End Fatigue

How Common are CFS, Fibromyalgia and Pain?

You are not alone! Recent research has shown that estimates of Fibromyalgia prevalence have increased by almost 400% in the last 10 years to include 7-8% of the adult population. CFS estimates have increased by 1000% from .5% to 2.5 % of the population. Chronic pain is estimated to affect 1/3 to 1/4 of adult Americans.

This all means that when it comes to being medically accepted, CFS and Fibromyalgia (and even chronic pain) are about to arrive!

You're not alone! How common are CFS and Fibromyalgia? Let's look at the numbers. Fibromyalgia was conservatively estimated to affect 6 million Americans in a major study published in 1995. (1)

A new study by the CDC (Centers For Disease Control-the main government research organization involved with CFS) exploring how common CFS is was released June 8, 2007. The title was "Prevalence of Chronic Fatigue Syndrome in metropolitan, urban, and rural Georgia," by WC Reeves, et al. (2)

The researchers called 19,381 individuals between the ages of 18 and 57. They report that about 2.54% of those surveyed fit the following criteria: "reported severe fatigue lasting 6 months or longer that was not alleviated by rest, that caused substantial reduction in occupational, educational, social or personal activities, and that was accompanied by at least 4 of the CFS case defining symptoms" (the CFS definition from 1994 by Fukuda, et al.)

The 2.54% prevalence would imply a CFS patient population of some 7.5 million in the U.S., not counting adolescent cases. The researchers found no significant difference in CFS prevalence between those in metro, urban, and rural populations, or between white and blacks

Fibromyalgia also appears to be becoming much more common. Four studies published in 2006 suggest that, using the same diagnostic criteria, fibromyalgia has gone from affecting approximately two percent of the European and African population 10 years ago to approximately eight percent just a decade later! (3-6) When individual country data from this study is analyzed, the surge in diagnoses tops 400 percent. This would suggest that over 22 million Americans have fibromyalgia.

This is the tip of the iceberg, however. It is estimated that many people (perhaps more than have overt Fibromyalgia) have a milder form of Fibromyalgia, but do not quite meet the diagnostic criteria. Given all of this, we are looking at upwards of 30-45 million Americans suffering with these illnesses.

You are not alone. And it seems that Effective Treatment has arrived just in time!

I include the references and study abstracts below for those of you who would like more information and the scientific references:

1. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995 Jan;38(1):19-28.

2. Reeves WC et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Population Health Metrics June 3, 2007, 5:5 doi: 10.1186/ 1478-7954-5-5

3. M. Matucci Cerinic, M. Zoppi, C. Taieb, J. Caubere, G. Hamelin and C. Schmitt. PREVALENCE OF FIBROMYALGIA IN ITALY: UPDATED RESULTS Annals of the Rheumatic Diseases 2006;65(Suppl 2):555

4. M. Guermazi, S. Ghroubi, M. Sellami, M. Elleuch, E. André, C. Schmitt, C. Taieb, J. Damak and M. Elleuch. EPIDEMIOLOGY OF FIBROMYALGIA IN TUNISIA. Annals of the Rheumatic Diseases 2006;65(Suppl 2):553

5. V. Cobankara, Ö. Ünal, M. Öztürk and A. Bozkurt . THE PREVALENCE OF FIBROMYALGIA AMONG TEXTILE WORKERS IN THE CITY OF DENIZLI IN TURKEY . Annals of the Rheumatic Diseases 2006;65(Suppl 2):554

6. C. Schmitt, M. Spaeth, E. André, J. Caubere and C. Taieb . FIBROMYALGIA SYNDROME: A GERMAN EPIDEMIOLOGICAL SURVEY Annals of the Rheumatic Diseases 2006;65(Suppl 2):554

CDC Data Released June 8 Put Chronic Fatigue Syndrome Prevalence in the State of Georgia at 2.54% of Those Ages 18 to 59

Reeves WC et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Population Health Metrics June 3, 2007, 5:5 doi:10.1186/1478-7954-5-5

Abstract (provisional)

Background: Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources.

Methods: Based on a random-digit dialing survey we ascertained CFS cases and controls to estimate the prevalence of CFS in metropolitan, urban, and rural populations of Georgia. This report focuses on the 5,623 of 19,381 respondents ages 18 to 59 years old. Fatigued (2,438), randomly selected unwell not fatigued (1,429) and randomly selected well (1,756) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. Subsets of those identified by interview as having CFS-like illness (292), chronic unwellness which was not CFS-like (268--randomly selected), and well subjects (223, matched to those with CFS-like illness on sex, race, and age) completed a clinical evaluation.

Results: We estimated that 2.54% of persons 18 to 59 years of age suffered from CFS. There were no significant differences in prevalence of CFS between metropolitan, urban or rural populations or between white and black residents of the three regions. However, there were significant differences in female-to-male ratios of prevalence across the strata (metropolitan female : male 11.2 : 1, urban 1.7 : 1, rural 0.8 : 1).

