Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Fibromyalgia in Spondyloarthritis: Prevalence and Effect on Disease Activity and Treatment

Author(s): Saidane Olfa, Selma Bouden*, Meriam Sahli, Aicha Ben Tekaya, Leila Rouached, Tekaya Rawdha, Ines Mahmoud and Leila Abdelmoula

Volume 19, Issue 2, 2023

Published on: 10 October, 2022

Page: [214 - 221] Pages: 8

DOI: 10.2174/1573397118666220902100151

Price: $65

Abstract

Background: Fibromyalgia may be associated to Spondyloarthritis with which it shares some common symptoms such as sleep disorders, fatigue and diffuse pain, leading to diagnostic and treatment dilemmas.

Objectives: We aimed to determine the prevalence of fibromyalgia in axial spondyloarthritis and to determine how fibromyalgia might influence the assessments of disease activity and how it might impact treatment.

Methods: An observational cross-sectional study was conducted. The study included 100 patients with axial spondyloarthritis according to the Assessment of SpondyloArthritis international Society criteria. Fibromyalgia was diagnosed based on the 2010 American College of Rheumatology criteria. Demographics, disease characteristics, activity parameters and treatment were compared between patients with and without fibromyalgia. Patients were recruited from the hospitalization unit and the outpatient clinic of rheumatology.

Results: The mean age of patients was 44.65 ± 13.13 years, with a sex ratio equal to 2. The prevalence of fibromyalgia was 20%. Fibromyalgia associated factors were advanced age and a late age at the onset of axial spondyloarthritis. Disease activity parameters such as global pain VAS, BASDAI, ASDAS-ESR, ASDAS-CRP, BASFI and BAS-G as well as MASES and BASMI were significantly higher in the presence of FM. Doses of paracetamol were significantly higher among FM+ patients. Also, treatment duration of the current anti-TNF alpha agent was significantly shorter among FM+ patients.

Conclusion: Our study showed that fibromyalgia was associated with axial spondyloarthritis in 20% of patients. Its presence was associated with higher disease activity parameters and negative impact on the treatment.

Keywords: Fibromyalgia, spondyloarthritis, prevalence, disease activity, BASDAI, ASDAS, TNF alpha blockers treatment

