Fibromyalgia is a chronic disease characterized by widespread musculoskeletal pain and tenderness at specific points in the body. In addition to pain, common symptoms include persistent fatigue, sleep disturbances, cognitive difficulties, and emotional problems. Now, a pooled data analysis of the available evidence warns that fibromyalgia may be related to an increased risk of death, as a result of vulnerability to accidents, infections and, especially, suicide, according to the conclusions published in the journal RMD Open.
These worrisome findings have led researchers to request that these patients follow regular monitoring of their physical and mental health to minimize these risks as much as possible.
Although the cause of fibromyalgia is unclear, its prevalence continues to rise, and mounting evidence recognizes that this debilitating condition often coexists with other health problems, including rheumatic, intestinal, neurological, and mental health disorders.
Until now, some studies have suggested that people with fibromyalgia may be more likely to have additional medical comorbidities that can increase the risk of serious complications or death, from mood disorders such as depression and anxiety, as well as illnesses chronic diseases such as cardiovascular diseases, diabetes, autoimmune diseases and irritable bowel syndrome, among others.
This new meta-analysis suggests that given the magnitude of the pain they experience and the likelihood of other painful and debilitating conditions in these patients, it is thought that they are probably running a increased risk of dying prematurely.
To strengthen this hypothesis, the researchers reviewed the findings of 8 relevant studies, published between 1999 and 2020, out of an initial total of 33. They combined the results of 6 of them, involving a total of 188,751 adults, all of whom had other coexisting conditions. .
The analysis showed that fibromyalgia was associated with a 27% increased risk of death from all causes over time, although this was not true for people diagnosed using the 1990 criteria.
But diagnostic criteria for fibromyalgia have evolved since 1990 along with a greater understanding of the range of clinical symptoms associated with the condition, and were revised accordingly in 2010, 2011 and 2016, the researchers note.
Specifically, the analysis showed that the risk of death from cancer was 12% lower than for the general population of the same age, and only marginally higher (5%) for accidents. But it was 44% higher for infections, including pneumonia and sepsis, and more than 3 times higher for suicide.
Whether this increased risk is due to fibromyalgia itself or co-occurring conditions is unclear, the researchers note, as their research was not designed to assess this. But this is an important issue, they stress, that needs to be addressed in future research.
And they caution that their findings should be interpreted in light of the different designs and small numbers of participants in the studies included in their analysis. “Due to significant heterogeneity between the studies, which were also small in number, no clear conclusions can be drawn from the available data,” they write. “However, it is possible that for the subgroup of patients diagnosed by the 1990 criteria there is no increased risk of mortality, and for those diagnosed by later versions the risk is greater,” they add.
And there are plausible explanations for their findings, they suggest. “The finding of increased accident-associated mortality may be due to the fatigue, unrefreshing sleep, and concentration difficulties that accompany fibromyalgia, and have been a component of its diagnostic criteria since 2010.
“Increasing evidence supports the involvement of the immune system and inflammation in the pathophysiology of fibromyalgia, which may explain the finding of increased mortality from infections. Physical comorbidity may be an additional explanation.” And the reduced risk of death from cancer may be due to the extensive use of health services by these patients, they add.
The risks identified in their analysis “could represent a serious public health problem, given the high prevalence of the condition,” which doctors don’t always take seriously, they note. “Studies have shown that medical personnel are reluctant to accept fibromyalgia as a medical condition and face emotional and psychological difficulties in interacting with these patients and coping with their disorder,” they point out.
“Fibromyalgia is often called an ‘imaginary condition,’ with ongoing debates about the legitimacy and clinical utility of this diagnosis. Our review provides further evidence that fibromyalgia patients should be taken seriously, with a particular focus on detection of suicidal ideation, accident prevention, and infection prevention and treatment.”
Fuente: The BMJ