Dr. White's reply to my letter “Comment on the Fibromyalgia Label: More Cons Than Pros” (1) would be appropriate if fibromyalgia was actually a disease, which Dr. White clearly believes. However, my comments question this assumption and mention some of the problems that have resulted from this simplified point of view. The issue was first discussed in an excellent 1997 editorial by Winfield in which he notes that “fibromyalgia is not a distinct entity, the American College of Rheumatology fibromyalgia criteria detect just the tip of the iceberg,” and that “painful tender joints are a measure of general psychologic distress” (2). In the January 2003 issue of Arthritis & Rheumatism, Ehrlich states categorically that “fibromyalgia is not a diagnosis” and “should not be dignified with names that imply disease states (3),” although he does not appear to be aware of how frequently the term is used in rural areas. More attention should be paid to medical practices in regions like the rural South where the fibromyalgia label is often used as a surrogate for a wide spectrum of stress-related psychoneurotic disorders including chronic anxiety and depression. Many of these patients have widespread pain and tender joints that do satisfy the American College of Rheumatology fibromyalgia criteria (4). Since these important underlying conditions often go unrecognized (as opposed to the fibromyalgia label), just the “tip of the iceberg” is all that is seen and treated, frequently with ineffective polypharmacy and poor outcomes.
More Comments on the “Fibromyalgia” Label
To the Editor:
- 1 , , , , . Reply to comment on the “fibromyalgia” label: more cons than pros [letter]. Arthritis Rhem (Arthritis Care Res) 2003; 49: 144–-5.
- 2 . Fibromyalgia: what's next [editorial]? Arthritis Care Res 1997; 10: 219–21.
- 3 . Fibromyalgia is not a diagnosis: comment on the editorial by Crofford and Clauw [letter]. Arthritis Rheum 2003; 48: 276.
- 4 , , , , , , et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990; 33: 160–72.
Stephen G. Gelfand MD, FACP, FACR*, * Myrtle Beach, SC.