Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose : Recent advances in the definition of the fibromyalgia syndrome (FM) have led to the development of the polysymptomatic distress (PSD) scale, providing a quantitative measure of the PSD continuum and an alternative definition of fibromyalgia. We examined PSD and FM in the general population.
Methods: We studied a representative random sample of 2,322 subjects from the German general population between the ages of 20 and 90 years. Patients completed the widespread pain index (WPI) and measures of fatigue, somatic symptom intensity, depressed mood and the Short Form Health Survey SF-12, including physical function, bodily pain, and vitality. The effect of age was assessed with quantile regression at the 25th, 50th, 75th and 95th percentiles, and the mediated effect of age with 2-stage least squares (2SLS) instrumental variable regression.
Results : The PSD score was substantially skewed to the right with a mean and median of 5.3 (SD 4.6) and 3.8. All FM-related variable scores worsened with age and with increases in PSD. Age explained 11% of the variance of PSD, but the effect of age was mediated through bodily pain. In quantile regression of PSD on age, PSD increased 50% faster in patients in the 75th and 95th percentiles of PSD than the 50th percentile. Abnormal somatic symptom intensity scores and widespread pain appeared at the 80th percentile of PSD, cutpoints for somatization and depressive disorder at the 85th percentile, the WPI criterion for FM at the 90-95th percentile, and the PSD FM criteria and FM diagnosis at the 95th-100th percentile of PSD.
Conclusion: The PSD scale supports the hypothesis that FM represents the end of a continuum of distress. Age is causally associated with PSD and FM, but is mediated primarily by pain. The effect of age on PSD and fibromyalgia is greatest in persons with more than average PSD.
Table 1. Values of key covariates at percentiles of polysymptomatic distress (PSD).
|
Percentile
|
PSD
|
WPI
|
VAS Fatigue
|
SF12 PCS
|
SF12 PF
|
SF12 BP
|
Age
|
PHQ 15
|
PHQ 9
|
FMS (%)
|
WP (%)
|
|
>0-5 |
0.2 |
0.0 |
0.0 |
57.0 |
99.7 |
98.7 |
41.1 |
0.4 |
0.3 |
0.0 |
0.0 |
|
>5-20 |
1.1 |
0.1 |
0.9 |
56.1 |
98.7 |
97.7 |
40.8 |
0.7 |
0.9 |
0.0 |
0.0 |
|
>20-35 |
2.0 |
0.3 |
1.7 |
55.3 |
97.3 |
94.8 |
45.2 |
1.2 |
1.1 |
0.0 |
0.0 |
|
>35-40 |
2.9 |
0.8 |
2.2 |
54.1 |
95.3 |
92.6 |
45.3 |
2.1 |
2.0 |
0.0 |
0.0 |
|
>40-50 |
3.8 |
1.3 |
2.7 |
52.4 |
90.9 |
88.8 |
47.1 |
2.8 |
2.1 |
0.0 |
0.0 |
|
>50-55 |
4.7 |
1.8 |
3.2 |
52.6 |
92.5 |
87.7 |
49.8 |
3.0 |
2.4 |
0.0 |
0.0 |
|
>55-65 |
5.6 |
2.1 |
3.9 |
51.6 |
89.8 |
86.2 |
49.6 |
3.6 |
2.9 |
0.0 |
0.0 |
|
>-65-70 |
6.5 |
2.6 |
4.4 |
50.8 |
87.3 |
83.5 |
51.5 |
4.6 |
3.5 |
0.0 |
0.0 |
|
>70-75 |
7.4 |
3.1 |
4.9 |
48.5 |
77.7 |
75.0 |
54.0 |
4.6 |
4.1 |
0.0 |
0.0 |
|
>75-80 |
8.3 |
4.0 |
5.0 |
49.0 |
78.2 |
77.5 |
53.2 |
5.1
|
4.5 |
0.0 |
2.0
|
|
>80-85 |
9.2 |
4.9 |
5.1 |
44.8 |
68.6 |
67.9 |
59.3 |
6.3
|
5.2
|
0.0 |
11.4 |
|
>85-90 |
10.5 |
5.9 |
5.5 |
44.6 |
64.0 |
64.1 |
57.6 |
6.7 |
5.8 |
0.0 |
24.1 |
|
>90-95 |
12.9 |
7.9
|
6.2
|
42.2 |
57.6 |
56.1 |
60.6 |
8.3 |
6.6 |
0.0 |
53.4 |
|
>95-100 |
18.7
|
13.8 |
6.6 |
37.8 |
46.0 |
43.1 |
64.3 |
11.3 |
8.2 |
100.0
|
100.0 |
|
Mean |
5.2 |
2.5 |
3.0 |
51.6 |
86.8 |
84.7 |
48.9 |
3.4 |
2.8 |
4.2 |
8.8 |
|
Correlation With PSD |
1.0 |
0.91 |
0.78 |
0.63 |
0.61 |
0.64 |
0.35 |
0.75 |
0.61 |
|
|
Disclosure:
W. Häuser,
None;
F. Wolfe,
None;
J. Rasker,
None;
E. Brähler,
None;
H. Glaesmer,
None.
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