A Survey of Ontario Rheumatologists on Fibromyalgia

This week, a study was released in the Journal of Clinical Rheumatology entitled "Should rheumatologists retain ownership of fibromyalgia?  A survey of Ontario rheumatologists".  

As background, the American College of Rheumatology developed a definition of fibromyalgia in 1990, bringing fibromyalgia into the rheumatology orbit.  However, there is a debate underway within the rheumatology community about whether fibromyalgia really belongs under rheumatology.  A comment was published in the Journal of Rheumatology in 2009 which stated:

"The time is ripe for rheumatologists to consider abrogating care of these patients for these reasons: the pathogenesis of FM is now firmly centered in the nervous system, and FM is not a musculoskeletal complaint. Optimal patient management requires attention to the many symptom components of FM in addition to pain management. Patients with FM will also require prolonged care with continued tailoring of treatments, as symptoms are likely to change over time. Finally, as 2% to 4% of the population suffers from FM, it would be unrealistic to require that all or most of these patients be evaluated or followed by rheumatologists."

In the current study, the authors invited all 150 rheumatologists in Ontario to participate in an on-line survey.  Eighty of them did so.  Of those responding, 71% said that rheumatologists should not retain ownership of fibromyalgia, while 89% said that the family physician should be the main care provider for these patients.  Though we are not sure what the seventy rheumatologists who did not respond would have said, the findings suggest that there is a reasonable level of support among rheumatologists for withdrawing from the fibromyalgia area.  And if these are the feelings of Ontario rheumatologists, these are very possibly the feelings of rheumatologists in other province and states as well.  

These survey findings are not a particular surprise.  We already recognized the ambivalence within the system.  In many ways, we welcome the fact that the issues are now on the table. However, this also means that we could be entering a critical time of change in the health care system for fibromyalgia patients.  The Canadian Community Health Survey made it clear that Fibromyalgia patients already have a high level of unmet needs.  We certainly do not want to see existing services withdrawn without new services to replace them.  
There is a need to address  the concerns of the rheumatologists, but any dialogue must first and foremost address the concerns of patients.  

Abstract of current study:  http://www.ncbi.nlm.nih.gov/pubmed/22547393
For full article, follow the link in upper right corner, 34.95$US.
Comment from Journal of Rheumatology:  http://jrheum.org/content/36/4/667.full

Margaret Parlor
President
National ME/FM Action Network
www.mefmaction.com