THU0644-HPR TRENDS IN DIAGNOSIS AND TREATMENT OF FIBROMYALGIA AMONG MEXICAN PHYSICIANS.
Authors: R. I. Arvizu-Rivera, N. Escobedo-Zuñiga, I. J. Colunga-Pedraza, A. Cárdenas, G. Serna-Peña
Journal: Annals of the Rheumatic Diseases (2020)

Background: Fibromyalgia (FM) is a disease characterized by widespread pain which affects 2-8% of the population. Previous studies have shown lack of awareness of classification criteria and accompanying symptoms of FM, as well as heterogeneity in the management of these patients among both rheumatologist and non-rheumatologist physicians. Objectives: The objective of this study was to explore the trends in diagnosis and management of fibromyalgia among general practitioners, family physicians, psychiatrists, neurologists and rheumatologists in northeastern Mexico Methods: We designed an online survey to yield data on perception of FM, knowledge of existing classification criteria including the ACR 1990, ACR 2010, ACR 2010 modified and AATP classification criteria, as well as pharmacologic and nonpharmacologic therapy for the treatment of FM. Participants should have finished their residence at least in 2019. General practitioners, family physicians, psychiatrists, neurologists and rheumatologists were included. Results: A total of 236 participants were included, most of the participants were general practitioners, 149 (59.3%). Other specialties included were rheumatologists 21 (8.9%), neurologists 18 (7.6%), psychiatrists 8 (3.4%), and family physicians 49 (20.8%). FM was considered a clinical entity by 208 (88.1%) participants. Participants’ characteristics are shown in Table 1. Twenty-eight (11.9%) participants didn’t know any classification criteria for FM, and 38 (16.1%) participants answered that they didn’t use any classification criteria to make a formal diagnosis of FM. The 1990 ACR classification criteria was used the most, 62 (26.3%); closely followed by the 2010 modified ACR classification criteria, 61 (25.8%). A total of 101 (42.8%) participants made a formal diagnosis of FM in the previous year and 179 (75.8%) referred the patient to another specialist. Most patients were referred to a rheumatologist, 126 (53.4%). One-hundred and fifty-eight (66.9%) participants believe rheumatologist should be the main care providers for patients with FM. Table 1. Participants’ characteristics. Variable Age, median (25p-75p) 33 (27-38) Women, n (%) 203 (86) Rheumatologists, n (%) 21 (8.9) General practitioners, n (%) 140 (59.3) Public practice, n (%) 113 (47.9) Public and private practice, n (%) 51 (21.6) &lt; 5 years of practice, n (%) 100 (42.4) &gt; 15 years of practice, n (%) 30 (12.7) Conclusion: A total of 88.1% of physicians know at least one classification criteria for the diagnosis of FM. In Mexico, rheumatologists are considered the main care providers for patients with FM. Regarding therapies with level 1A evidence for efficacy in the treatment of FM, only cognitive behavioral therapy and patient education were used by more than 50% of physicians. Serotonin-norepinephrine reuptake inhibitor and tricyclic antidepressants (both of which have level 1A evidence) were only used by 20.8 and 29.2%, respectively. References: [1]Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55. Table 2. Pharmacologic and non-pharmacologic treatment of fibromyalgia among physicians. Variable n (%) Exercise (any kind), n (%) 91 (38.6) Aerobic exercise (aerobic), n (%) 86 (36.4) Cognitive behavioral therapy, n (%) 127 (53.8) Patient education, n (%) 142 (60.2) Gabapentinoids, n (%) 107 (45.3) Tricyclic antidepressants, n (%) 69 (29.2) Selective serotonin reuptake inhibitors, n (%) 121 (51.3) Serotonin-norepinephrine reuptake inhibitor, n (%) 49 (20.8) Muscle relaxers, n (%) 85 (36) NSAID, n (%) 137 (58.1) Opioids, n (%) 27 (11.4) Mindfulness, n (%) 42 (17.8) Disclosure of Interests: None declared