Conclusions: We estimated that 2.54% of the Georgia population suffers from CFS, which is 6 to 10 fold higher than previous population-based estimates in other geographic areas. These differences may reflect broader screening criteria and differences in the application of the case definition, however we cannot exclude the possibility that CFS prevalence may be higher in Georgia than other areas where it has been measured. Although the study did not identify differences in overall prevalence between metropolitan, urban, and rural Georgia populations, it did suggest the need for additional stratified analyses by geographic strata.

The next 4 studies were presented at EULAR-A major European Fibromyalgia conference

Session: Fibromyalgia

Saturday, 24 June 2006

Prevalence of Fibromyalgia in Italy: Updated Results

M. Matucci Cerinic1, M. Zoppi1, C. Taieb2, J. Caubere3, G. Hamelin2 and C. Schmitt

1Div Rheumatology, Univ Firenze, Firenze, Italy, 2Santé Publique, Qualité de Vie, Economie de la Santé, Pierre Fabre SA, Paris, 3Pierre Fabre Santé, Pierre Fabre Santé, Castres, France

Background: Fibromyalgia syndrome (FM) is an under diagnosed disorder of unknown etiology affecting over 5% of the patients in a general medical practice. The prevalence rate is thought to be about 2% in the general population, 5.8% of women ages 40-60 and as high as 8% in women ages 55-64, but recent European estimates are needed.

Objectives: To assess the estimated prevalence of possible fibromyalgia sufferers among the general adult population in Italy using a screening questionnaire, the LFES-SQ (London Fibromyalgia Epidemiology Study - Screening Questionnaire) developed by White KP [1].

Methods: In a previous study [2], the screening questionnaire (the LFES-SQ plus 3 questions on fatigue) was administered to a random community sample of 1000 persons interviewed by telephone. The sample was representative of the Italian population. Positive responders to the screening questionnaire were classified as "possible FMS sufferers''. In the present study, a random sample of patients coming to a Rheumatologist department at a hospital in Firenze, were administered the same screening questionnaire while diagnosis of fibromyalgia was independently confirmed by a rheumatologist, based on the 1990 ACR criteria. By combining the proportion of "possible FMS sufferers'' among the general population and the ratio of patients with confirmed fibromyalgia among patients positive to the LFES-SQ, it was possible to estimateprevalence of fibromyalgia.

Results: In the previous study, among 1000 persons interviewed, 126 (12,6%) were found to be positive to the LFES-SQ. In the present study, 246 patients were administered the LFES-SQ, 63were positive, and among these 47 (74,6%) were found to have a confirmed diagnosis of fibromyalgia. Thus, our current estimate of prevalence in the general population in Italy is 9,4% overall, 14,5% among women and 3,8% among men.

Conclusion: Current estimates of prevalence are much higher than what could be expected based on previous studies. Further studies and analyses may be needed to confirm these figures.

References: 1. White KP et al. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. Journal of Rheumatology. 1999;26:1570-157

2. Zoppi M et al. Fibromyalgia Syndrome: An Italian Epidemiological Survey. EULAR 2005, Vienna, AB0354

Annals of the Rheumatic Diseases 2006;65(Suppl 2):555

Session: Fibromyalgia

Poster Presentations (SAT0346)

Saturday, 24 June 2006

Epidemiology of Fibromyalgia in Tunisia

M. Guermazi, S. Ghroubi1, M. Sellami², M. Elleuch³, E. André⁴, C. Schmitt⁵, C. Taieb⁵, J. Damak⁶ and M. Elleuch

¹Service de Médecine Physqiue, Hôpital Habib Bourguiba, ²Service de Rhumatologie, Hôpital Hedi Chaker, Sfax, ³Service de Rhumatologie, Hôpital La Rabta, Tunis, Tunisia, ⁴Pierre Fabre Santé, Pierre Fabre Santé, Castres, ⁵Qanté Publique, Qualité de Vie, Economie de la Santé, Pierre Fabre SA, Paris, France, ⁶Service de Médecine Communautaire, Hôpital Hedi Chaker, Sfax, Tunisia

Background: Fibromyalgia syndrome (FMS) is an under diagnosed disorder of unknown etiology affecting over 5% of the patients in a general medical practice. The prevalence rate is about 2% in the general population, 5.8% of women ages 40-60 and as high as 8% in women ages 55-64.

Objectives: To assess the estimated prevalence of possible fibromyalgia sufferers among the general adult population (>15 years old) in Tunisia using a screening questionnaire, the LFES-SQ (London Fibromyalgia Epidemiology Study-Screening Questionnaire) developed by White KP [1].

Methods: In our study the Arab version of a screening questionnaire (the LFES-SQ plus 3 questions on fatigue) was administrated to a random community sample of persons in the region of Sfax(Tunisia). The sample was recruited so as to be representative of the population in Sfax. Subjects were interviewed face-to-face and positive responders to the screening questionnaire wereclassified as ``possible FMS sufferers''. Positive responders were invited to a consultation at a Rheumatologist department of the nearest of 2 hospitals in Sfax. They underwent diagnosis by a qualified rheumatologist to confirm or exclude fibromyalgia, using the 1990 ACR criteria.

