THE OVERDIAGNOSIS OF FIBROMYALGIA SYNDROME

PURPOSE: AS fibromyalgia syndrome (FM) has gained greater acceptance a nd awareness in both the medical and the lay community, the possibilit y of overdiagnosis exists. Diffuse body pain in a woman is likely to s uggest this diagnosis. We report the diagnosis of FM in 11 female pati ents whose primary cause for musculoskeletal symptoms was spondyloarth ritis rather than only FM. PATIENTS AND METHODS: Of a total of 321 new rheumatology referrals in a I-year period, 35 (11%) were diagnosed wi th FM. A further 11 (3%) were referred with either a previous diagnosi s of FM or a presumed diagnosis of FM in whom the musculoskeletal synd rome could be attributed to previously unrecognized spondyloarthropath y. RESULTS: The 11 female patients had mostly experienced musculoskele tal symptoms for prolonged periods of time ranging from 1 to 40 years. Symptoms included prominent spinal pain involving at least 2 location s in the spine (n = 10), night pain that disturbed sleep (n = 10), and prolonged morning stiffness (n = 9). A previous history of enthesopat hy, or history in the patient or first-degree relative of one of the s eronegative associated diseases, such as psoriasis or ulcerative colit is, occurred in nine patients. Most patients had already undergone ext ensive investigations by various specialists in musculoskeletal medici ne, but spondyloarthritis had only infrequently been considered a diag nostic possibility. CONCLUSION: Spondyloarthropathy in women may prese nt subtly and have considerable overlap in symptomatology with FM. A d iagnosis of spondyloarthropathy should be considered in women with an ill-defined pain syndrome with prominent spinal pain and associated en thesopathy, or history or family history of seronegative-associated di sease. It is possible that a primary diagnosis of FM is being made too freely, without consideration of other diagnoses, in the setting of i ll-defined musculoskeletal pain. (C) 1997 by Excerpta Medica, Inc.