On the surface, the 2 articles by Wolfe et a1 in this issue of Arthritis & Rheumatism (1,2) give chilling messages: first, fibromyalgia costs as much or more than other rheumatic conditions, and, second, patients with fibromyalgia, managed by the experts, do not get better, in general, over an average 7-year followup. These findings are significant contributions from distinguished physicians who have done much to increase our understanding of fibromyalgia.
The authors followed up, over a period of 7 years, 538 patients whose median duration of disease at enrollment was 7.8 years. Patients from Wichita were enrolled consecutively, and the subjects form the other 5 centers were a quota of patients selected "on a most recently seen basis." Overall, the mean pain, physical disability, fatigue, and depression scores were constant over the followup period; mean yearly medical costs based on the patients' reports were calculated to be $2,274, similar to self-reported costs for osteoarthritis.
The authors discuss the limitations of the studies, and we would emphasize several methodologic points. First, the method of subject ascertainment limits the internal validity and generalizability of the findings. The subjects are really 2 different cohorts assembled 14 years apart; the number of dropouts and the amount of