Background/Purpose: In fibromyalgia (FMS), it is normal to expect people burdened with the uncertainty of unresolvable medical issues to face a certain amount of anxiety.  A high number of medical and anxiety symptoms are seen in FMS; however, the normal reaction hypothesis may not fully explain the linkage. Another possibility is that anxiety levels differ in FMS relative to other medical conditions and may even promote the progression of medical symptoms.  The purpose of this study is to determine if anxiety in FMS differs from other rheumatic disorders after adjusting for illness intensity.

Methods: The study was comprised of 191 patients seen in a rheumatologic practice.  Of these, 79 had FMS and 112 had Non-FMS rheumatic disease.  Diagnosis was based on ACR criteria.  The two samples were closely matched on age (FMS:  51.2 ± 12.0 vs. 51.9± 15.9); the FMS sample had slightly less education (FMS: 14.8 ± 2.1 vs. 15.5 ± 2.0).  The 0.7 year difference between means was significant (p <0.05).    

Patients were administered the 9-item Anxiety scale of the Profile of Mood States,  and the Symptom Review section of the 1999 American College of Rheumatology Patient Forms.  On the Anxiety scale,  participants rated the anxiety variables listed in Table 1 on a 5 point scale,  with 0= not at all and 4 = extremely.  The anxiety score is the sum of the ratings.  The system review is a symptom checklist covering 13 organ systems.  Illness intensity is the number of symptoms endorsed as significantly affecting the individual.

Results: The mean anxiety levels of patients on the 9 items are shown in Table 1. FMS patients scored higher on 8 of the 9 anxiety items.  As a whole, anxiety was significantly higher in FMS patients (12.7 ± 9.4 vs. 7.7 ±6.3; p<0.001).  The score of 7.7 in the non-FMS group is in the normal range of healthy individuals (normative mean: 8.2±6.0).  Illness intensity was also significantly higher in FMS participants (16.7± 11.8 vs. 8.7± 8.5: p <0.001). An analysis of covariance was used to subtract by statistics the effects of a higher number of medical symptoms on anxiety.  Difference in anxiety remained significant after the affects of the number of medical symptoms endorsed was removed (p<0.01).  

Conclusion: Results of the analysis of covariance essentially eliminates the greater number of medical problems in FMS as an explanation for the higher level of anxiety in FMS.  With symptom intensity eliminated, the results could be read as suggesting that patients with FMS are more anxiety prone than other rheumatic disease patients.

However, more needs to be learned about the source of higher anxiety in FMS, since competing explanations are present.  For example, the argument could be made that unexplained malfunctions of the body could in and of themselves be catalysts for excessive worry and higher levels of anxiety.  Undoubtedly patients with FMS have a greater number of medically unexplained problems.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anxiety-in-fibromyalgia-patients/