RT Journal Article
SR Electronic
T1 Accuracy of the Diagnosis of Fibromyalgia by Family Physicians: Is the Pendulum Shifting?
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 170
OP 173
DO 10.3899/jrheum.080468
VO 36
IS 1
A1 ELENA SHLEYFER
A1 ALAN JOTKOWITZ
A1 ANATTE KARMON
A1 ROMAN NEVZOROV
A1 HAGIT COHEN
A1 DAN BUSKILA
YR 2009
UL http://www.jrheum.org/content/36/1/170.abstract
AB Objective. We evaluated the accuracy of diagnosis of fibromyalgia (FM) by family physicians. Methods. We performed a retrospective cohort analysis of 646 consecutive patients newly referred to the outpatient rheumatology clinic of Soroka University Medical Center from January 1, 2005, until December 31, 2007. The kappa statistic was used to measure agreement between family-physician and rheumatologist diagnoses for FM in the total patient cohort as well as in groups stratified by ethnicity. Sensitivity and specificity of family-physician diagnosis of FM were calculated using rheumatologist diagnosis as the gold standard. There were no exclusion criteria. Results. During the time period of the study, 646 new patients were seen in the rheumatology clinic. Of 196 patients referred with an initial diagnosis of FM, the consultant rheumatologist confirmed this diagnosis in 71% of cases. The overall kappa for FM diagnosis between family physicians and rheumatologists was 0.70 (p < 0.001), indicating a good level of agreement. Agreement was substantially lower among Bedouin patients (κ = 0.35, p = 0.003). All other patients in our study were Jewish Israelis. Using rheumatologist diagnosis as the gold standard, overall sensitivity and specificity of FM diagnosis by family physicians were 87.4% and 88.3%, respectively. Conclusion. Family physicians in our region are able to accurately diagnose FM. Future studies might focus on evaluating the factors and biases accounting for differences in level of diagnostic accuracy for FM among various ethnic groups.