Fibromyalgia is associated with increased mortality, according to results of a systematic review and meta-analysis published in Rheumatic & Musculoskeletal Diseases.
Researchers searched PubMed, Scopus, and Web of Science databases for the key words “fibromyalgia” and “mortality” to identify studies that included associations between fibromyalgia and all-cause or specific-cause mortality as well as an effect measure such as a hazard ratio (HR), standardized mortality ratio (SMR), or odds ratio (OR) quantifying the relationship between fibromyalgia and mortality.
Of the 557 articles identified, 8 cohort studies published in English between 1999 and 2021 met eligibility criteria. . . Risk of study bias was assessed using the Newcastle-Ottawa scale.
The researchers identified 188,751 patients with fibromyalgia. Meta-analysis of data on these patients showed an increased HR for all‑cause mortality (HR, 1.27; 95% CI 1.04, 1.51). However, this increase was not found in the group of patients diagnosed using the 1990 criteria for fibromyalgia.
Borderline increases were found in the SMRs for mortality from accidents (1.95; 95% CI, 0.97-3.92), infections (1.66; 95% CI, 1.15-2.38), and suicide (3.37; 95% CI, 1.52-7.50). In contrast, a decrease in the SMR for mortality from cancer (0.82; 95% CI, 0.69-0.97) was found; the authors noted that this association may be attributed to extensive use of health services, including medical imaging (which could serve as secondary prevention or early detection), by patients with fibromyalgia.
Limitations of the study included differing definitions of fibromyalgia used in the studies that were included in the meta-analysis. Moreover, the authors did not evaluate whether fibromyalgia or the degree of comorbidity that accompanied it was associated with mortality, and comorbidity may account for the association between fibromyalgia and mortality. The study was also limited by the paucity of studies assessing each cause of mortality and the high degree of heterogeneity between the studies included.
“These potential associations indicate that fibromyalgia should be taken seriously, with a special focus on screening for suicidal ideation, accident prevention, and the prevention and treatment of infections,” the authors concluded.
Treister-Goltzman Y, Peleg R. Fibromyalgia and mortality: a systematic review and meta-analysis. RMD Open. 2023;9:e003005. doi:10.1136/rmdopen-2023-003005