Salaffi (UniMarche): ‘Even 7 years to be diagnosed with fibromyalgia’

It has no objective clinical signs but an infinite series of symptoms. These include chronic pain that has been widespread for at least three months, asthenia, mental and physical fatigue, cognitive problems, genitourinary disorders, migraines, stiffness, abdominal pain and cramps, anxiety and depression that compromise the daily life of those who deal with fibromyalgia, a chronic rheumatic disease that affects about 2 million Italians. “With such a wide and varied range of ailments and pains, it can take several years, even seven, to arrive at the unambiguous diagnosis of fibromyalgia. It is absurd but it is so “. This is stated by Fausto Salaffi, associate professor of Rheumatology at the Polytechnic University of Marche and national manager of the Fibromyalgia register.” Pain – explains Salaffi – is the main symptom of fibromyalgia and is described by the patient in a very varies: tension, stiffness, cramp, cut, shock, stab, burn, including the sensation of being spread all over the place ”. An extremely disabling pathology that “causes disability to the patient – underlines the rheumatologist – who in order not to feel pain reduces any physical and work activity, in some cases reaching total immobility”. Even the most harmless external stimuli such as wearing clothes or being touched are perceived by the patient as unbearable pain. Pain that becomes more intense on cold, humid and rainy days, while most patients report a beneficial effect of heat. “Even inactivity and hyperactivity – according to Salaffi – aggravate the symptoms which, on the other hand, improve thanks to moderate physical activity. The role of physical and mental stress is known as a factor in worsening both pain and all the symptoms possibly associated with it. An early diagnosis is therefore essential to prevent, not only the accentuation of symptoms, but also the establishment of vicious circles such as pain-mood disorders, pain-immobility, which make management complex. But the combination of the numerous clinical manifestations and the severity of each single symptom presents extreme variability. This makes the early recognition of fibromyalgia problematic ”. Although it is a long-known clinical condition, fibromyalgia has only recently received a scientific definition and formal recognition. “The first criteria for the classification of fibromyalgia – recalls Salaffi – were proposed in 1990 by the American college of rheumatology (Acr) and in 1992 the WHO recognized fibromyalgia as a pathology with the Copenhagen Declaration. Furthermore, in 2009 the The European Parliament has asked the Commission and the Council to develop a Community strategy for its recognition as a disease, encourage Member States to improve access to diagnosis and treatments and promote data collection. But given the many concerns raised by the scientific community regarding the usefulness of formulating the diagnosis of fibromyalgia through the search for ‘tender points’ in 2010, 2011 and 2016, the new classification criteria were reformulated by the Acr “. According to these criteria – he continues – for the diagnosis of fibromyalgia, 3 characteristics must exist at the same time: pain spread in specific areas and regions of the body; presence of characteristic symptoms (asthenia, unrefreshing sleep, cognitive problems, migraine, abdominal pain / cramps, depression) that compromise daily life; duration of symptoms equal to at least 3 months “. Several tools are available for the evaluation of patients with fibromyalgia but it is thanks to the severity levels of the disease that it is possible to stratify different disease ‘clusters’, that is “to personalize the therapeutic intervention and implement monitoring strategies – Salaffi points out – according to international recommendations. These aspects are among the main strategic priorities of the Higher Institute of Health and the Ministry of Health regarding the recognition of fibromyalgia as a chronic disease and the definition of the essential levels of assistance (Lea) “.” Our study conducted with the Italian Society of rheumatology (Sir) and sponsored by the Ministry of Health – reports Salaffi – has made it possible to arrive at a definition of the thresholds or levels of severity of the disease, essential for the inclusion of fibromyalgia in the list of chronic disabling diseases. The analysis of the demographic and clinimetric characteristics of 2,339 patients studied at 19 rheumatology centers, distributed throughout the national territory, allowed the stratification of the levels of disease severity that could support the rational management, both of the treatment and of the evaluation. of the progression of the disease. The evaluation tools used were represented by the modified version of the Fibromyalgia impact questionnaire (Fior), by the modified Fas (Fibromyalgia assessment status modified) and by the Polysymptomatic distress scale (Pds). The relative levels (threshold values) of disease severity were calculated for each individual instrument “. And on the definition of the severity levels of the disease, the associate professor of Rheumatology at the Polytechnic University of Marche is among the authors of the publications “Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients” (Rheumatology – Oxford) , “Diagnosis of fibromyalgia: comparison of the 2011/2016 ACR and AAPT criteria and validation of the modified Fibromyalgia Assessment Status (Rheumatology Oxford). In addition to being frequent, it is also devious: it is no coincidence that it is called an “invisible disease” because it is difficult to diagnose. Persistent pain and other disabling symptoms are not easily objectified, but the life of those affected is a daily ordeal. To counter this sense of abandonment and “frustration”, Alfasigma supports patients with Fibromyalgia Syndrome through correct and verified information, with the aim of raising public awareness, spreading greater awareness and improving the quality of life of patients. Alfasigma will deal with, with the help of experts, topics on which a lack of communication has been found, putting the patient in the condition of being able to be an active protagonist in his own treatment path.