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Fibromyalgia linked to worsening status in RA patients
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The presence of fibromyalgia, as well as an increase in the number of fibromyalgia symptoms, can predict a worsening functional status for patients with rheumatoid arthritis, according to a study published in Arthritis Care and Research.
The researchers, from the University of British Columbia, in Vancouver, Canada, and Brigham and Women’s Hospital, in Boston, also found that, among patients with both RA and fibromyalgia, the magnitude of the difference in changes in questionnaire responses were 4- to 7-fold greater than typical changes among those with established RA.
“[Fibromyalgia], a debilitating syndrome characterized by widespread, nonarticular pain is more common in RA patients, with a prevalence of approximately 20%, compared to 2.5% in the general population,” Hyein Kim, MD, MPH, from the University of British Columbia, and colleagues wrote. “In several cross-sectional studies in RA, [fibromyalgia] has been associated with substantially higher self-reported disease activity and worse functional status.”
To determine the impact of fibromyalgia on changes in the functional status of patients with RA over the course of 2 years, the researchers evaluated 156 participants in the Brigham Rheumatoid Arthritis Sequential Study who were enrolled in a substudy on the effects of pain in RA. Participants completed semiannual questionnaires, including the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and the Polysymptomatic Distress (PSD) scale, and underwent annual physical examinations and laboratory tests.
Among the participants, 16.7% had fibromyalgia. The researchers used a multivariable linear regression model to adjust for age, sex, race, baseline MDHAQ score, disease duration, rheumatoid factor/cyclic citrullinated peptide antibody seropositivity, disease activity and psychological distress.
According to the researchers, compared with patients without fibromyalgia, RA patients with fibromyalgia had a 0.14 greater 2-year increase in MDHAQ score (P = 0.021). In secondary analyses, higher PSD scale scores were linked to greater 2-year increases in MDHAQ score (beta coefficient = 0.013; P = 0.011).
“Our results have many potential clinical implications. Among individuals with RA, a formal assessment of [fibromyalgia] characteristics, using the PSD scale, may identify a subgroup of individuals who are more likely to experience clinically important declines in functional status,” Kim and the other researchers wrote. “These individuals may benefit from treatment programs, such as physical and occupational therapy, targeted towards maintaining and/or improving physical function.” – by Jason Laday
Disclosure: Kim reports no relevant financial disclosures. See the full study for additional author disclosures.
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