EULAR Revised Recommendations for Fibromyalgia Save

The European League Against Rheumatism (EULAR) has published updated recommendations on the management of fibromyalgia in the Annals of the Rheumatic Diseases (Citation source http://buff.ly/29I7e8C). 

Using the GRADE system, a multidisciplinary group of physicians from 12 countries sought to evaluate the literature and update the EULAR 2005 recommendations, specifically focusing on pharmacological/non-pharmacological management of fibromyalgia and the outcomes of pain, fatigue, sleep, and daily functioning. 

A total of 2,979 articles were identified, of which 275 full papers and 106 reviews and/or meta-analyses were eligible. Pharmacological treatments reviewed included amitriptyline, anticonvulsants, growth hormone, monoamine oxidase inhibitors (MAOIs), non-steroidal anti-inflammatory drugs (NSAIDs), serotonin-noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors, sodium oxybate, and tramadol. Non-pharmacologic treatments reviewed included acupuncture, capsaicin, exercise, massage, mindfulness/mind-body therapy, among others. 

Analysis of the meta-analyses showed that exercise received a "strong for" recommendation. According to expert opinion, a graduated approach should begin with patient education and non-pharmacological treatments. If non-responsive, additional therapies should be considered and tailored using psychological therapies, pharmacotherapy for severe pain or sleep disturbance, and a multimodal rehabilitation program for severe disability. Despite the recommendation, these were evaluated as "weak" based on available data. 

While other countries (Canada, Israel) have guidelines with strong recommendations for anticonvulsants (pregabalin, gabapentin) and SNRIs (duloxetine, milnacipran), the updated EULAR guidelines only provide a weak one. 

These EULAR recommendations are based on high-quality reviews and meta-analyses. The authors call for more research to determine who will benefit from specific interventions for fibromyalgia.