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National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Health Care and Aging Studies Branch
Arthritis Program
Mailstop K-51
4770 Buford Highway NE
Atlanta, GA 30341-3724
Phone: 770.488.5464
Fax: 770.488.5964
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Arthritis Types — Overview
Fibromyalgia
I. Background
- Fibromyalgia is a disorder of unknown etiology characterized by
widespread pain, abnormal pain processing, sleep disturbance,
fatigue and often psychological distress. People with fibromyalgia
may also have other symptoms; such as,
- Morning stiffness
- Tingling or numbness in hands and feet
- Headaches, including migraines
- Irritable bowel syndrome
- Problems with thinking and memory (sometimes called "fibro
fog")
- Painful menstrual periods and other pain syndromes
- The American College of Rheumatology (ACR) 1990 criteria are used for clinical diagnosis
classification. Diagnosis is based on the presence of widespread
pain (at least 3 months duration) and tenderness on 11 of 18
pressure points.
Full criteria.*
- May often co-occur (up to 25-65%) with other rheumatic
conditions such as rheumatoid arthritis (RA), systemic lupus
erythematosus (SLE), and ankylosing spondylitis (AS).
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II. Prevalence
- The prevalence of fibromyalgia is about 2%, affecting an
estimated 5.0 million adults in 2005. Prevalence was much higher
among women than men (3.4% versus 0.5%).1
- Most people with fibromysialgia are women (Female: Male ratio
7:1). However, men and children also can have the disorder.
- Most people are diagnosed during middle age and prevalence
increases with age.
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III. Incidence
NOTE: for the following sections using data based on ICD9-CM codes,
there is no specific single code for fibromyalgia. According to coding
rules, fibromyalgia is coded to 729.1 which is labeled “Myocitis and
Myalgia, unspecified” and can include other conditions. Thus, numbers
based on ICDM9-CM code 729.1 for mortality, ambulatory care and
hospitalizations may be overestimates.
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IV. Mortality
- ~23 deaths per year from 1979–1998. [Unpublished CDC data]
- Crude numbers of deaths coded as underlying cause-of-death
as 729.1 rose from 8 in 1979 to a high of 45 in 1997.
- In 1998,”Myositis and Myalgia, Unspecified” accounted for
only 0.45% (42/9367) of all deaths attributed to arthritis and
other rheumatic conditions.
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V. Hospitalizations
- In 1997, ~7,440 hospitalizations listed ICD9-CM code 729.1 as
the principal diagnosis.2
- People with fibromyalgia have approximately 1 hospitalization
every 3 years.3
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VI. Ambulatory Care
- 2.2 million ambulatory care visits.4
- 1.8 million Physician Office visits.
- 187,000 Outpatient Department visits.
- 266,000 Emergency Department visits.
- Medical and psychiatric co-morbidity are stronger determinants
of high physician use than functional co-morbidity among patients
with fibromyalgia.5
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VII. Costs
- Average yearly service utilization costs/person = $2,274.3
- Total annual costs (direct and indirect)/person = $5,945.6
- Medications, complimentary and alternative medicine and
diagnostic tests are the largest components of direct medical costs
among women with fibromyalgia.7
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VIII. Impact on health-related quality of life (HRQOL)
- Fibromyalgia patients scored lowest on 7 of 8 subscales (except
role-emotional) of the SF-36 compared to patients with other chronic
diseases.8,9
- Fibromyalgia patients scoring their perceived "present quality
of life" averaged a score of 4.8 (1 = low to 10 = highest).10
- Standard, generic HRQOL instruments may not be sensitive enough
to capture quality-of-life issues for many people with fibromyalgia.
- Adults with fibromyalgia are 3.4 times more likely to have major
depression than peers without fibromyalgia.11
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IX. Unique characteristics
- Causes and/or risk factors for fibromyalgia are unknown, but
some things have been loosely associated with disease onset:
- Stressful or traumatic events, such as car accidents, post
traumatic stress disorder (PTSD)
- Repetitive injuries
- Illness (e.g. viral infections)
- Certain diseases (i.e., SLE, RA, chronic fatigue syndrome)
- Genetic predisposition12,13
- People with fibromyalgia react strongly (abnormal pain
perception processing) to things that other people would not find
painful.
- Multidisciplinary treatment is recommended, including screening
and treatment for depression, although evidence is insufficient to
make global recommendations
- Aerobic exercise and anti-depressant therapy have scientific evidence for effectiveness in reducing disease symptoms.14
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X. References
- Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the
prevalence of arthritis and other rheumatic conditions in
the United States. Part II. Arthritis Rheum 2008;58(1):26–35.
- Lethbridge-Cejku M, Helmick CG, Popovic JR. Hospitalizations for
arthritis and other rheumatic conditions: Data from the 19976
National Hospital Discharge Survey. Medi Care
2003;41(12):1367–13673.
- Wolfe F, Anderson J, Harkness D, et al. A prospective,
longitudinal, multicenter study of service utilization and costs in
fibromyalgia. Arthritis Rheum 1997;40(9):1553–1555.
- Hootman JM, Helmick CG, Schappert S. Magnitude and
characteristics of arthritis and other rheumatic conditions on
ambulatory medical care visits, United States, 1997. Arthritis
Care Res 2002;47(6):571–581.
- Bernatsy S, Dobkin PL, DeCivita M, Penrod JR. Co-morbidity and
physician use in fibromyalgia. Swiss Med Wkly
2005;135(5-6):76–81.
- Robinson RL, Birnbaum HG, Morley MA, et al. Economic cost and
epidemiolgical characteristics of patients with fibromyalgia claims.
J Rheumatol 2003;30(6):1318–13125.
- Penrod JR, Bernatsky S, Adam V, Baron M, Dayan N, Dobkin PL.
Health services costs and their determinants in women with
fibromyalgia. J Rheumatol 2004;31(7):1391–1398.
- Picavet HSJ, Hoeymans N. Health related quality of life in
multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3
study. Ann Rheum Dis 2004;63:723–729.
- Schlenk EA, Aelen JA, Dunbar-Jacob J, et al. Health-related
quality of life in chronic disorders: A comparison across studies
using the MOS SF-36. Qual Life Res 1998;7(1):57–65.
- Bernard Al, Prince A, Edsall P. Quality of life issues for
fibromyalgia patients. Arthritis Care Res 2000;13(1):42–50.
- Patten SB, Beck CA, Kassam A, Williams JV, Barbui C, Metz LM.
Long-term medical conditions and major depression: strength of
association for specific conditions in the general population.
Can J Psychiatry 2005;50(4):195–202.
- Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB,
Starck LO, keck PE. Family study of fibromyalgia. Arthritis Rheum
2004;50(3):944-952.
- Neumann L, Buskila D. Epidemiology of fibromyalgia. Curr Pain
Headache Rep 2003;7(5):362–368.
- Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh
MJ, Hewett JE, Johnson JC. A meta-analysis of fibromyalgia treatment
interventions. Ann Behav Med 1999;21(2):180–191.
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XI. Resources
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* Links to non-Federal
organizations are provided solely as a service to our users. Links do not
constitute an endorsement of any organization by CDC or the Federal
Government, and none should be inferred. The CDC is not responsible for
the content of the individual organization Web pages found at this link.
Page last reviewed: June 8, 2008
Page last modified: January 11, 2008 Content Source:
Division of
Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
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