The Impact of Fibromyalgia in Spondyloarthritis: From Classification Criteria to Outcome Measures

Alunno, Alessia; Carubbi, Francesco; Stones, Simon; Gerli, Roberto; Giacomelli, Roberto; Baraliakos, Xenofon

doi:10.3389/fmed.2018.00290

Cited by 25 publications

(17 citation statements)

References 71 publications

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“…(38,40,41) Because symptoms of central sensitization overlap those of inflammatory rheumatic diseases, it can be challenging to determine disease severity due to the primary rheumatic disease vs the burden of central sensitization, particularly when evaluating outcome measures that rely on patient-reported symptoms. (38,42,43) For example, it may be difficult to distinguish true enthesitis resulting from inflammation of the entheses vs entheseal tenderness due to central sensitization when using clinical examinations that rely on palpitation of tender entheseal insertion sites. Use of imaging techniques and development of more sensitive screening tools may help improve differentiation between central sensitization and axSpA or other rheumatic diseases in the future, but these methods are not commonly employed in longitudinal observational cohort studies due to time and cost.…”

Section: Accepted Articlementioning

confidence: 99%

“…Use of imaging techniques and development of more sensitive screening tools may help improve differentiation between central sensitization and axSpA or other rheumatic diseases in the future, but these methods are not commonly employed in longitudinal observational cohort studies due to time and cost. (38,42) Distinguishing the degree of symptoms due to central sensitization from that of axSpA is important to guide treatment decisions and accurately assess treatment response.…”

Section: Accepted Articlementioning

confidence: 99%

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Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Mease

McLean²,

Dube³

et al. 2021

J Rheumatol

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Objective To compare patient characteristics and disease burden between men and women with axial spondyloarthritis (axSpA) in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry. Methods Patients aged ≥18 years with axSpA enrolled in the Corrona PsA/SpA Registry between March 2013 and November 2018 who were not concurrently diagnosed with PsA were included. Patient demographics, clinical characteristics, disease activity, patient-reported symptoms, work productivity, and treatment history at enrollment were compared between men and women using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher’s exact tests for categorical variables. Results Of 498 patients with axSpA and available sex information, 307 (61.6%) were men and 191 (38.4%) were women. Compared with men, women had higher disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and physician global assessment, and had higher tender/swollen joint counts and enthesitis scores (all P≤0.01). Women also had worse patient-reported symptoms (pain, fatigue, HAQ-S, and EQ-VAS; all P<0.05), greater work and activity impairment, and were less likely to work full time than men. Prior csDMARD and prednisone use was more common in women than in men (both P<0.05). Additionally, women were more likely to have diagnoses of depression and fibromyalgia (both P<0.01). Conclusion In this US registry of patients with axSpA, women had higher overall disease burden and more peripheral manifestations than men. Improved awareness of sex differences in the presentation of axSpA may aid physicians in earlier identification and improved disease management.

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Section: Accepted Articlementioning

confidence: 99%

Section: Accepted Articlementioning

confidence: 99%

Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Mease

McLean²,

Dube³

et al. 2021

J Rheumatol

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“…An alternative explanation is that having fibromyalgia distorts the measures used to assess axSpA. Indeed, Alluno et al [27] demonstrated that measures thought to be disease specific such as the Bath indices are not axSpA specific. However it is unlikely that this can entirely account for the current observations.…”

Section: Discussionmentioning

confidence: 99%

AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS)

et al. 2019

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Background Around 1 in 8 patients with axial spondyloarthritis (axSpA) also meet criteria for fibromyalgia and such patients have considerable unmet need. Identifying effective therapy is important but to what extent fibromyalgia-like symptoms relate to axSpA disease severity has not been established. The aim of the current analysis was to determine whether distinct clusters of axSpA patients exist and if so to determine a) whether they differ in terms of prevalence of fibromyalgia and b) the features of patients in clusters with high prevalence. Methods The British Society for Rheumatology Biologics Register (BSRBR-AS) recruited axSpA patients from 83 centres 2012–2017. Clinical data, and information from patients was collected (including research criteria for fibromyalgia). Cluster analysis was undertaken using split samples for development and validation both in the whole population and the sub-group which met fibromyalgia criteria. Results One thousand three hundred thirty-eight participants were included of whom 23% met research criteria for fibromyalgia. Four clusters were identified. Two exhibited very high disease activity, one which was primarily axial ( n = 347) and a smaller cluster ( n = 32) with axial and peripheral disease, and in both groups more than half of members met criteria for fibromyalgia. The remaining two clusters ( n = 437, n = 462) had overall less severe disease however the one which showed greater disease activity and poorer quality of life had a higher proportion meeting fibromyalgia criteria (16% v. 4%). Within those meeting fibromyalgia criteria there were three clusters. The two main groups were defined by level of symptom severity with a smaller third cluster noted to have high average swollen and tender joint counts and high levels of comorbidity. Conclusions The major feature defining clusters with a high proportion of persons meeting criteria for fibromyalgia is high axSpA disease activity although clusters with features of fibromyalgia in the absence of high disease activity also show moderately high prevalence. Management may be most successful with pharmacologic therapy to target inflammation but enhanced by the concurrent use of non-pharmacologic therapy in such patients.

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“… 48 For this reason, objective measures, such as C-reactive protein (CRP), and the Ankylosing Spondylitis Disease Activity Score play a key role in discriminating between pain caused by inflammatory activity and pain due to the interference of FM. 49 …”

Section: Introductionmentioning

confidence: 99%

Comorbid pain in axial spondyloarthritis, including fibromyalgia

López-Medina

Moltó

2020

Therapeutic Advances in Musculoskeletal

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The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response. In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

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The Impact of Fibromyalgia in Spondyloarthritis: From Classification Criteria to Outcome Measures

Cited by 25 publications

References 71 publications

Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry

AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS)

Comorbid pain in axial spondyloarthritis, including fibromyalgia

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