AB1632-HPR FIBROMYALGIA MANAGEMENT IN LATIN AMERICA: DATA FROM THE FIBROLATAM SURVEY
Authors: G. Maldonado, E. R. Soriano, C. Rios
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The management and evaluation of fibromyalgia (FM) is complex, the perception of the disease has been a debate within the medical community and patients. This group of authors created a survey (FibroLatam) and distributed to region in order to determine the various aspects of fibromyalgia management. <h3>Objectives:</h3> Analyze the approach to fibromyalgia management among rheumatologists practicing in Latin America. <h3>Methods:</h3> Prospective observational study that involves a creation of a 38-question survey to inquire about the perception of rheumatologist towards fibromyalgia. Survey was validated by rheumatologist of the region and validated in Spanish, English and Portuguese. PANLAR Research and Ethical Committee supported the project. The survey was sent in January 24th, 2023 through PANLAR communication department to all members. Data analysis was performed with SPSS v.29. <h3>Results:</h3> We received a total of 434 surveys, 55% male and 45% women with a mean average of 48.06±12.35 [27-80]. The majority was focused on adult rheumatology with 98.5% and 1.5% pediatrics rheumatology. FM was the reason of consult in ~26% of the cases. We inquire regarding non-pharmacologic approach, 46.5% considered the use of multimodal therapies (educational, psychological and exercise) very effective, and 39.5% of rheumatologist always recommended it. Behavioral health was recommended frequently and always, in 37.1% and 29.7%, respectively. Considering the pharmacologic therapies, the use of duloxetine was frequently recommended in 63.4%, pregabalin 62.7%, amitryptiline 38.2%, cyclobenzaprine 32.7% and milnacipram 0.9%. The most effective dose of pregabalin was considered to be 150mg daily in 49.3%. The use of opioids was reported as never 19.8%, infrequently 38.5%, sometimes 27.2% frequently on 12.7% and always in 1.8%; and 50.5% of rheumatologist considered that the use of opioids are not appropriate for the FM management. The most common opioids used were tramadol in 82%, followed by codein 29%, tapendalol 9%, buprenorphine 7.1%, oxycodone 2.8%, methadone 2.1 and morphine 1.4%. Approximately, 41.5% of the rheumatologists considered the use of tramador moderately effective, and 9.4% not at all effective. The use of cannabinoids was considered slightly effective in 14.7%, moderately in 23.5%, very effective 10.6%, and extremely effective in 1.8%; it was frequently recommended in 2.8%. Lastly, 26.7% of the rheumatologist report not having experience with the use of medicinal cannabinoids. <h3>Conclusion:</h3> Pregabalin and duloxetine are the drugs of choice for rheumatologists in the region, however the doses of pregabalin are usually low or subtherapeutic. The management of fibromyalgia in the region follows the recommendations of the currently available guidelines; prioritizing multimodal therapies and the use of duloxetine, amitriptyline pregabalin, cyclobenzaprine and to a lesser extent opioids. Most rheumatologists considered the use of opioids inappropriate. However, the use of medicinal cannabinoids was present less frequently, probably due to restrictions and because they are not included in current guidelines. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>