CO:07:6 | Hidden in plain sight: fibromyalgia prevalence and correlates in 3,000 non-clinical Italian subjects
Abstract
Background. To determine the prevalence of fibromyalgia according to the ACR2016 criteria in a non-clinical Italian population and to identify significant demographic, clinical and lifestyle correlates.
Materials and Methods. A voluntary survey was distributed across various Italian regions to randomly selected individuals from the general population. The survey included questions regarding demographic information, ACR 2016 fibromyalgia diagnostic criteria, sleep quality measures, physical activity levels, and comprehensive health history. Descriptive statistics, group comparisons, and multivariate logistic regression were employed to analyze data.
Results. 3.000 participants were recruited (68.5% female, mean age 36.17±15.91, mean BMI 23.70±3.97). 5.1% (Table 1) met the ACR 2016 diagnostic criteria, with a WPI of 8.42±2.54 and SS score of 8.33±2.01, compared to 1.50±1.50 and 3.36±2.14 respectively in non-fibromyalgia subjects (p<0.0001). Fibromyalgia prevalence was higher in females (6.76%) than males (1.48%, p=0.0001), with increased prevalence in older age groups (Figure 1. 3.54% in 18-30y vs 8.23% in 51-60y, p=0.001). BMI extremes showed higher prevalence (8.11% in BMI<18.5 and 10.29% in BMI>29.9 vs 4.11% in normal BMI, p=0.0014). Those who reported physical inactivity showed higher fibromyalgia prevalence (6.46% in sedentary, 3.57% in those exercising 3-4 times/week, p=0.04). Also, fibromyalgia was more prevalent among those reporting very poor sleep (49.32%) compared to very good sleep (1.00%, p<0.001). Sleep duration was shorter in the fibromyalgia group (5.99±1.65 vs 6.85±1.00 hours, p<0.0001). In females, fibromyalgia prevalence was highest in those with surgical menopause (17.46%), followed by physiological menopause (11.04%), compared to 3.64% in those with regular cycles (p=0.001). Family history of fibromyalgia (Table 2) was higher in the fibromyalgia group (28.76% vs 6.99%, p<0.0001), as was family history for other rheumatologic disorders. In non-fibromyalgia subjects, fibromyalgia family history was associated with higher SS total scores (3.86±2.02 vs 3.32±2.15, p=0.0004) and sub-scores. In fibromyalgia subjects, WPI was higher in those with family history (9.14±2.91 vs 8.14±2.33, p=0.046). Multivariate analysis revealed gender-specific associations. In males, associations with fibromyalgia diagnosis included sleep duration (OR=0.29, 95%CI 0.16-0.52), positive family history (OR=8.90, 95%CI 2.35-33.74), and a non-linear BMI relationship. In females, fibromyalgia was associated with sleep duration (OR=0.62, 95%CI 0.53-0.72), family history (OR=4.11, 95%CI 2.65-6.37), and menstrual irregularities, especially surgical menopause (OR=3.02, 95%CI 1.19-7.67).
Conclusions. This study identifies a 5.1% prevalence of fibromyalgia in a non-clinical Italian population, with higher frequency in females. Increased prevalence was found with older ages, BMI extremes, physical inactivity and poor sleep quality. Menstrual irregularities demonstrated relationships with fibromyalgia prevalence, with elevated rates among women with surgical menopause. Family history correlated with WPI and SS scores, as well as fibromyalgia diagnosis, suggesting potential genetic factors. 
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