Background/Purpose: Fibromyalgia is a chronic pain disorder characterized by widespread pain, fatigue, sleep disturbances, cognitive dysfunction and frequent psychiatric comorbidities. Estimated prevalence of fibromyalgia is 1-5%, with an estimated female to male ratio of 3-6:1. The influence of gender on epidemiologic and clinical characteristics as well as on therapeutic strategies of fibromyalgia patients is still incompletely understood. In the current study, we aimed to describe the clinical and epidemiologic profile of male compared with female fibromyalgia patients, in a real-word cohort.

Methods: We conducted a retrospective cross-sectional observational study, including all patients diagnosed with fibromyalgia in the electronic medical record database of a tertiary hospital during the period 2010-2021. Patient files were subsequently screened individually, and data was collected, including sociodemographic characteristics, medical and psychiatric diagnoses, and treatment regimens, including use of medical cannabis.

Results: Altogether, we found 3044 patients diagnosed with fibromyalgia, 401of them were male (13.2%). Most of the patients (84%) were followed up at the Rheumatology Institute and 16% at the Pain Clinic. We subsequently created a random cohort of 438 female patients and compared it to the male cohort. The mean age of female patients was significantly higher than that of males (52.7 years versus 44.9, p< 0.001). Obesity was significantly more prevalent among female patients than among male patients (16% versus 9.2% respectively, p= 0.003), whereas Obstructive Sleep Apnea Syndrome was more prevalent in males (6.7% versus 1.8%, p< 0.001). Male patients had a significantly higher prevalence of Post-Traumatic Stress Disorder (PTSD) compared with females (14% versus 5.7%, p< 0.001). No significant differences were observed in other psychiatric comorbidities such as depression and anxiety. Only three male patients had a documented diagnosis of erectile dysfunction. Females were more frequently treated by Amitriptyline and Tramadol. There were no differences in the use of Pregabalin or Duloxetine between males and females. Almost half of the male patients (48%) were treated with medical cannabis compared with 34.6% of females (p< 0.001). A significant correlation was observed between a diagnosis of PTSD and the use of medical cannabis in both genders.

Conclusion: Significant clinical gender-specific characteristics were observed in our real-world cohort of fibromyalgia patients.

PTSD and use of medical cannabis appeared to be significantly more common among male patients while obesity was more common among females. Further research into the clinical and pathogenetic mechanisms underlying these differences are warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gender-related-clinical-profile-of-fibromyalgia-patients/