Instituto Nacional de Cardiología Ciudad de México, Federal District, Mexico
Viridiana Del Río Guerrero1, Laura Aline Martínez Martínez1, Karina Arias Callejas1, Natalia Carbonell-Bobadilla2, Alejandra Mejía Segura1, Gibrán Azamar Morales1, Alejandra Espinosa Orantes1, Mauricio Mora Ramírez1, Fernanda Mejía Ávila1, Raúl Molina Sánchez1, Angélica Vargas-Guerrero1, Luis H Silveira1 and Manuel Martínez-Lavín3, 1Instituto Nacional de Cardiología, Ciudad de México, Mexico, 2National Institute of Cardiology Ignacio Chávez, Ciudad de México, Mexico, 3Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
Background/Purpose: Allodynia is a key fibromyalgia (FM) feature. Women suffering from FM display more often sphygmomanometry-elicited allodynia when compared to women with osteoarthritis, rheumatoid arthritis or healthy controls [1]. The importance of recognizing FM in a Rheumatology clinic cannot be overstated. FM overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Proper FM diagnosis leads to more effective multimodal therapy. For epidemiological purposes FM can now be identified using the 2016 Wolfe et al FM diagnostic criteria questionnaire.
Sphygmomanometry is a simple mandatory test in all clinical settings. The objective of this cross-sectional study was to define if sphygmomanometry is a useful screening tool for FM identification in a Rheumatology outpatient clinic.
Methods: All patients attending our adult Rheumatology outpatient clinic were invited to participate. Before their medical consultation they filled-out the 2016 Wolfe et al FM diagnostic criteria questionnaire. Then a Rheumatologist-in-training, unaware of the questionnaire calculation, performed the routine medical visit. During physical examination the following query was posed to all patients: "I am going to take your blood pressure, tell me if the cuff´s pressure brings forth pain". Blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry-induced allodynia was defined as any local discomfort elicited during blood pressure testing. If a patient voiced any discomfort, a follow-up dichotomic question ensued; "did it hurt much or little".
Results: Of the first 268 studied patients, 215 (80.2%) were female. Female cohort displayed the following features; 24.3% had FM according to Wolfe et al 2016 diagnostic criteria, 23.8% had sphygmomanometry-induced allodynia, 7.5% had "much" local pain elicitation during blood pressure testing. Sphygmomanometry-induced allodynia was more frequent in women with FM (55.8%) versus women without FM (13.6%) p = 0.0001. Sphygmomanometry-evoked allodynia had 56% sensitivity and 86% specificity for FM diagnosis. Moreover, having "much" local pain elicitation during sphygmomanometry had 97.1% specificity for FM diagnosis.
Men behaved differently; 18.9% fulfilled FM diagnostic criteria, but only 1.9% had sphygmomanometry-evoked allodynia.
Conclusion: In this Rheumatology outpatient clinic, there was an unexpected high FM prevalence. Inquiring female patients for local discomfort during sphygmomanometry is a simple helpful FM screening procedure that can be implemented in all clinical settings. Substantial local pain elicitation during blood pressure testing strongly indicates the presence of FM.
Disclosures: V. Del Río Guerrero, None; L. Martínez Martínez, None; K. Arias Callejas, None; N. Carbonell-Bobadilla, None; A. Mejía Segura, None; G. Azamar Morales, None; A. Espinosa Orantes, None; M. Mora Ramírez, None; F. Mejía Ávila, None; R. Molina Sánchez, None; A. Vargas-Guerrero, None; L. Silveira, None; M. Martínez-Lavín, None.
