Insights into diagnosis and treatment of fibromyalgia among Moroccan rheumatologists: a cross sectional online survey.

Introduction: This study outlines the diagnostic and therapeutic approaches - both pharmacological and non-pharmacological - used by Moroccan rheumatologists in managing fibromyalgia (FM). It also addresses other key aspects, such as assessing the psychosocial context of patients and referring them to other medical specialties.

Material and methods: A descriptive cross-sectional study was conducted using a survey designed to assess the management approach of Moroccan rheumatologists towards FM. The survey was carried out anonymously.

Results: Out of 275 rheumatologists, 140 responded to the questionnaire (with a total of approximately 450 rheumatologists in Morocco). Ninety-nine percent (n = 139) reported encountering FM patients in their practice. Diagnosis of FM was predominantly based on clinical assessment without a scoring system (n = 66; 47%), while 20.7% (n = 29) used the FIRST score. A substantial proportion (70%) of participants requested biological and imaging workups despite apparent FM, with 92% (n = 129) opting for an inflammatory workup. Regarding the treatment aspect, paracetamol was the first-line analgesic prescribed by 58% (n = 81), followed by tramadol (n = 43; 30.9%). Pregabalin was the most commonly prescribed first-line treatment (n = 37; 27.4%), with antidepressants being the second-line choice in 35.8% (n = 42). Non-pharmacological treatments such as physical therapy, therapeutic education, and psychotherapy were the most highly recommended. Nearly all rheumatologists (n = 131; 93.6%) emphasized the need for multidisciplinary management for FM patients, often referring them to psychiatrists either alone or in conjunction with other specialists.

Conclusions: Diagnosing and treating FM presents significant challenges. This survey sheds light on the diverse approaches adopted by Moroccan rheumatologists towards managing patients with FM, emphasizing the importance of multidisciplinary care in addressing the complex needs of these patients.