Background/Purpose – Fibromyalgia (FM) is a chronic debilitating disorder considered to be part of a spectrum of central sensitization syndromes. The diagnosis of FM is a complex one, affected by many different factors including stigmatization of the disease, confounders such as comorbidities and different characteristics of patient and doctor.

Aim  Investigating the time passing from initial complaints till final diagnosis by an expert rheumatologist, and delineating the patient and physician characteristics affecting that time, using the comprehensive database of a large HMO in Israel.

Methods

Using a retrospective database search we identified patients diagnosed with FM by a rheumatologist or at release from hospitalization during (“confirmed FM patients”), and sex and age matched FM-free enrollees. Different complaint patterns were tested, to ascertain time of initial complaints. The pattern with the best combination of sensitivity and specificity was applied on an FM population of all patients diagnosed by a primary physician, rheumatologist, or at release from hospitalization, during the same period (“primary physician population”). Patient and primary physician factors associated with time between initial complaints and FM diagnosis were assessed. A multilevel generalized mixed linear model with a log-linked gamma distribution was used to account for clustering of patients associated with the same primary physician

Results Our study included 4,603 “confirmed FM patients”, of whom 90.8% were women, with a mean age of 50.63 years (±11.37). The complaint pattern chosen, as time of initial complaints, comprised of  >= 4 complaints within 6 months. This pattern was found in 73.2% (1,944/2,656) of the “confirmed FM patients”, 18.4% (1,685/9,173) of the FM-free patients. Applying this pattern on the primary physician population, revealed a mean time  to diagnosis of  4.7±3.6 years. Within this time, the mean (SD) time that FMS patients were associated with the “physician at diagnosis” was 2.9±2.8. The patient factors most significantly associated with a longer time to diagnosis, were older age, female gender and low socioeconomic status. The physician characteristics most significantly associated with a longer time to diagnosis were older age, internal or general specialty vs. family specialty, and physician’s medical studies in West vs. East Europe.

Conclusion  The time to diagnosis of FM is significantly influenced by patients a and physician characteristics. This knowledge can contribute to future research and to better planning of physician education, concerning this disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/understanding-the-factors-influencing-time-to-diagnosis-in-fibromyalgia/