Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnoses and functional disability.
OBJECTIVE
Recent studies of the relationship between fibromyalgia and psychiatric disorders have yielded conflicting findings, and many of these inconsistencies seem to result from methodological differences.


METHODS
We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis from a tertiary care clinic using physician-administered, structured psychiatric interviews and self-reported measures of illness appraisal, coping, and functional disability.


RESULTS
Patients with fibromyalgia had significantly higher lifetime prevalence rates of mood and anxiety disorders, as well as higher mean numbers of medically unexplained physical symptoms across several organ systems. Ninety percent of the patients with fibromyalgia had a prior psychiatric diagnosis compared with less than half of the patients with rheumatoid arthritis.


CONCLUSIONS
Despite the absence of organic pathology, the patients with fibromyalgia had equal or greater functional disability and were less well adapted to their illness. Although the pathophysiology of fibromyalgia remains unclear, co-morbid psychiatric disorders and functional disability remain an important focus of treatment in this population.
Walker
E A
EA
Department of Psychiatry, University of Washington, Seattle 98195, USA. edwalker@u.washington.edu
Keegan
D
D
Gardner
G
G
Sullivan
M
M
Katon
W J
WJ
Bernstein
D
D
D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000523:psychology*; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D010147:Pain Measurement; D010348:Patient Care Team; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology*; D012017:Referral and Consultation; D012803:Sick Role; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology