AB0281 THE 2016 REVISED ACR FIBROMYALGIA CRITERIA IDENTIFY A HIGHER PREVALENCE OF FIBROMYALGIA IN RHEUMATOID ARTHRITIS PATIENTS: A CROSS-SECTIONAL STUDY FROM INDIA.

Abstract

BackgroundFibromyalgia (FM) prevalence in rheumatoid arthritis (RA) is reported around 5-50% as per older American College of Rheumatology (ACR) FM Criteria, while in India reported around 15% (1). The Revised 2016 ACR FM criteria has greater sensitivity and specificity of 94% and 91% respectively compared to older criteria (2). To best of our knowledge, no study has evaluated presence of FM in RA as per revised 2016 ACR FM criteria.Objectives1) To study prevalence of FM as per revised 2016 ACR FM criteria in RA patients.2) To compare Disease activity, Disability status, Quality of life, Anxiety and Depression in RA with and without FM.MethodsThis cross-sectional study included 200 RA patients and equal number of controls. FM was diagnosed using revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in RA patients was assessed using disease activity scores (CDAI, SDAI, DAS-28 CRP, WHO-Qol BREF and Health Assessment Questionnaire CRD HAQ-DI). Presence of depression and anxiety was determined using validated Hospital Anxiety and Depression Scale (HADS).ResultsFM was present in 31% and 4% of RA patients and healthy controls respectively in our study using 2016 ACR FM criteria. This is significantly higher compared to the 15% and 2.5% in RA and healthy control populations respectively of the study by Dhir V. et studying a similar population of Indian patients, using 1990 ACR FM criteria. RA patients with FM were older, predominantly females, had longer disease duration, were more on steroids, had higher disease activity and more functional disability. In a multivariable linear regression analysis, FM was important predictor of DAS28 score & CDAI, even after adjusting for other independent variable like disease duration, CRP, SJC, functional disability. RA patients with FM had a poorer quality of life and had higher prevalence of anxiety and depression. No difference was noted in use of disease modifying agents, biological or ts-DMARDs in RA patients with or without FM.Table 1.Characteristics of RA with FM and RA without FM patients.RA without FM (n=138)RA WITH FM (n=62)P VALUEMean ± sdMean ± sdAge, yrs.,47.17±12.4451.37±12.330.028Duration of RA4.1±3.596.46±6.090.006TJC, 0-284.57±2.866.87±3.08<0.001SJC,0-282.3±2.373.37±2.870.011Pain VAS,0-10036.38±16.1655.24±11.18<0.001ESR39.01±20.6746±20.390.028CRP11.61±11.1516.43±15.720.032CDAI14.6±6.6919.68±6.71<0.001SDAI15.74±7.3321.34±7.48<0.001DAS-28 CRP4.1±1.14.85±0.84<0.001PDS,0-318.68±3.2216.27±2.33<0.001Physical score*, 0–10054.83±12.1634.37±9.41<0.001Psychological score, 0–10059.78±14.3439.84±12.74<0.001Social score, 0–10060.68±12.7551.5±12.76<0.001Environmental score, 0-10059.21±11.0449.35±9.73<0.001CRD HAQ-DI1.04±0.641.8±1.03<0.001Anxiety, n (%)23(17%)53(85%)<0.001Depression, n (%)44(32%)59(95%)<0.001TJC: tender joint count (28 joints); SJC: swollen joint count (28 joints); CDAI: Clinical disease activity index; SDAI: Simplified disease activity index; DAS 28: disease activity score (28 joints); PDS: Polysymptomatic distress score of fibromyalgia; *Domain scores of quality of life (WHO-Qol BREF).ConclusionThe prevalence of FM in RA patients is significantly higher with 2016 ACR FM Criteria as compared to older criteria in similar population of RA patients. A significant number of patients had anxiety and depression that needs to be clinically attended. The presence of FM in RA adversely affects the Disease activity, quality of life, functional disability.