[Care pathway to diagnosis in fibromyalgia and inflammatory rheumatic diseases: A patient-centered approach using a comparative mixed-methods study].

BACKGROUND

Many doctors have a complicated relationship with patients with fibromyalgia (FM), whereas they feel more comfortable with patients with well-defined clinico-biological illnesses. The aim of the study was to compare the care pathways as experienced by patients with FM or those facing well-defined rheumatic diseases.

METHODS

Consecutive participants diagnosed with FM, spondyloarthritis (SpA), or rheumatoid arthritis (RA) were prospectively recruited from a tertiary outpatient center. Utilizing a semi-structured guide, participants were interviewed. A quantitative analysis compared medical pathway characteristics, and a qualitative analysis explored their experiences.

RESULTS

Nineteen participants with FM and 18 with PR or SpA were included. Patients with FM exhibited increased consumption of medical care, a stronger impact on their daily lives, and a diagnostic delay that was seven times longer. All participants reported an overwhelming experience of pain and a perceived lack of credibility regarding this pain. An altered doctor-patient relationship was more prevalent among participants with FM, who expressed pessimism, feelings of rejection, and an increased need for attentive listening.

CONCLUSION

Compared to usual rheumatic diseases, fibromyalgia is characterized by a prolonged diagnostic latency and faces a lack of acknowledgment, leading to a distortion in the doctor-patient relationship. However, whatever the underlying disease, patients report a lack of consideration of their pain, as long as it is unexplained.