Results: A total of 470 subjects were interviewed. Among these, 86 were positive to the LFES-SQ. Of the positive responders, 77 accepted a consultation with a rheumatologist to confirm diagnosis fo fibromyalgia. Diagnosis could be confirmed in 39 subjects. Thus, the estimated prevalence of fibromyalgia in Tunisia was 39/77 x 86/470 = 9,3%.

Conclusion: These estimates are higher than the ones obtained in the White study, but they are consistent with estimates of prevalence in many European countries. A second phase of the study is planned to recruit another 500 subjects in order to enhance the power and confirm these estimates.

References: White KP, et al. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. Journal of Rheumatology. 1999;26:1570-157

Annals of the Rheumatic Diseases 2006;65(Suppl 2):553

Session: Fibromyalgia

Poster Presentations (SAT0346)

Saturday, 24 June 2006

The Prevalence of Firbroyalgia Among Textile Workers in the City of Denizli in Turkey

V. Cobankara, Ö. Ünal1, M. Öztürk2 and A. Bozkurt3

1Internal Medicine, Pamukkale University Medical School, Denizli, 2Internal Medicine, Gazi University Medical School, Ankara, 3Public Health, Pamukkale University Medical Schoool, Denizli, Turkey

Background: Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, reduced sleep quality and multiple tender points. A recent population study from Turkey found the prevalence of FM as 3.6%. A prevalence study among textile workers has not yet been performed.

Objectives: We performed a prevalence survey among textile workers in the city of Denizli in Turkey.

Methods: The field survey was done in two stages. In the first stage 655 (523 female, 132 male) textile worker were asked to fill a screening questionnaire in four textile factories. In the next stage individuals who were positive for widespread pain were examined by an experienced rheumatologist. Patients who had 11 tender points according to ACR 1990 FM classification criteria were diagnosed as FM syndrome and later a detailed clinical and laboratory evaluation was done.

Results: Forty-eight patients (7.3%) ((one male 0.76% of males), 47 female (9.0% of females)) of 655 textile workers were diagnosed as FM. The clinical features were as follows; all the patientshad widespread pain, 12.5% had arthralgia, 14.6% had Raynaud's phenomenon, 41.6% had sleep disturbance, 87.5% had headache, 52% had irritable bowel disease. Complete blood count, urineanalysis, biochemical tests, thyroid stimulating hormone levels and radiological examinations were all unremarkable. Incresed age, female sex, marital status (being married), low household income and, increased number of children were risk factors for FM in our study.

Conclusion: This is the first study investigating FM prevalence among textile workers in Turkey. The prevalence of FM appears higher than the prevalence of FM reported before from Turkey. The clinical features of patients in this study were not different than the clinical features of patients of the out patients clinics.

Session: Fibromyalgia

Poster Presentations (SAT0346)

Saturday, 24 June 2006

Fibromyalgia Syndrome: A German Epidemiological Survey

C. Schmitt, M. Spaeth², E. André³, J. Caubere³ and C. Taieb¹

¹Santé Publique, Qualité de Vie, Economie de la Santé, Pierre Fabre SA, Paris, France, ²Rheumatologische Praxis, Rheumatologische Praxis, Munich-Planegg, Germany, ³Pierre Fabre Santé, Pierre Fabre Santé, Castres, France

Background: Fibromyalgia Syndrome (FM) is an under diagnosed disorder of unknown etiology affecting over 5% of the patients in a general medical practice. The prevalence rate is about 2% in the general population, 5.8% of women ages 40-60 and as high as 8% in women ages 55-64.

Objectives: To assess the estimated prevalence of possible FM sufferers among the general adults population (>15 years old) in Germany using a screening questionnaire, the LFES-SQ (London Fibromyalgia Epidemiology Study - Screening Questionnaire) developed by White KP [1].

Methods: In our study the screening questionnaire (the LFES-SQ plus 3 questions on fatigue) was administrated to a random community sample of persons interviewed by telephone and positive responders to the screening questionnaire were classified as "possible FMS sufferers''. Using a ratio calculated in the White study between patients "positive'' (+) to the screening questionnaireand the number of patients really diagnosed with FMS, we applied this ratio to our population of "possible FMS sufferers'' to obtain an estimate of the prevalence of possible fibromyalgia sufferers in Germany.

Results: A total of 1002 persons were interviewed by telephone using the LFES-SQ screening questionnaire, of which 523 women and 479 men. Among men, 35 (7,3%) were found to be positiveto the LFES-SQ and among women, 75 (14,3%) were positive. Using the ratio of persons with a confirmed diagnosis of fibromyalgia among persons positive to the LFES-SQ that was estimated inthe White study (0,63 for women and 0,36 for men), it could be estimated that prevalence of fibromyalgia among men in Germany is 2,6% and 9,0% in women.

Conclusion: Those estimates are higher than those obtained in the White study, but they are consistent with prevalence figures in other European countries. The next step will be to validate a local ratio of actual FMS persons to LFES-SQ positive persons in Germany.

References: 1. White KP, et al. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. Journal of Rheumatology. 1999;26:1570-157

Annals of the Rheumatic Diseases 2006;65 (Suppl 2):554