Il 12 maggio and the World Fibromyalgia Daya clinical condition known for some time but which only in recent years has received a more precise scientific definition and formal recognition: in 1992, the World Health Organization recognized fibromyalgia as a pathology.
Both Ferrara Health Authorities are involved in the management of the pathology, with dedicated Operational Units and Services.
THE MAIN ROLE OF THE RHEUMATOLOGY OPERATIONAL UNIT OF THE UNIVERSITY HOSPITAL OF FERRARA (directed by prof. Marcello Govoni) in the treatment of this pathology consists above all inconsultancy activities for ascertaining the diagnosis in doubtful cases and in collaboration for the management of cases refractory to standard first level therapies. The care of the patient suffering from fibromyalgia takes place in the context of Primary Care, by the General Practitioner (GP) who makes use, in appropriately selected cases, of the support of a multi-professional and interdisciplinary team. Patients can access the general specialist clinic with a simple referral from their doctor for an initial rheumatological visit. This is very important to know correctly intercept the pathology to avoid unnecessary (or even harmful) treatments for patients and to direct them to the most appropriate path for them in collaboration with GPs and other professionals (pain therapists, psychologists, physiatrists, physiotherapists, occupational therapists).
At Sant’Anna Rheumatology, for a few years, the Dr. Cecilia de GiorgioAMPA kinesiologist (Preventive and Adapted Motor Activity) care individualized physical activity projects and programs for small groups of patients suffering from this disease and other rheumatological pathologies that belong to the Rheumatology Center of the Cona hospital. During this year, regional funding was assigned to the Local Health Authority of Ferrara and intended for the implementation of a project (soon to be activated), in collaboration with the local rheumatology specialists and theClinical and Community Psychology Operational Unitentitled “Remote physical activity program for maintaining physical performance, consultation and psychological support in patients with fibromyalgia”.
For some years, thanks to a Intercompany agreement between the University Hospital and the Local Health Authority of Ferraraadditional hours were also made available specialist activity, at a local level, specifically dedicated to patients suffering from fibromyalgia. There is also a close collaboration with theRegional Association of Rheumatic Patients (AMRER) with which educational initiatives are organised. The Association also provides information support for patients also regarding therapeutic courses of adapted physical activity – available at various spa establishments in the Emilia-Romagna region – with which ad hoc agreements have been put in place (“hydro courses -fibromyalgia at the spa in Emilia-Romagna”).
Furthermore, the Rheumatology Operational Unit of S.Anna actively collaborated in the drafting of a regional document (among the first in Italy)published in February 2018: “Guidelines for the diagnosis and treatment of Fibromyalgia”.
“The fibromyalgia patient – highlights the prof. Govoni – Still Today he is, in many ways, an “orphan” patient in terms of taking charge and the most appropriate treatment paths. It is therefore necessary to clearly define the roles and tasks of the various health professionals in patient management, share strategies and therapeutic paths in an interdisciplinary way – based on solid scientific evidence – and provide general practitioners with useful indications for the management of these patients in the context of primary care. The epidemiological data tell us about very substantial numbers of patients; however, it should be remembered that the most serious cases, which have a heavy impact on the quality of life, are fortunately much fewer. It is therefore very important that certification of the diagnosis, definition of the level of severity, need for treatment and tests are clearly defined”.
THE ROLE OF THE USL COMPANY. The territorial rheumatology network of the Local Health Authority of Ferrara – whose Referent and the Dr. Ilaria Farina – is present on all the Districts of the province (Central North, South East and West). The AUSL specialist rheumatology activity is carried out at the Community Houses of San Rocco Citadel of Ferrara, Lands and Rivers of Copparo, Portomaggiore – Ostellato and Comacchio. Furthermore, it is carried out atDelta hospital a Lagosanto, l’“Santissima Annunziata” hospital in Cento and the“Mazzolani – Vandini” hospital in Argenta.
The first rheumatological visits are carried out in the area – requested by GPs or other specialists – which can be booked at the pharmacy, for patients with suspected rheumatological pathologies, including fibromyalgia. The rheumatology specialists in the area are trained by long years of experience and study in the recognition of the pathology. After the diagnosis, care and management over time can be guaranteed for a constant and accurate evaluation.
Implementing Hospital – Territory integration and multi-professional collaboration has the objective of providing these patients with a complete care network aimed at reducing the impact that this pathology has on the quality of life and on society.
THE ROLE OF THE EMILIA-ROMAGNA REGION. In 2016 the Emilia-Romagna Region established a multidisciplinary technical working group for the development of guidelines that contain precise diagnosis criteria, developed on the basis of international and national scientific evidence to identify fibromyalgia, particularly in the most severe forms and disabling; as well as providing indications for the treatment of people affected by this pathology. The Region has also decided to distribute over 380 thousand euros of state funding among the health authorities of Emilia-Romagna, for the implementation of the paths and activities envisaged in the guidelines, part of which (€32,888) assigned to the Local Health Authority of Ferrara.
THE ILLNESS. It is a complex pathology, classified by the Italian Society of Rheumatology among the widespread forms of extra-articular diseases and painful syndromes. The clinical picture is dominated by the symptom of pain but can be very varied, including other somatic and autonomic symptoms, such as tension headache or migraine, irritable bowel syndrome, dysmenorrhea, a state of generalized weakness, sleep disorders, mood disorders ( anxiety, depression), cognitive disorders. The diagnosis is essentially clinical, but may require the aid of some laboratory and instrumental tests to exclude other pathologies. The therapeutic approach, although international indications exist (EULAR guidelines), is still based heavily on the clinician’s experience and makes use of a articulated approach and, necessarily individualized, and adapt to the individual patient based on the dominant type of symptoms. It also involves a primarily non-pharmacological approach (gentle gymnastics, aerobic physical activity, cognitive-behavioural pathways), but also pharmacological. Although the disease is not life-threatening, its impact on the patient’s quality of life can be very significant.
Fibromyalgia is more common in women than men and can develop at any age. Its prevalence is estimated to be between 2-3% and 8% and the incidence between 7-11 cases per year per 1,000 people.