Misdiagnosis of Fibromyalgia: A Reviewof Cases Re-Diagnosed with Other Diseases, 2025, Adawi

[Dolphin]

doi:10.20944/preprints202505.0379.v1

https://www.preprints.org/frontend/manuscript/839d13f70b1c6c37c3739b40d7859a23/download_pub

Article
Misdiagnosis of Fibromyalgia: A Review of Cases
Re‐Diagnosed with Other Diseases
Adawi Mohammad ¹,* and Awni Yousef ²
1 Laniado MC, Ariel University, General Health Services, Yael 82 Nof Hagalil
2 Bar Ilan University, General Health Services
* Correspondence: adawimo1802@gmail.com; Tel.: +972544564960

Abstract:

Abstract

Fibromyalgia is a chronic pain syndrome associated with tenderness, mood disorders, poor sleep, and cognitive dysfunction. However, there is no established pathological basis for fibromyalgia, and its diagnosis is often difficult. To clarify the features and difficulties of diagnosing fibromyalgia, we conducted a review and meta‐analysis of the outcomes of cases initially diagnosed with fibromyalgia. We accumulated previously published cases and data of newly recruited patients either for or against the outcomes by prospective or retrospective approaches. The presence of alternative diseases with the disappearance of fibromyalgia‐like symptoms is well documented for cases of diverse ages and suggests that revised diagnoses may depend on patients’ recall bias, selection bias, or the ideas of the physicians. Although discrepancies in the results were seen according to the type of case series, we preliminarily identified the most frequent diseases, such as hypothyroidism‐like syndrome in adult patients and familial Mediterranean fever in child cases. The prevalence of fibromyalgia in patients with legitimate diseases should be reconsidered. Synopsis Fibromyalgia is a chronic pain syndrome associated with mood disorders, poor sleep, and cognitive dysfunction, and there is no established pathological basis and no currently available cure. The presence of diverse comorbid conditions and diverse symptomatologies within and between the comorbid conditions suggests that fibromyalgia may encompass more than one illness under one name. Our meta‐analysis carefully demonstrates features of the diagnosis of fibromyalgia as follows: (i) the number of patients allocated to other diagnoses as a result of the revised diagnosis varied depending on the type of series of fibromyalgia cases; (ii) cases with congenital or chronic conditions, such as juvenile fibromyalgia, have legitimate diseases, and the rareness of the report suggests the referral and continuation bias of previous pediatric‐based fibromyalgia research; and (iii) a chartbased study also demonstrated the entity bias for the diagnosis of fibromyalgia, similar to previous treatment‐based and database studies, thereby suggesting that fibromyalgia may not be distinct from other disorders. Our meta‐analytic result is well in concordance with some non‐rheumatological studies analyzing cases diagnosed in a specialized pain therapy clinic, whose conclusions are generally contradictory to the criteria. The combination of the literature and the current study should further help emphasize the early and differential diagnoses of patients presenting with symptoms meeting the fibromyalgia criteria in the clinic. Future treatment‐based and nosological studies may benefit from our suggestions to prevent undiagnosed comorbid diseases or syndromes.

Keywords: fibromyalgia; chronic pain; diagnosis; meta‐analysis; comorbidities

 

[Dolphin]

When people have symptoms that involve muscle, connective tissue, and/or nervous systems, clinicians must pay attention to differentiating FM from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The two diseases may cause similar symptoms, and they are both associated with depression and stress or traumatic events. There are many theories explaining the similarities and the differences of the two diseases and their relationship. ME/CFS is a chronic and systemic, but potentially reversible, disorder. It is not degenerative. However, central nervous system involvement in FM and ME/CFS is similar. Brain and spinal cord function may be impaired or even partially degenerated if the diseases become chronic. Nevertheless, severity and patterns of the central nervous system dysfunctions are different. In terms of medical care, treatments for the two diseases are similar. But as ME/CFS is reversible, patients should not overwork their muscles. They should strive to distribute exercises evenly throughout the body and avoid isolating any activity to a small group of muscles. Also, it is important to note that ME/CFS significantly worsens symptoms of FM. Brain cortex hyperexcitability in FM may be involved with the generation of chronic pain syndrome. ME/CFS may induce myofascial pain in patients with FM. Additionally, hypothalamus activity is significantly decreased in patients with ME/CFS. Patients with FM display both increases and decreases. In conclusion, ME/CFS may increase brain cortex hypoactivity, which is normally present in FM [9].

 

[Dolphin]

6.3. Specific Diseases Identified in Misdiagnosed Cases

A wide variety of diseases account for the majority of reclassifications from fibromyalgia to a different disease on reanalysis, but certain diseases have been reported multiple times. Based on our review of the published studies, at least 5.7% of the cases in the misdiagnosed category published so far have been reclassified to individual diseases. Of those, 21.9% were reclassified as rheumatoid arthritis, 15.6% were systemic lupus erythematosus, and 15.6% were chronic fatigue syndrome. Rheumatoid arthritis, lupus, and chronic fatigue syndrome are three of the individual diseases reported to be part of the misdiagnosis for fibromyalgia. These diseases were reclassified from fibromyalgia in 21.9% of the published case reports from our literature review [5]. Patients suffering from systemic hardships may display a range of possible pathologies. A testing bias may pre‐select a group of patients more likely to give a false positive diagnosis of a catch‐all disease. By examining individual diseases, with the above biases in mind, the authors hope to reveal possible trends and preconceptions in the clinical community regarding fibromyalgia diagnosis. There was insufficient data available to perform more in‐depth statistical analyses to investigate other common diagnoses. The high level of redirection to rheumatoid arthritis, lupus, or chronic fatigue syndrome in our study, however, correlated well with other studies on diagnoses being confused with fibromyalgia. Further research needs to be undertaken to produce a more thorough comparison of the common misdiagnoses, a full statistical analysis, and to question how this might reflect the state of the current diagnostic protocols [9].

 

[MrMagoo]

Wow, it sounds like AI wrote it

 

[Utsikt]

But as ME/CFS is reversible, patients should not overwork their muscles.

This makes no sense at all.

Also, it is important to note that ME/CFS significantly worsens symptoms of FM.

Uhm, what?

 

[Trish]

This doesn't look like a preprint worth wasting time on.

 

[ME/CFS Skeptic]

Assume these are the main results:

Based on our review of the published studies, at least 5.7% of the cases in the misdiagnosed category published so far have been reclassified to individual diseases. Of those, 21.9% were reclassified as rheumatoid arthritis, 15.6% were systemic lupus erythematosus, and 15.6% were chronic fatigue syndrome

 

[perchance dreamer]

The prevalence of fibromyalgia in patients with legitimate diseases should be reconsidered.

Arghhh!!!

 

[Peter T]

Arghhh!!!

I was hoping that ‘legitimate diseases’ was a translation/language issue.