New fibromyalgia guidelines published by EULAR

The European League Against Rheumatism (EULAR) has published updated guidelines on fibromyalgia, providing evidence-based recommendations, including non-drug tools and psychological interventions for the management of the condition.

The new recommendations represent the first update to the EULAR guidelines for fibromyalgia management for more than a decade and include evidence to support pharmacologic, non-pharmacologic, complementary, and alternative medicines and treatment.

The working group, which included 18 members from 12 European countries, reviewed data from 107 systematic reviews and/or meta-analyses. The authors found the strongest evidence for patient education and nonpharmacologic intervention (exercise) as part of initial therapy. Beyond this, the recommendations highlighted the need for an individualised approach, which may include pharmacologic, psychological, and/or rehabilitative interventions, depending on the individual patient. The authors caution, however, that the “size of effect for many treatments is relatively modest,” and that further research is needed to determine optimal treatment strategies and improve patient outcomes.

When evaluating the data, the researchers took into account factors such as the number of trials, number of patients, outcomes assessed, and adverse events. The group then based recommendations on a 4-point scale (“strong for/weak for/weak against/strong against”), with the strength of the recommendation based on “the balance between desirable and undesirable effects (considering values and preferences), confidence in the magnitude of effects and resource use.”

In addition to the new recommendations, the committee highlighted five priority questions for research, including:

• Is monotherapy better than a multimodal approach?
• What type of exercise is most beneficial (strength or aerobic training)?
• Do patient characteristics predict therapeutic response?
• Does fibromyalgia with concurrent inflammatory joint disease require a different therapeutic approach?
• Who is best equipped to manage patients with fibromyalgia?

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