Graphical Abstract

[1]
Mease P, Arnold LM, Choy EH, et al. Fibromyalgia syndrome module at OMERACT 9: Domain construct. J Rheumatol 2009; 36(10): 2318-29.
[http://dx.doi.org/10.3899/jrheum.090367] [PMID: 19820221]
[2]
Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W. Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias. PLoS One 2018; 13(9): e0203755.
[http://dx.doi.org/10.1371/journal.pone.0203755] [PMID: 30212526]
[3]
Yunus MB. The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat 2012; 2012: 584573.
[http://dx.doi.org/10.1155/2012/584573] [PMID: 22191024]
[4]
Heikkilä S, Ronni S, Kautiainen HJ, Kauppi MJ. Functional impairment in spondyloarthropathy and fibromyalgia. J Rheumatol 2002; 29(7): 1415-9.
[PMID: 12136899]
[5]
Dougados M, Perrot S. Fibromyalgia and central sensitization in chronic inflammatory joint diseases. Joint Bone Spine 2017; 84(5): 511-3.
[http://dx.doi.org/10.1016/j.jbspin.2017.03.001] [PMID: 28300697]
[6]
Salaffi F, Gerardi MC, Atzeni F, et al. The influence of fibromyalgia on achieving remission in patients with long standing rheumatoid arthritis. Rheumatol Int 2017; 37(12): 2035-42.
[http://dx.doi.org/10.1007/s00296-017-3792-4] [PMID: 28875224]
[7]
Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009; 68(6): 777-83.
[http://dx.doi.org/10.1136/ard.2009.108233] [PMID: 19297344]
[8]
Almodóvar R, Carmona L, Zarco P, et al. Fibromyalgia in patients with ankylosing spondylitis: Prevalence and utility of the measures of activity, function and radiological damage. Clin Exp Rheumatol 2010; 28(6)(63): S33-9.
[PMID: 21176420]
[9]
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: The bath ankylosing spondylitis disease activity index. J Rheumatol 1994; 21(12): 2286-91.
[PMID: 7699630]
[10]
Lukas C, Landewé R, Sieper J, et al. Development of an ASAS endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009; 68(1): 18-24.
[http://dx.doi.org/10.1136/ard.2008.094870] [PMID: 18625618]
[11]
Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: The development of the bath ankylosing spondylitis functional index. J Rheumatol 1994; 21(12): 2281-5.
[PMID: 7699629]
[12]
Jones SD, Steiner A, Garrett SL, Calin A. The bath ankylosing spondylitis patient global score (BAS-G). Br J Rheumatol 1996; 35(1): 66-71.
[http://dx.doi.org/10.1093/rheumatology/35.1.66] [PMID: 8624626]
[13]
Lequesne MG. The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 1997; 24(4): 779-81.
[PMID: 9101517]
[14]
Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The bath AS metrology index. J Rheumatol 1994; 21(9): 1694-8.
[PMID: 7799351]
[15]
Heuft DL, Spoorenberg A, Tubergen A, et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003; 62(2): 127-32.
[http://dx.doi.org/10.1136/ard.62.2.127] [PMID: 12525381]
[16]
Creemers MC, Franssen MJ, Hof MA, Gribnau FWJ, Putte LBA, Riel PLCM. Assessment of outcome in ankylosing spondylitis: An extended radiographic scoring system. Ann Rheum Dis 2005; 64(1): 127-9.
[http://dx.doi.org/10.1136/ard.2004.020503] [PMID: 15051621]
[17]
Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011; 38(6): 1113-22.
[http://dx.doi.org/10.3899/jrheum.100594] [PMID: 21285161]
[18]
Kim SM, Lee SH, Kim HR. Applying the ACR preliminary diagnostic criteria in the diagnosis and assessment of fibromyalgia. Korean J Pain 2012; 25(3): 173-82.
[http://dx.doi.org/10.3344/kjp.2012.25.3.173] [PMID: 22787548]
[19]
Azevedo VF, Paiva E, Felippe LR, Moreira RA. Occurrence of fibromyalgia in patients with ankylosing spondylitis. Rev Bras Reumatol 2010; 50(6): 646-50.
[http://dx.doi.org/10.1590/S0482-50042010000600005] [PMID: 21243305]
[20]
Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi PP, Atzeni F. Fibromyalgia in patients with axial spondyloarthritis: Epidemiological profile and effect on measures of disease activity. Rheumatol Int 2014; 34(8): 1103-10.
[http://dx.doi.org/10.1007/s00296-014-2955-9] [PMID: 24509896]
[21]
Haliloglu S, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A. Fibromyalgia in patients with other rheumatic diseases: Prevalence and relationship with disease activity. Rheumatol Int 2014; 34(9): 1275-80.
[http://dx.doi.org/10.1007/s00296-014-2972-8] [PMID: 24589726]
[22]
Graceffa D, Maiani E, Sperduti I, Ceralli F, Bonifati C. Clinical remission of psoriatic arthritis in patients receiving continuous biological therapies for 1 year: The experience of an outpatient dermatological clinic for psoriasis. Clin Exp Dermatol 2015; 40(2): 136-41.
[http://dx.doi.org/10.1111/ced.12504] [PMID: 25438647]
[23]
Baraliakos X, Regel A, Kiltz U, et al. Patients with fibromyalgia (FM) do not fulfill classification criteria for axial spondyloarthritis (AXSPA) but patients with axspa may fulfill classification criteria for FM. Ann Rheum Dis 2015; 74(2): S80.
[http://dx.doi.org/10.1136/annrheumdis-2015-eular.5965]
[24]
