Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Mortality in Fibromyalgia: An 8,186 Patient Study over 35 Years.
Wolfe1, Frederick, Hassett3, Afton L., Walitt4, Brian T., Michaud2, Kaleb D.
The issue of mortality in fibromyalgia (FM) is important because, if increased, it supports the seriousness of FM. One population based epidemiological study found that chronic widespread pain, effectively a criterion of the 1990 and 2010 ACR FM criteria, was associated with the risk of increased mortality, although that finding was not confirmed in another large population-based study. Reasons that mortality might be increased in fibromyalgia include substantial use of analgesics and anti-depressants, high levels of somatic symptoms, and high rates of depression. It seems possible that depression, socio-demographic characteristics or iatrogenesis could lead to increased mortality. The risk could also be increased if fibromyalgia is a representation of more extensive widespread pain or more severe symptoms. In this study we determined if mortality is increased among patients diagnosed with fibromyalgia.
We studied 8,186 fibromyalgia patients seen between 1974 and 2009 in 3 settings: all fibromyalgia patients in a clinical practice, patients participating in a longitudinal outcome study and patients invited to participate in the outcome study who refused participation. Internal controls included 12, 329 patients with osteoarthritis. Deaths were determined by multiple source communication, and all patients were also screened in the US National Death Index (NDI). We calculated standardized mortality ratios (SMR) based on age and sex stratified US population data, after adjustment for NDI non-response.
There were 539 deaths, and the overall SMR was 0.90 (95% CI 0.61, 1.26). Among 1,665 clinic patients the SMR was 0.92 (95% CI 0.81, 1.05). Sensitivity analyses varying the rate of NDI non-identification did not alter the non-association. Adjusted for age and sex, the hazard ratio for fibromyalgia compared with osteoarthritis was 1.05 (95% CI 0.94, 1.17). The standardized mortality odds ratio compared with the US general population was increased for suicide, OR 3.31 (2.15, 5.11), for accidental deaths, 1.45 (1.02, 2.06), pneumonia 1.69 (1.12, 2.57) and septicemia 2.49 (1.61, 3.68), but not for malignancy 0.95 (0.76, 1.18).
Deaths were predicted by BMI, smoking, HAQ, fatigue, pain, mood and SF-36 in separate analyses adjusted for age and sex.
Mortality does not appear to be increased in patients diagnosed with fibromyalgia, but the risk of death from suicide and accidents was increased. The data are consistent with an in submission Danish study that reported no increase in overall mortality or cancer, but an increase in suicides.
To cite this abstract, please use the following information:
Wolfe, Frederick, Hassett, Afton L., Walitt, Brian T., Michaud, Kaleb D.; Mortality in Fibromyalgia: An 8,186 Patient Study over 35 Years. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :651