The primary focus of the article of Silverman et al (BMC Musculoskeletal Disorders 2010, 11:66) towards the characterization of fibromyalgia (FM) severity is fundamental to a greater understanding of this condition. As correctly identified the limitations associated with potential biomarkers has not assisted in attempts of defining FM severity. It should also be noted a similar circumstance exists for the definition of the state of remission in FM, where often a lack of symptoms is viewed as a lack of the condition (ie an altered biology). While the study and general interpretations of the outcomes are well constructed, there is however concern of the attempts to relate the measurement of FM severity with disease progression. This has led the authors to propose "..to slow progression is likely to have a broader clinical and economic impact...". This is a very valid statement if FM is a progressive condition. As stated within the discussion the findings related to severity progression of FM are equivocal. The study of Silverman et al uses a snap-shot, rather than longitudinal, design with self-selecting participants. The evidence, presented by the authors, associated with progression is based on the relationship of self-assessed severity and duration of FM, with the suggestion that a mild form of the condition develops into moderate-severe forms after 1-2 years. An alternative interpretation could be that those patients with a mild form are still coming to terms with their FM during the initial 12 months and thereby participate in such a survey. Thereafter, this patient group, perhaps, are more capable of accommodating for, and managing their condition, thus being less likely to respond to such a survey as that forming this article. With this form of investigation, with participants self-selecting, it is essential that the reasons for engagement, or not as the case maybe, are considered in the design to avoid a skew of the outcomes and their interpretation.
Is fibromyalgia a progressive condition?
5 August 2010
The primary focus of the article of Silverman et al (BMC Musculoskeletal Disorders 2010, 11:66) towards the characterization of fibromyalgia (FM) severity is fundamental to a greater understanding of this condition. As correctly identified the limitations associated with potential biomarkers has not assisted in attempts of defining FM severity. It should also be noted a similar circumstance exists for the definition of the state of remission in FM, where often a lack of symptoms is viewed as a lack of the condition (ie an altered biology).
While the study and general interpretations of the outcomes are well constructed, there is however concern of the attempts to relate the measurement of FM severity with disease progression. This has led the authors to propose "..to slow progression is likely to have a broader clinical and economic impact...". This is a very valid statement if FM is a progressive condition. As stated within the discussion the findings related to severity progression of FM are equivocal. The study of Silverman et al uses a snap-shot, rather than longitudinal, design with self-selecting participants. The evidence, presented by the authors, associated with progression is based on the relationship of self-assessed severity and duration of FM, with the suggestion that a mild form of the condition develops into moderate-severe forms after 1-2 years. An alternative interpretation could be that those patients with a mild form are still coming to terms with their FM during the initial 12 months and thereby participate in such a survey. Thereafter, this patient group, perhaps, are more capable of accommodating for, and managing their condition, thus being less likely to respond to such a survey as that forming this article.
With this form of investigation, with participants self-selecting, it is essential that the reasons for engagement, or not as the case maybe, are considered in the design to avoid a skew of the outcomes and their interpretation.
Competing interests
None declared