Magrey MN, Diomampo S, Khan MA. Do validated tools of disease activity in ankylosing spondylitis measure fibromyalgia pain? Arthritis Rheumatol 2016; 68(10): 1.
[25]
Bello N, Etcheto A, Béal C, Dougados M, Moltó A. Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis Res Ther 2016; 18: 42.
[http://dx.doi.org/10.1186/s13075-016-0943-z] [PMID: 26860612]
[26]
Wach J, Letroublon MC, Coury F, Tebib JG. Fibromyalgia in spondyloarthritis: Effect on disease activity assessment in clinical practice. J Rheumatol 2016; 43(11): 2056-63.
[http://dx.doi.org/10.3899/jrheum.160104] [PMID: 27633820]
[27]
Moltó A, Etcheto A, Gossec L, et al. Evaluation of the impact of concomitant fibromyalgia on TNF alpha blockers’ effectiveness in axial spondyloarthritis: Results of a prospective, multicentre study. Ann Rheum Dis 2018; 77(4): 533-40.
[http://dx.doi.org/10.1136/annrheumdis-2017-212378] [PMID: 29183878]
[28]
Fan A, Pereira B, Tournadre A, et al. Frequency of concomitant fibromyalgia in rheumatic diseases: Monocentric study of 691 patients. Semin Arthritis Rheum 2017; 47(1): 129-32.
[http://dx.doi.org/10.1016/j.semarthrit.2017.01.005] [PMID: 28216193]
[29]
Macfarlane GJ, Barnish MS, Pathan E, et al. Co occurrence and characteristics of patients with axial spondyloarthritis who meet criteria for fibromyalgia: Results from a UK national register. Arthritis Rheumatol 2017; 69(11): 2144-50.
[http://dx.doi.org/10.1002/art.40185] [PMID: 28622461]
[30]
Amiri A, Sedighi O. Prevalence of fibromyalgia in patients with ankylosing spondylitis. Med J DY Patil Univ 2014; 7(3): 338-41.
[http://dx.doi.org/10.4103/0975-2870.128977]
[31]
Baraliakos X, Regel A, Kiltz U, et al. Patients with fibromyalgia rarely fulfil classification criteria for axial spondyloarthritis. Rheumatology (Oxford) 2018; 57(9): 1541-7.
[http://dx.doi.org/10.1093/rheumatology/kex318] [PMID: 28968885]
[32]
Rençber N, Saglam G, Hüner B, Kuru O. Presence of fibromyalgia syndrome and its relationship with clinical parameters in patients with axial spondyloarthritis. Pain Physician 2019; 22(6): E579-85.
[PMID: 31775411]
[33]
Fan A, Tournadre A, Pereira B, et al. Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases. Rheumatology (Oxford) 2016; 55(10): 1746-50.
[http://dx.doi.org/10.1093/rheumatology/kew244] [PMID: 27313278]
[34]
Brikman S, Furer V, Wollman J, et al. The effect of the presence of fibromyalgia on common clinical disease activity indices in patients with psoriatic arthritis: A cross-sectional study. J Rheumatol 2016; 43(9): 1749-54.
[http://dx.doi.org/10.3899/jrheum.151491] [PMID: 27252430]
[35]
Buskila D, Neumann L, Sibirski D, Shvartzman P. Awareness of diagnostic and clinical features of fibromyalgia among family physicians. Fam Pract 1997; 14(3): 238-41.
[http://dx.doi.org/10.1093/fampra/14.3.238] [PMID: 9201499]
[36]
Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010; 62(5): 600-10.
[http://dx.doi.org/10.1002/acr.20140] [PMID: 20461783]
[37]
Choy EH, Arnold LM, Clauw DJ, et al. Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome. J Rheumatol 2009; 36(10): 2330-4.
[http://dx.doi.org/10.3899/jrheum.090368] [PMID: 19820222]
[38]
Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46(3): 319-29.
[http://dx.doi.org/10.1016/j.semarthrit.2016.08.012] [PMID: 27916278]
[39]
Bellato E, Marini E, Castoldi F, et al. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat 2012; 2012: 1-17.
[http://dx.doi.org/10.1155/2012/426130]
[40]
Altan L, Sivrioglu Y, Ercan I. Can bath ankylosing spondylitis disease activity index be affected by accompanying fibromyalgia or depression? Arch Rheumatol 2015; 30(1): 34-9.
[http://dx.doi.org/10.5606/ArchRheumatol.2015.4801]
[41]
Leung YY, Thumboo J. Fibromyalgia as a contextual factor influencing disease activity measurements in spondyloarthritis and psoriatic arthritis. J Rheumatol 2016; 43(11): 1953-5.
[http://dx.doi.org/10.3899/jrheum.161156] [PMID: 27803340]
[42]
Roussou E, Ciurtin C. Clinical overlap between fibromyalgia tender points and enthesitis sites in patients with spondyloarthritis who present with inflammatory back pain. Clin Exp Rheumatol 2012; 30(6) (Suppl. 74): 24-30.
[PMID: 22935170]
[43]
Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O. Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 2007; 27(9): 865-8.
[http://dx.doi.org/10.1007/s00296-007-0344-3] [PMID: 17476510]
[44]
Atzeni F, Boccassini L, Franco M, et al. Chronic widespread pain in spondyloarthritis. Reumatismo 2014; 66(1): 28-32.
[http://dx.doi.org/10.4081/reumatismo.2014.761] [PMID: 24938193]
[45]
Strand V, Boers M, Idzerda L, et al. It’s good to feel better but it’s better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. J Rheumatol 2011; 38(8): 1720-7.
[http://dx.doi.org/10.3899/jrheum.110392] [PMID: 21807792]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy