Типичная врачебная практика ведения пациентов с фибромиалгией
Типичная врачебная практика ведения пациентов с фибромиалгией
Насонова Т.И., Парфенов В.А., Мухаметзянова А.Х. Типичная врачебная практика ведения пациентов с фибромиалгией. Consilium Medicum. 2022;24(11):796–799. DOI: 10.26442/20751753.2022.11.202013
Nasonova TI, Parfenov VA, Mukhametzyanova AKh. Typical practice for managing patients with fibromyalgia. Consilium Medicum. 2022;24(11):796–799. DOI: 10.26442/20751753.2022.11.202013
Типичная врачебная практика ведения пациентов с фибромиалгией
Насонова Т.И., Парфенов В.А., Мухаметзянова А.Х. Типичная врачебная практика ведения пациентов с фибромиалгией. Consilium Medicum. 2022;24(11):796–799. DOI: 10.26442/20751753.2022.11.202013
Nasonova TI, Parfenov VA, Mukhametzyanova AKh. Typical practice for managing patients with fibromyalgia. Consilium Medicum. 2022;24(11):796–799. DOI: 10.26442/20751753.2022.11.202013
Фибромиалгия (ФМ) проявляется хроническим распространенным болевым синдромом, нарушениями сна, ощущением усталости и субъективными когнитивными нарушениями. Отмечается поздняя диагностика ФМ в разных странах, отсутствуют данные о типичной врачебной практике ведения пациентов с ФМ в нашей стране. Цель. Пронализировать предшествующую типичную практику ведения пациентов с ФМ. Материалы и методы. Под наблюдением находились 53 пациента с ФМ (47 женщин и 6 мужчин), средний возраст 46,8±14,6 года. Оценивались длительность симптомов ФМ (годы), интенсивность болевого синдрома по цифровой рейтинговой шкале, качество жизни с помощью обновленного опросника для оценки влияния ФМ (FIQR), эмоциональное состояние по госпитальной шкале тревоги и депрессии, проводимое лечение. Результаты. Длительность симптомов до установления диагноза ФМ составила 7,0 (2,0–15,0) года. Интенсивность боли при первичном осмотре у пациентов с ФМ по цифровой рейтинговой шкале – 7,1±1,9 балла, влияние на качество жизни пациентов с ФМ по FIQR – 54,9±18,4 балла. У большинства (85%) пациентов диагноз ФМ до госпитализации не поставлен. Не выявлено статистически значимых отличий в интенсивности боли (p=0,478), уровне качества жизни (p=0,611), уровне тревоги (0,159) и депрессии (0,347) в группах пациентов, у которых установлен или отсутствовал диагноз ФМ. Заключение. ФМ редко диагностируется в нашей стране, даже в случаях установления диагноза пациенты во многих случаях не получают эффективного лечения, что отражает низкую информированность врачей о современных методах диагностики и лечения ФМ.
Background. Fibromyalgia (FM) is manifested by chronic widespread pain syndrome, sleep disorders, fatigue and subjective cognitive impairment. There is a late diagnosis of FM in different countries; there is no data on the typical medical practice of managing patients with FM in our country. Aim. To analyse the previous typical practice of managing patients with FM. Materials and methods. Fifty three patients with FM (47 women and 6 men) were under observation; the average age was 46.8±14.6 years. The duration of FM symptoms (years), the intensity of pain syndrome according to a Numerical Rating Scale (NRS), quality of life using The Revised Fibromyalgia Impact Questionnaire (FIQR), emotional state according to the Hospital Anxiety and Depression Scale (HADS), and treatment were evaluated. Results. The duration of symptoms before the diagnosis of FM was 7.0 (2.0–15.0) years. The intensity of pain during the initial examination in patients with FM according to NRS – 7.1±1.9 points, the effect on the quality of life of patients with FM according to FIQR – 54.9±18.4 points. The majority of patients (85%) were not diagnosed with FM before hospitalization. There were no statistically significant differences in the intensity of pain (p=0.478), the level of quality of life (p=0.611), the level of anxiety (0.159) and depression (0.347) in the groups of patients who had or did not have a diagnosis of FM. Conclusion. FM is rarely diagnosed in our country, even in cases of diagnosis, patients in many cases do not receive effective treatment, which reflects the low awareness of doctors about modern methods of diagnosis and treatment of FM.
Keywords: fibromyalgia, chronic pain, chronic widespread pain syndrome, diagnosis of fibromyalgia, treatment of fibromyalgia
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1. Marques AP, Santo ASDE, Berssaneti AA, et al. Prevalence of fibromyalgia: literature review update. Revista Brasileirade Reumatologia. 2017;57(4):356-63. DOI:10.1016/j.rbre.2017.01.005
2. Jones GT, Atzeni F, Beasley M, et al. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheum. 2015;67(2):568-75. DOI:10.1002/art.38905
3. Storozhenko ON. Rasprostranennost' i faktory riska sindromov fibromialgii i khronicheskoi generalizovannoi boli v populyatsii g. Yekaterinburga: dis. … kand. med. nauk. Moscow, 2004. Available at: https://rusneb.ru/catalog/000199_000009_004060836. Accessed: 23.10.2022 (in Russian).
