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EULAR revised recommendations for the management of fibromyalgia.
Ann Rheum Dis 2017; 76(2):318-328AR

Abstract

OBJECTIVE

The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.

METHODS

A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.

RESULTS

2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).

CONCLUSIONS

These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Authors+Show Affiliations

Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. Department of Rheumatology, Cantonal Hospital, Fribourg, Switzerland.Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.ICRCCS Galeazzi Orthopaedic Institute, Milan, Italy.Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany. Department of Psychosomatic Medicine, Technische Universität München, München, Germany.Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden.Department of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.Rheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal.Hacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.Finnish Institute of Occupational Health, Helsinki, Finland.Patient Representative, Bristol, UK.Mater Misericordiae University Hospital, Dublin, Ireland.Patient Representative, Limassol, Cyprus.Centre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France.Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27377815

Citation

Macfarlane, G J., et al. "EULAR Revised Recommendations for the Management of Fibromyalgia." Annals of the Rheumatic Diseases, vol. 76, no. 2, 2017, pp. 318-328.
Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328.
Macfarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Fluβ, E., ... Jones, G. T. (2017). EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases, 76(2), pp. 318-328. doi:10.1136/annrheumdis-2016-209724.
Macfarlane GJ, et al. EULAR Revised Recommendations for the Management of Fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. PubMed PMID: 27377815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EULAR revised recommendations for the management of fibromyalgia. AU - Macfarlane,G J, AU - Kronisch,C, AU - Dean,L E, AU - Atzeni,F, AU - Häuser,W, AU - Fluβ,E, AU - Choy,E, AU - Kosek,E, AU - Amris,K, AU - Branco,J, AU - Dincer,F, AU - Leino-Arjas,P, AU - Longley,K, AU - McCarthy,G M, AU - Makri,S, AU - Perrot,S, AU - Sarzi-Puttini,P, AU - Taylor,A, AU - Jones,G T, Y1 - 2016/07/04/ PY - 2016/04/15/received PY - 2016/06/10/revised PY - 2016/06/14/accepted PY - 2016/7/6/pubmed PY - 2017/6/1/medline PY - 2016/7/6/entrez KW - Fibromyalgis/Pain Syndromes KW - Multidisciplinary team-care KW - Treatment SP - 318 EP - 328 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 76 IS - 2 N2 - OBJECTIVE: The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'. METHODS: A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. RESULTS: 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). CONCLUSIONS: These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/27377815/EULAR_revised_recommendations_for_the_management_of_fibromyalgia_ L2 - http://ard.bmj.com/cgi/pmidlookup?view=long&pmid=27377815 DB - PRIME DP - Unbound Medicine ER -