Objectives: To evaluate the feasibility of the substitution by a specialised rheumatology nurse in the diagnosis of fibromyalgia from the perspective of safety, satisfaction and health status.
Methods: Hundred ninety-three patients, referred by the GP on suspicion of fibromyalgia, were randomized: 97 to the early referral group and, 96 to the control group. In the early referral group, patients were seen within 2-3 weeks by a specialised rheumatology nurse who took a structured history and initiated protocolled screening diagnostics (blood determination of Hb, ESR, CRP, TSH, serum alkaline phosphatase and creatinine). During a standard supervision, the rheumatologist was informed by the nurse, performed a brief physical examination and confirmed or rejected the diagnosis of the specialised nurse. Patients in the control group were managed as usual; they were seen by the rheumatologist after a regular waiting period of about three months.
Feasibility was measured by patient satisfaction, satisfaction of health care provider (nurse and doctor), change in health status (EQ-5D) between start with study and 9 months follow-up, and number of missed diagnoses.
Results: The mean waiting time after randomisation was 2.8 weeks in the early referral group and 12.1 weeks in the control group. In the control group, 7 patients cancelled their appointment because of the waiting time. Patients in the intervention group were significantly more satisfied with their diagnostic process: they found the waiting time more acceptable (p≤0.0001), felt more free to tell their story (p=0.004) and felt more reassured (p=0.003); the specialised rheumatology nurse had more attention for the (psycho)social aspects of their complaints (p≤0.0001), took more time (p=0.002), gave more and clearer information (p=0.002) and gave more (useful) advises (p≤0.0001). In the control group, 78.3% of the patients indicated in retrospect, that they would have preferred a specialised nurse over the rheumatologist, would they have been given the option. Contrarily, in the intervention group only 6.7% indicated that they would have preferred the rheumatologist over a specialised nurse. The supervision of the rheumatologist was experienced of additional value by 88.0%. All involved health care providers were very satisfied with the substitution by a specialised rheumatology nurse in the diagnosis of FM.
After 9 months follow-up, a slight improvement in health status (EQ-5D and thermometer) was found in both groups. In both groups, none of the diagnoses was changed 12-24 months after randomization..
The intervention group had less contacts with a rheumatologist or specialised rheumatology nurse than the control group (p=0.044). In the intervention group, FM was significantly more diagnosed than in the control group.

Conclusion: The results suggest that it is feasible to deploy a specialised rheumatology nurse supervised by a rheumatologist in the diagnosis of FM. Patients are more satisfied with a supervised, protocolled consultation of the specialised rheumatology nurse than with the consultation of the rheumatologist. In both groups, none of the diagnoses were changed 12-24 months follow-up.