EULAR revised recommendations for the management of fibromyalgia

G J MacFarlane, C Kronisch, L E Dean, F Atzeni, W Häuser , E Flüß, E Choy, E Kosek, K Amris, J Branco , F Dincer, P. Leino-Arjas, K Longley, G M McCarthy, S Makri, S Perrot, P Sarzi-Puttini, A Taylor, G T Jones

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Abstract

Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.

Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.

Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).

Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
Original languageEnglish
Pages (from-to)318-328
Number of pages11
JournalAnnals of the Rheumatic Diseases
Volume76
Early online date10 Jan 2017
DOIs
Publication statusPublished - 1 Feb 2017

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Fibromyalgia
Meta-Analysis
Expert Testimony
Sleep
Drug therapy
Therapeutics
Pain
Patient Education
Mood Disorders
Patient rehabilitation
Fatigue
Publications
Decision Making
Rehabilitation
Education
Decision making
Organizations
Fatigue of materials
Pharmacology
Guidelines

Keywords

  • fibromyalgia
  • guidelines
  • management
  • therapy
  • review

Cite this

EULAR revised recommendations for the management of fibromyalgia. / MacFarlane, G J; Kronisch, C; Dean, L E; Atzeni, F; Häuser , W; Flüß, E; Choy, E; Kosek, E; Amris, K; Branco , J; Dincer, F; Leino-Arjas, P.; Longley, K; McCarthy, G M; Makri, S; Perrot, S; Sarzi-Puttini, P; Taylor, A; Jones, G T.

In: Annals of the Rheumatic Diseases, Vol. 76, 01.02.2017, p. 318-328.

Research output: Contribution to journalArticle

MacFarlane, GJ, Kronisch, C, Dean, LE, Atzeni, F, Häuser , W, Flüß, E, Choy, E, Kosek, E, Amris, K, Branco , J, Dincer, F, Leino-Arjas, P, Longley, K, McCarthy, GM, Makri, S, Perrot, S, Sarzi-Puttini, P, Taylor, A & Jones, GT 2017, 'EULAR revised recommendations for the management of fibromyalgia', Annals of the Rheumatic Diseases, vol. 76, pp. 318-328. https://doi.org/10.1136/annrheumdis-2016-209724
MacFarlane, G J ; Kronisch, C ; Dean, L E ; Atzeni, F ; Häuser , W ; Flüß, E ; Choy, E ; Kosek, E ; Amris, K ; Branco , J ; Dincer, F ; Leino-Arjas, P. ; Longley, K ; McCarthy, G M ; Makri, S ; Perrot, S ; Sarzi-Puttini, P ; Taylor, A ; Jones, G T. / EULAR revised recommendations for the management of fibromyalgia. In: Annals of the Rheumatic Diseases. 2017 ; Vol. 76. pp. 318-328.
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abstract = "Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.",
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T1 - EULAR revised recommendations for the management of fibromyalgia

AU - MacFarlane, G J

AU - Kronisch, C

AU - Dean, L E

AU - Atzeni, F

AU - Häuser , W

AU - Flüß, E

AU - Choy, E

AU - Kosek, E

AU - Amris, K

AU - Branco , J

AU - Dincer, F

AU - Leino-Arjas, P.

AU - Longley, K

AU - McCarthy, G M

AU - Makri, S

AU - Perrot, S

AU - Sarzi-Puttini, P

AU - Taylor, A

AU - Jones, G T

N1 - Funding The project was funded by EULAR.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

AB - Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

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KW - guidelines

KW - management

KW - therapy

KW - review

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VL - 76

SP - 318

EP - 328

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

ER -