4. Wolfe F, Ross K, Anderson J, et al. Aspects of fibromyalgia in the general population: Sex, pain threshold, and fibromyalgia symptoms. J Rheumatol. 1995;22(1):151-6.
5. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28. DOI:10.1002/art.1780380104
6. Arnold LM, Hudson JI, Hess EV, et al. Family study of fibromyalgia. Arthritis Rheum. 2004;50(3):944-52. DOI:10.1002/art.20042
7. Häuser W, Sarzi-Puttini P, Fitzcharles M. Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol. 2019;37 Suppl. 116(1):90-7. Available at: https://pubmed.ncbi.nlm.nih.gov/30747096/ Accessed: 23.10.2022.
8. Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-28. DOI:10.1136/annrheumdis-2016-209724
9. Arnold LM, Bennett RM, Crofford LJ, et al. AAPT Diagnostic Criteria for Fibromyalgia. J Pain. 2019;20(6):611-28. DOI:10.1016/j.jpain.2018.10.008
10. Choy E, Perrot S, Leon T, et al. A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Serv Res. 2010;10:102. DOI:10.1186/1472-6963-10-102
11. Walitt B, Nahin RL, Katz RS, et al. The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLOS One. 2015;10(9):e0138024. DOI:10.1371/journal.pone.0138024
12. Yakhno NN. Bol', prakticheskoe rukovodstvo. Moscow: MEDpress-inform, 2022 (in Russian).
13. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27. DOI:10.1097/j.pain.0000000000001384
14. Nasonova TI, Mukhametzyanova AK, Tabeyeva GR, etal. Modern approaches to thetreatment of fibromyalgia. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):83-9 (in Russian). DOI:10.14412/2074-2711-2021-5-83-89
15. Bennett RM, Kamin M, Karim R, et al. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med. 2003;114(7):537-45. DOI:10.1016/s0002-9343(03)00116-5
16. Walitt B, Klose P, Üçeyler N, et al. Antipsychotics for fibromyalgia in adults. Cochrane Database Syst Rev. 2016;2016(9). DOI:10.1002/14651858.cd011804.pub2
17. Teplyakova OV, Popov AA, Volkova LI, et al. Fibromyalgia: clinical presentations and variants of the disease. Sovremennaia Revmatologiia. 2020;14(2):45-51 (in Russian). DOI:10.14412/1996-7012-2020-2-45-51
18. Guymer EK, Littlejohn GO, Brand CK, et al. Fibromyalgia onset has a high impact on work ability in Australians. Int Med J. 2016;46(9):1069-74. DOI:10.1111/imj.13135
19. Fitzcharles MA, Ste-Marie PA, Rampakakis E, et al. Disability in Fibromyalgia Associates with Symptom Severity and Occupation Characteristics. J Rheumatol. 2016;43(5):931-6. DOI:10.3899/jrheum.151041
20. Wolfe F, Walitt BT, Katz RS, et al. Social security work disability and itspredictors in patients with fibromyalgia. Arthritis Care Res. 2014;66(9):1354-63. DOI:10.1002/acr.22305
21. Order of the Ministry of Labor and Social Protection of the Russian Federation of October 6, 2021 No. 680n “On Amendments to Appendix No. 1 to the Classifications and Criteria Used in the Medical and Social Expertise of Citizens by Federal State Institutions of Medical and Social Expertise, approved by order of the Ministry of Labor and social protection of the Russian Federation dated August 27, 2019 No. 585n. Available at: http://publication.pravo.gov.ru/Document/View/0001202201180015. Accessed: 23.10.2022 (in Russian).
22. White KP, Nielson WR, Harth M, et al. Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample. J Rheumatol. 2002;29(3):588-94. Available at: https://pubmed.ncbi.nlm.nih.gov/11908578/ Accessed: 23.10.2022.
23. Hughes G, Martinez C, Myon E, et al. The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis Rheum. 2006;54(1):177-83. DOI:10.1002/art.21545
24. Fitzcharles MA, Shir Y, Ablin JN, et al. Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines. Evid Based Complement Alternat Med. 2013;2013:528952. DOI:10.1155/2013/528952.
25. Häuser W, Ablin J, Perrot S, et al. Management of fibromyalgia: practical guides from recent evidence-based guidelines. Pol Arch Intern Med. 2017;127(1):47-56. DOI:10.20452/pamw.3877
26. Fitzcharles MA, Ste-Marie PA, Goldenberg DL, et al. 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 2013;18(3):119-26. DOI:10.1155/2013/918216
Авторы
Т.И. Насонова*, В.А. Парфенов, А.Х. Мухаметзянова
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*kuzminova_t_i@staff.sechenov.ru
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Tatiana I. Nasonova*, Vladimir A. Parfenov, Albina Kh. Mukhametzyanova