and some doctors may diagnose you with depression or anxiety. Some doctors may say, ‘You have muscle pain.’” Weber,” while others might say, “You have arthritis,” says Wolf.
Another possible scenario, he adds, is that you could go to your doctor with classic symptoms of fibromyalgia and your doctor might suggest a number of tests for other conditions, which could lead to what seems like an endless cycle of appointments. This is because fibromyalgia symptoms mirror those of many other conditions.
Fibromyalgia presents a unique diagnostic challenge
Wolf has devoted much of his research work to exploring this dilemma, most recently A study published on February 6, 2019 in the journal Arthritis Care and Research, highlights the unique challenge posed by fibromyalgia. He and colleagues at Forward evaluated 497 people who had visited a rheumatology clinic and asked them to complete a health assessment questionnaire as well as a questionnaire based on Diagnostic criteria for fibromyalgia developed by the American College of Rheumatology (ACR). They were also evaluated by physicians in the clinic.
Of the 497 people who completed the questionnaires, 121 (24.3 percent) had fibromyalgia, based on the ACR criteria. But 104 (20.9 percent) have already been diagnosed with the condition by a doctor.
Overall, clinicians failed to correctly diagnose 60 (49.6 percent) of those who met the ACR criteria for fibromyalgia. They also incorrectly diagnosed 43 people (11.4 percent) even though they did not meet the ACR criteria.
According to Wolfe, these findings are supported by a larger analysis of 3,000 people who visited his team’s primary care practices. The latest study will be published later this year in the journal Arthritis care and research.
Unfortunately, he says, these studies don’t really explain any confusion surrounding fibromyalgia. They only add to the controversy surrounding the condition.
Discussion: Expert opinion? Or the classification criteria?
In fact, in a comment posted with Arthritis Care and Research study, Don L. Goldenberg, MD”The gold standard for diagnosing fibromyalgia will remain the opinion of a rheumatologist, not the classification criteria, no matter how refined and intentional,” he wrote, a rheumatologist and professor emeritus at Oregon Health & Science University in Portland.
Wolf says that while he respects Dr. Goldenberg as a physician, he strongly disagrees with him.
in related Blog postcompares Goldenberg’s argument to a statement made by former US Supreme Court Justice Potter Stewart, who once admitted that although he could not define pornography, he “would know when [he saw] He-she.” Wolff says that he and colleagues’ findings suggest that many clinicians don’t necessarily know fibromyalgia when they see it.
Patients and clinicians must be willing to negotiate for a correct diagnosis
“Fibromyalgia is not a clearly defined disorder,” he explains.
Which, he adds, means that those who may have the condition need to be prepared to negotiate when they visit their doctor.
He continues, “Doctors should not be too afraid of the idea of a diagnosis of fibromyalgia, and patients should be aware of the symptoms and ask their physicians, ‘What if I have fibromyalgia?'” “
It may be the only way to get an accurate diagnosis.
