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Lipedema diagnosis is heavily reliant on patient history. Various objective assessments have been suggested; however, a standardized measurement process is lacking. A systematic review was undertaken to identify which imaging and measurement tools are used in lipedema quantification and to review their protocols. Six databases were searched with two reviewers screening citations for inclusion. Full peer-reviewed publications that included defined lipedema diagnosis criteria, no male cases within comparative cohorts, and used an imaging or measurement tool to quantify lipedema were included. Twenty studies met the inclusion criteria using 13 different tools to quantify individual physical lipedema characteristics to either enable differential diagnosis, and/or quantify treatment effect: tape measure, perometry, durometry, tonometry, bioimpedance spectroscopy, tissue di-electric constant, ultrasound, Dual-Energy X-ray Absorptiometry, magnetic resonance imaging (MRI), noncontrast MRI lymphangiography, Indocyanine green lymphography, lymphoscintigraphy, and dynamic lymphangiography. Eight imaging and five measurement tools assessed lymphatic transport disturbances (n = 8), limb size/volume (n = 4), adipose tissue thickness/mass/volume (n = 3), and tissue fluid presence (n = 2). Multiple tools were only used in studies completed in 2020 or later. A lack of consistency exists in tool protocols, measurement locations, and outcome analysis. Limited reporting of clinimetrics with data derived from small cohorts and heterogenous populations impacted the ability to recommend tools for clinical practice and research. Various tools were used for objective lipedema assessment; however, consistency in approach was lacking. Further investigations are required to establish the validity and reliability of measurement and imaging tools, protocols, measurement points, and outcome reporting/interpretation to quantify the physical attributes of lipedema.
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OBJECTIVES: To evaluate the presence of lipedema and lipedema-related factors in fibromyalgia patients. METHODS: The study included 100 female patients over the age of 18 who met the fibromyalgia diagnostic criteria. The patients were evaluated for the presence/stages of lipedema. The body mass index (BMI), waist-hip ratio, waist-height ratio, and presence of hematoma tendency/telangiectasias were recorded. Patients were asked to mark the severity of their pain (widespread/on lipedema) on a 10 cm visual analog scale (VAS). The ACR 2016 Fibromyalgia Diagnostic Criteria, The Beck Depression Inventory (BDI), and The Revised Fibromyalgia Impact Questionnaire were applied. RESULTS: Lipedema was observed in 50% of the patients (58% Stage 1 lipedema). In the lipedema group, age, duration of fibromyalgia diagnosis, hematoma tendency/presence of telangiectasias (for all; p < .001), menopausal status (p = .004), BDI score (p = .04), BMI (p = .02), history of medication for fibromyalgia (p = .01) were higher, and age at menarche (p = .01) was lower. Lipedema stage was moderately positively correlated with BMI, number of pregnancies (for both; r:0.53 p < .001) and waist-height ratio (r:0.43 p:0.002), while VAS-lipedema pain intensity was strongly positively correlated with VAS-widespread pain intensity (r:0.62 p < .001), and moderately positively correlated with symptom severity score (r:0.55 p < .001), BMI (r:0.54 p < .001), and fibromyalgia severity score (r:0.51 p < .001). Long fibromyalgia diagnosis time (p: 0.005), and low age at menarche (p: 0.05) were significant risk factors for the presence of lipedema. CONCLUSIONS: Lipedema is common in fibromyalgia patients. Long fibromyalgia diagnosis time and low age at menarche are significant risk factors for the presence of lipedema.
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Lipedema, historically underrecognized, has recently gained attention due to advancements in research and growing public awareness. The Brazilian Consensus Statement on Lipedema, developed by the Brazilian Society of Angiology and Vascular Surgery, aims to establish clear recommendations for the diagnosis, treatment, and management of lipedema. Using the Delphi methodology, experts elaborated 90 statements about lipedema, which were then evaluated by a panel of 113 professionals. The statements were analyzed using SurveyMonkey, with a 75% agreement threshold required for their inclusion in the consensus statement. Most statements achieved significant consensus, with only 9 topics requiring further investigation. This consensus statement highlights the complexity of lipedema, the effectiveness of conservative treatment over surgery, the need for multidisciplinary approaches, and the importance of awareness to reduce underdiagnosis and stigma. It also underscores the ongoing need for research to develop more effective management strategies.