High disease activity, widespread pain may signal fibromyalgia in patients with axial SpA
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High disease activity and widespread pain in patients with axial spondyloarthritis are associated with the development of fibromyalgia, according to data published in Rheumatology.
Meanwhile, low levels of disease activity and pain, alongside treatment with TNF inhibitors, are linked to recovery from fibromyalgia, the researchers wrote.
“The estimated prevalence of co-existing FM in axSpA is 14% (95% CI, 8-20) according to a recent meta-analysis,” Sella A. Provan, MD, PhD, of Diakonhjemmet Hospital, in Oslo, Norway, and colleagues wrote. “The identification of co-morbid FM in patients with axSpA could be especially important in the current treat to target era, as the presence of FM may interfere with the patient´s self-assessment of treatment response. We have previously shown that patients with axSpA and additional FM report higher levels of axSpA disease activity, depression, anxiety, fatigue and work interference, compared to patients with axSpA alone.”
“The presence of FM also contributes negatively to the life quality of these patients,” they added. “FM in axSpA may however not be a permanent state, and studies have reported that approximately 50% ‘recover’ following start of TNF inhibitor treatment. The identification of predictors for longitudinal FM development has been identified as a research priority in a recent systematic review and meta-analyses, and change in fibromyalgia state is of particular interest.”
To analyze the factors associated with fibromyalgia development, as well as recovery, among patients with axial SpA, Provan and colleagues studied data from the British Society of Rheumatology Biologics Register (BSRBR-AS). According to the researchers, this register is a prospective cohort study that recruited biologic-naïve patients with axial SpA from 83 secondary-care rheumatology centers across the United Kingdom between December 2012 and December 2017. For their own study, Provan and colleagues examined data from 801 participants who had two or more visits.
Fibromyalgia had been diagnosed using the self-reported Fibromyalgia Survey Diagnostic Criteria (FM-criteria) from 2015. Axial SpA disease activity measures and clinical findings were recorded at regular intervals, while Provan and colleagues identified predictors for fibromyalgia development and recovery between yearly visits using univariable and multivariable logistic regression models.
According to the researchers, 686 participants were free of fibromyalgia at baseline, of whom 45 later developed the disease during follow-up. Meanwhile, 115 participants had fibromyalgia at baseline, of whom 77 recovered during follow-up.
In the final multivariable model, high baseline Bath Ankylosing Disease Activity Index (OR = 1.27; 95% CI, 1.08-1.49) and Widespread Pain Index (WPI) (OR = 1.14; 95% CI, 1.02-1.28) were significantly associated with fibromyalgia development. Meanwhile, low baseline Bath Ankylosing Function Index (OR = 0.68; 95% CI, 0.53-0.86), WPI (OR = 0.84; 95% CI, 0.720-0.97) and initiating a TNF inhibitor (OR = 3.86; 95% CI 1.54–9.71) were significantly associated with fibromyalgia recovery.
“The current study shows that in patients with axSpA high levels of axSpA activity and presence of widespread pain are associated with the development of FM, while low levels of the same variables are associated with recovery from FM,” Provan and colleagues wrote. “The presence of comorbid FM should be considered in patients with a history of high SpA disease activity and widespread pain.”
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