Do you treat fibromyalgia in your practice or do you refer back to PCP after ruling out autoimmune inflammatory pathology?

The problem of managing fibromyalgia has been the topic of numerous Rheumatology National meetings and more after-hours clinic gatherings. The reality centers around your desire to take care of people; clearly, this is a group of patients who need someone to provide care. Rheumatologists are exceedingly well suited to provide this care, being comfortable with management options that are sometimes "out of the box." Many of these patients have underlying diseases that a non-rheumatologist would not consider, and many "conventional" rheumatology patients with established disease states such as RA, SLE, and OA have superimposed fibromyalgia. Therefore, we as rheumatologists simply have more tools at our disposal and more "practice" at providing...

During my practice, I had a special clinical and research interest in fibromyalgia so I did see fibromyalgia patients regularly. I set aside 2 half days weekly for fibromyalgia referrals and incorporated a group educational session after seeing new referrals. Any rheumatologist with an interest in chronic pain and fibromyalgia should use such a structure and utilize ancillary health care professionals. Otherwise, for most rheumatologists, our role should be to confirm the diagnosis and provide advice to the patient, family, and referring PCP, including options in long term chronic pain management. I do not believe that rheumatologists should make the too-often blanket statement, “We don’t see patients referred to us for fibromyalgia.”

I think it is up to the rheumatologist to decide whether they follow FM patients once they rule out autoimmune pathology. Some rheumatologists feel that in order to best serve the PCPs who refer, or because they feel comfortable taking care of FM, they are fine with continuing to provide care. Others would rather not – either because they are too busy seeing individuals with autoimmune disorders, or because they do not feel taking care of FM patients. I think either is fine – but I do think rheumatologists should at least do the latter, because at present there are likely a fair number of individuals with autoimmune disorders (or some other identifiable disease) who are misdiagnosed with FM.