AB0731 IMPACT OF FIBROMYALGIA ON DISEASE ACTIVITY INDICES, HEALTH RELATED QUALITY OF LIFE AND FATIGUE IN PATIENTS WITH PSORIATIC ARTHRITIS

Abstract

Background:Psoriatic arthritis (PsA), causes inflammation in joints and enthesis, emotional instability and poor quality of life (QOL).1Fibromyalgia (FM) may coexist with PsA, complicating its diagnosis and management.2The effect of FM on the QOL and fatigue in PsA patients has not been vastly studied.3Objectives:Assess the effect of FM on PsA patients’ disease activity indices, QOL and fatigue.Methods:This study included Group I: 37 PsA only patients (61.7%), 48.38 ± 11.69 years and group II: 23 FM-PsA patients (38.3%), 50.78 ± 11.8 years, according to classification criteria for PsA and 2016 Revisions to 2010/2011 FM diagnostic criteria. Psoriasis area severity index (PASI), disease activity in PsA (DAPSA), composite PsA activity index (CPDAI), PsA QOL and multidimensional assessment of fatigue (MAF) were assess in both groups. The severity and impact of FM was assessed in group II.Results:Patients with FM-PsA had a statistically higher PsA disease activity in subjective measures only but not in objective measures. Table 1Table 1.Comparison between the studied groups according to disease activityGroup I(37)Group II(23)Test ofSignificancePMean ± SDtCPDAI8.68 ± 3.3311.26 ± 2.033.735*<0.001*Median (Minimum – Maximum)UPASI8.3 (0 – 45.7)14.4(0.9 – 49.6)292.5*0.043*DAPSA29 (14 – 89)45.5 (20.5 – 99)226.0*0.002*C-reactive protein (mg/dl)6.3 (0.3 – 72)6 (0.8 – 61.6)409.50.80268 Tender joint count7 (2 – 64)23 (8 – 68)112*<0.001*66 Swollen joint count2 (0 – 23)4 (0 – 10)300.50.055Leeds enthesitis index2 (0 – 6)6 (3 – 6)76.5*<0.001*Dactylitic count0 (0 – 8)0 (0 – 7)4210.924U: Mann Whitney testt: Student t-testp: p value for comparing between the studied categories*: Statistically significant at p ≤ 0.05Patients in both groups had similar functional level by health assessment questionnaire (HAQ) (U=339, p=0.188) and QOL by PsAQOL (U=306, p=0.068). While, MAF was statistically higher in group II patients 34 ranging from 28 to 48.7 in group II vs 26.5 ranging from 0 to 49.5 in group I (U=172.5, p<0.001).In group II patients: the mean tender point count was 16.50 ± 1.84, fibromyalgia severity scale (FSS) was 20.7 ± 3.99 and fibromyalgia impact questionnaire (FIQ) was 57.22 ± 7.30. There was a statistically significant correlation between FSS and DAPSA (rs=0.59, p=0.003), PsAQOL (rs=0.64, p=0.001) and HAQ (rs=0.613, p=0.002), and between FIQ and PASI (r=0.488, p=0.018), PsAQOL (r=0.576, p=0.004), HAQ (r=0.557, p=0.006) and MAF (r=0.619, p=0.002).Conclusion:These results might highlight the importance of considering FM as a contextual factor in disease activity assessment in patients with PsA, especially in those with discrepancies in TJC/patients reported outcomes versus SJC/inflammatory markers or persistently high disease activity indices.