Injustice and low socioeconomic status impact fibromyalgia severity
Feelings of injustice and low socioeconomic status can have a significant impact on disease severity in patients with fibromyalgia, according to data from a large survey presented at the European League Against Rheumatism (EULAR) Annual Congress 2017 held recently in Madrid, Spain.
Among 4,516 French patients with fibromyalgia who took part in the web-based national survey, mean Fibromyalgia Impact Questionnaire (FIQ) global score was 51/100, indicating moderate disease severity. Feelings of injustice, underemployment and low income were found to have the most significant impact on patients’ FIQ global score. [EULAR 2017, abstract OP0274]
“An increase in FIQ global score indicates worsening fibromyalgia. In our study, feelings of injustice were associated with a 4.5-point increase in FIQ global score [p<0.001]. Low income of less than EUR 1,000 per month was associated with a 2.3-point increase in FIQ global score compared with a monthly income of EUR 3,000 [p<0.0001], while having a part-time job was associated with a 2.4-point increase in FIQ compared with full-time employment [p<0.0001],” reported Professor Françoise Laroche of the Saint Antoine University Hospital, Paris, France.
“Surprisingly, 77 percent of patients reported feelings of injustice, while 62 percent reported cognitive symptoms,” she continued. “In contrast, anxiety and depression were reported by 52 percent and 48 percent of patients, respectively.”
In the survey, 33 percent of patients reported having full-time work, while 22 percent were working part time. Sixty-five percent of patients had been on sick leave in the previous 12 months.
“Interestingly, none of the factors independently associated with sick leave were related to fibromyalgia symptoms,” noted Laroche. “Factors independently associated with sick leave included daily work travel time, work difficulties, obstructions in career development, sedentary occupation plus repetitive movement at work, as well as difficulty in recognizing fibromyalgia pathology by colleagues.”
The large web-based survey was conducted in 2014 by the Fibromyalgie-SOS Association, a national patient association in France. The survey questionnaire included 103 qualitative and quantitative questions developed by medical experts (including rheumatologists) and patients.
“Most fibromyalgia studies were performed at specialized centres and recruited patients with the most severe disease. Our survey was conducted to assess the real impact of fibromyalgia in daily life, and to determine patient clusters based on disease severity,” said Laroche.
Patients in the survey had a mean age of 48 years and were predominantly female (93 percent). Most patients had had fibromyalgia symptoms for 12 years and a diagnosis for 5 years. Diagnosis was made by a rheumatologist in 54 percent of the cases.
“For 47 percent of the patients, receiving a diagnosis was considered a relief,” said Laroche.
In most cases, treatment was provided by GPs (85 percent), physiotherapists (63 percent) and rheumatologists (54 percent), but 41 percent of patients also received osteopathy treatment. Medications were prescribed to 76.6 percent of patients and included antidepressants (81.5 percent), paracetamol and weak opioids (64 percent), antiepileptic agents (54.5 percent), NSAIDs (53.8 percent), and anxiolytics (52.4 percent).
Osteoarthritis was the most common somatic comorbidity and was reported by 49 percent of patients. Seventy-three percent of patients reported triggering events (psychological, 76 percent; physical, 50 percent), while 80–90 percent reported factors that aggravated their disease, including conflicts, excess activities, physical injuries, displacements and weather changes.