Fibromyalgia
Prevalence of Fibromyalgia: A Survey in Five European Countries

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Objective

A survey was performed in 5 European countries (France, Germany, Italy, Portugal, and Spain) to estimate the prevalence of fibromyalgia (FM) in the general population.

Methods

In each country, the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) was administered by telephone to a representative sample of the community over 15 years of age. A positive screen was defined as the following: (1) meeting the 4-pain criteria alone (LFESSQ-4), or (2) meeting both the 4-pain and the 2-fatigue criteria (LFESSQ-6). The questionnaire was also submitted to all outpatients referred to the 8 participating rheumatology clinics for 1 month. These patients were examined by a rheumatologist to confirm or exclude the FM diagnosis according to the 1990 American College of Rheumatology classification criteria. The prevalence of FM in the general population was estimated by applying the positive-predictive values to eligible community subjects (ie, positive screens).

Results

Among rheumatology outpatients, 46% screened positive for chronic widespread pain (LFESSQ-4), 32% for pain and fatigue (LFESSQ-6), and 14% were confirmed FM cases. In the whole general population, 13 and 6.7% screened positive for LFESSQ-4 and LFESSQ-6, respectively. 3The estimated overall prevalence of FM was 4.7% (95% CI: 4.0 to 5.3) and 2.9% (95% CI: 2.4 to 3.4), respectively, in the general population. The prevalence of FM was age- and sex-related and varied among countries.

Conclusion

FM appears to be a common condition in these 5 European countries, even if data derived from the most specific criteria set (LFESSQ-6) are considered.

Section snippets

Screening Questionnaire

The screening questionnaire used was the LFESSQ developed by the Department of Epidemiology and Biostatistics, Rheumatology Division of the University of London in Western Ontario (12). This 6-item questionnaire was designed with 4 items relating to widespread pain plus 2 items relating to fatigue (Table 1). According to White and coworkers (12), a positive screen was defined in 1 of the 2 following ways: (a) meeting the pain criteria alone (LFESSQ-4), or (b) meeting both the pain and the

Demographic Characteristics

The demographic characteristics of rheumatology outpatients (n = 1125) and representative community subjects (n = 4517) are presented in Table 2.

Regarding outpatients, their mean (SD) age was 56 (15) years, and 75% (95% CI: 72 to 77) were women. The proportion of women was significantly higher in France, Germany, and Portugal (81-85%) than in Italy and Spain (64-65%) and Spanish patients were the oldest. Compared with rheumatology outpatients, community subjects were significantly younger (45 ±

Discussion

To our knowledge, this is the first study that provides estimates of FM prevalence in the general population of 5 European countries using identical methodology. For this purpose, a screening questionnaire, the LFESSQ, was administered via telephone to national probabilistic samples of community subjects of more than 15 years old.

The sensitivity of LFESSQ-4 (widespread pain) and LFESSQ-6 (widespread pain and fatigue) criteria sets for FM (according to ACR criteria) were reported to be 100% (95%

Acknowledgments

Ten rheumatologists authored the present article. All participated in data collection in 8 rheumatology outpatient clinics for which they received financial support from Pierre Fabre. The Public Health, Quality of Life, Health Economics teams of Pierre Fabre provided technical assistance, material, and financial support for the survey performed in representative community samples.

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This work was supported by the Public Health Department of Pierre Fabre.

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