Abstract 1820: Evolution of Health Status Changes Over Time among Women with Fibromyalgia
S Reisine, J Fifield, S Walsh, D Dauser, & M Abeles

Purpose: Fibromyalgia (FM) strongly associates with impaired health status. This study sought to assess health status changes among women with FM over four years and to determine whether various health status measures change in conjunction with each other over time.

Methods: A sample of women (N = 287) with FM, recruited from a national sample of rheumatologists, completed a telephone interview at baseline and annually for 4 years. Health status measures included assessments of pain, fatigue, depression (measured by the Center for Epidemiologic Studies Depression Scale [CESD]), and quality of life (measured by the Modified Health Assessment Scale [MHAQ] and the Mental and Physical Component Scores of the SF-12).

Results: Seventy-nine percent of FM patients completed all assessments. Drop outs were more likely to be unemployed, non-White, and had lower MHAQ scores. The health status measures were modestly correlated. Pain and fatigue were moderately associated (r = .58) and increased together over the 4 years. Pain and fatigue were negatively associated with the SF-12 (i.e., as pain and fatigue increased SF-12 scores decreased). Pain was not strongly associated with CESD or SF-12 Mental Health Scores.

Conclusions: Data from this semi-longitudinal survey suggests that the pain and fatigue, the two major symptoms of FM, tend to change together over time but independently of measures of psychological distress suggesting that distress might represent a separate and distinct dimension of FM.

Editorial Comments: Although psychological distress (most notably anxiety and depression) is common among adults with FM, it is unclear whether this distress should be considered part of cluster of symptoms that characterizes FM. The results of this study indicate that pain and fatigue co-vary together overtime while psychological distress and quality of life vary independently and somewhat unsystematically with pain and fatigue. This implies that psychological distress should not be considered a component of the rubric of symptoms that constitute FM. It also raises the possibility that the pain and fatigue in FM is not driven strongly by psychological distress. In other words, psychological distress may not mediate the experience of pain and fatigue to the extent previously thought. Obviously, this single observation needs to be confirmed especially in light of the potential conceptual overlap between the measures used in this study.

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