Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis

Abstract

BackgroundFibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. With this study we aimed to estimate the prevalence of FM in SpA and to compare the clinical/disease features and TNF inhibitors (TNFi) in patients with/without FM.MethodFM was defined by a score = > 5/6 of the Fibromyalgia Rapid Screening Tool (FiRST). SpA patients (according to the rheumatologist) and consecutively consulting in the day care hospital but also in the outpatient clinic at the rheumatology department of a tertiary care university hospital were included.Demographics, disease characteristics, activity and severity and TNFi treatment were compared in patients with and without FM; retention rate of the first TNFi and associated factors were explored (Kaplan Meier and Cox regression).ResultsOf the 196 enrolled SpA patients, 42 (21.4 %) were positively screened for FM. No statistically significant differences in the prevalence of FM were found with regard to the fulfillment of the ASAS criteria for peripheral/axial SpA, nor with regard to the fulfillment of the imaging vs. clinical arm of the ASAS criteria. However, patients with coexisting FM presented significantly with more enthesitis, higher disease activity (BASDAI and VAS) and poorer function scores (BASFI). No differences were found with regard to the initiation of TNFi treatment (79.0 % vs. 70.0 %, respectively), but the retention rate of the first TNFi after 2 years was shorter in the group of patients with FM (28.1 % (95 % CI 12.5-44.0) vs. 41.7 % (95 % CI 32.2-51.3), p = 0.01).ConclusionThis study confirms that coexistent FM in SpA might impact the patient-reported outcome indices for disease activity and function, and the retention rate of TNFi treatment.

Spondyloarthritis and fibromyalgia: interfering association or differential diagnosis?

“…This should not be mis interpreted. This may in part explain the higher frequency of enthesitis in SpA patient with associated fibromyalgia [11].…”

“…No fibromyalgia patient fulfilled ASAS classification criteria, but 14 and 34 % of axial SpA patients (without difference between nonradiographic axial SpA and ankylosing spondylitis) fulfilled 1990 and 2010 fibromyalgia criteria, respectively (and 30 and 46 % of RA patients). In the study of Bello [11], no difference in the prevalence of fibromyalgia was found between the patients fulfilling the clinical arm and those fulfilling the imaging arm of the ASAS criteria. In these studies, fibromyalgia presentation did not seem to interfere with classification, even if, in nonrx-axSpA, female gender is more prevalent, as in fibromyalgia.…”

“…SpA patients with fibromyalgia have significantly higher values of indexes such as BASDAI, BASFI, ASQol [11][12][13], and higher frequency of enthesitis [11]. Presence of fibromyalgia may impair therapeutic response (or its evaluation) of anti-TNF therapy, whereas the percentage of patients with SpA exposed to anti-TNF was similar with and without fibromyalgia; the percentage of switchers was significantly higher and the duration and retention of the first anti-TNF was shorter in patients with fibromyalgia [11].…”

“…In a population of 60 patients with inflammatory back pain, 30 % fulfilled the clinical criteria for fibromyalgia (assessed by tender points) [15]. Finally, using a screening tool for fibromyalgia (FiRST) on 196 patients fulfilling ASAS criteria, the prevalence of fibromyalgia was 21.4 % [11], more frequently women.…”

“…Its etiology remains unknown, and the prevalence has been evaluated 2 to 7 % in the general population, with a female predominance [11]. The prevalence of fibromyalgia in SpA has been assessed in several studies using different criteria for fibromyalgia and different subsets of SpA.…”