EULAR revised recommendations for the management of fibromyalgia - European League against Rheumatism (EULAR)
Fibromyalgia is common with a prevalence of 2% in the general population.1 ,2 However, its diagnosis and management remain a challenge for patients and healthcare professionals. It often takes >2 years for a diagnosis to be made with an average of 3.7 consultations with different physicians.3 Referral to specialists and investigations results in high healthcare use, for up to 10 years prior to diagnosis, compared with persons who do not have fibromyalgia.4 Although pain is the dominant symptom in fibromyalgia, other symptoms such as fatigue, non-refreshed sleep, mood disturbance and cognitive impairment are common, but not universal, have an important influence on quality of life and emphasise that it is a heterogeneous and complex condition.5 ,6
The original European League Against Rheumatism (EULAR) recommendations for the management of fibromyalgia assessed evidence up to and including 2005.7 Given the paucity of information and poor quality of the studies available, it was recommended that the guidelines be revised after a period of 4 years. However, no subsequent revision took place and thus a decade later we revisit the recommendations with the aim of making them more evidence based. In the time since the original recommendations, there have been a considerable number of individual trials examining pharmacological and non-pharmacological interventions and, moreover, there have been systematic reviews conducted for nearly all of the commonly used management strategies. Our aim therefore was, using the systematic reviews conducted and taking into account their quality, to make evidence-based recommendations for the use of individual pharmacological and non-pharmacological approaches, and how these could be combined. Further, we aimed to identify priority areas for future research.
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