Abstract

BackgroundFibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. With this study we aimed to estimate the prevalence of FM in SpA and to compare the clinical/disease features and TNF inhibitors (TNFi) in patients with/without FM.MethodFM was defined by a score = > 5/6 of the Fibromyalgia Rapid Screening Tool (FiRST). SpA patients (according to the rheumatologist) and consecutively consulting in the day care hospital but also in the outpatient clinic at the rheumatology department of a tertiary care university hospital were included.Demographics, disease characteristics, activity and severity and TNFi treatment were compared in patients with and without FM; retention rate of the first TNFi and associated factors were explored (Kaplan Meier and Cox regression).ResultsOf the 196 enrolled SpA patients, 42 (21.4 %) were positively screened for FM. No statistically significant differences in the prevalence of FM were found with regard to the fulfillment of the ASAS criteria for peripheral/axial SpA, nor with regard to the fulfillment of the imaging vs. clinical arm of the ASAS criteria. However, patients with coexisting FM presented significantly with more enthesitis, higher disease activity (BASDAI and VAS) and poorer function scores (BASFI). No differences were found with regard to the initiation of TNFi treatment (79.0 % vs. 70.0 %, respectively), but the retention rate of the first TNFi after 2 years was shorter in the group of patients with FM (28.1 % (95 % CI 12.5-44.0) vs. 41.7 % (95 % CI 32.2-51.3), p = 0.01).ConclusionThis study confirms that coexistent FM in SpA might impact the patient-reported outcome indices for disease activity and function, and the retention rate of TNFi treatment.

Highlights

  • Fibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis

  • No differences were found with regard to the initiation of TNF inhibitors (TNFi) treatment (79.0 % vs. 70.0 %, respectively), but the retention rate of the first TNFi after 2 years was shorter in the group of patients with FM (28.1 % vs. 41.7 %, p = 0.01)

  • Few data are available to date, but it has already been reported that SpA patients with FM tend to present with higher self-reported disease activity indices (i.e., Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) making interpretation of disease activity and treatment response in SpA patients with concomitant FM very challenging [19,20,21]

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Summary

Introduction

Fibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. FM can frequently be associated with other rheumatic diseases such as rheumatoid arthritis and Sjögren syndrome [16], and some studies have reported the prevalence of FM at 12.6–15.0 % in SpA, but studies are sparse [16,17,18]. This FM-SpA association may present diagnostic and treatment dilemmas because some SpA symptoms (e.g., pain at entheses, fatigue, stiffness, and tenderness) can be found in FM [12, 19]. Few data are available to date, but it has already been reported that SpA patients with FM tend to present with higher self-reported disease activity indices (i.e., Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) making interpretation of disease activity and treatment response in SpA patients with concomitant FM very challenging [19,20,21]

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