POS0027 SPONDYLOARTHRITIS AND COMORBID FIBROMYALGIA IN PATIENTS WITH ACUTE ANTERIOR UVEITIS: CLINICAL AND ULTRASONOGRAPHIC ASSESSMENT

Abstract

BackgroundMusculoskeletal pain is an important feature in patients (pts) with anterior acute uveitis (AAU), as a symptom of spondyloarthritis (SpA). Fibromyalgia (FM), which is more prevalent in pts with chronic inflammatory diseases, has a widely recognized effect on both differential diagnosis and evaluation of outcome measures in SpA.ObjectivesTo estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of pts with AAU, and to compare clinical and ultrasonographic findings in SpA pts with (SpAFM+) and without (SpAFM-) concurrent FM and SpA.Methods152 consecutive pts affected by AAU from the Immunology Eye Unit (AUSL-IRCCS Reggio Emilia, Italy) were enrolled.A complete rheumatological assessment, including 68/66 peripheral joint count, Leeds Enthesitis Index (LEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Fibromyalgia Impact Questionnaire (FIQ) was performed.Using an Esaote MyLabClass, 18-6MHz linear multifrequency transducer, 6 entheses (lateral epicondyle, distal quadriceps insertion, proximal and distal patellar tendon insertions, calcaneal insertion of Achilles tendon and plantar fascia) were evaluated bilaterally for the presence of any elementary lesion, structural damage and active enthesitis, according to OMERACT definitions2.Pts were classified as having SpA and/or FM according to ASAS criteria and 2010 ACR diagnostic criteria for FM, respectively.Results103 pts were diagnosed with anterior acute non granulomatous uveitis (AANGU) and 49 with anterior acute granulomatous uveitis (AAGU) (F/M 93/59, age 46.2±12.3 years, BMI 25±5.1, disease duration 43.8±85.2 months).14 pts (9.2%) met the ACR criteria for FM, of whom 8 pts had concomitant FM and SpA. All FM pts had AANGU. FM pts showed significantly higher enthesitis count and report worse disease activity and function scores (Table 1). Fulfillment of ASAS criteria was associated with FM (p=0.004).Table 1.Demographic and clinical data of FM patients (results for continuous variables expressed as mean ± standard deviations, for discrete variables as n° and percentage)FM + (14)FM - (138)pOR (95%CI)Age48 ± 11.746.1 ± 12.40.569Female10 (71.4%)83 (60%)0.409BMI24.7 ± 5.525 ± 5.20.831AANGU14 (100%)89 (64.5%)0.005SpA8 (57%)30 (22%)0.0044.8 (1.6 – 14.9)ax-SpA6 (43%)18 (13%)0.0045 (1.6 – 16.1)Psoriasis2 (14.3%)9 (6.5%)0.268IBP7 (50%)19 (14%)0.0016.3 (2 – 19.9)Buttock pain9 (64%)24 (17%)<0.0018.6 (2.63 – 27.8)History of enthesitis7 (50%)20 (14.5%)0.0015.8 (1.9 – 18.6)TJC2.6 ± 3.80.6 ± 1.80.072LEI1.9 ± 1.20.5 ± 1<0.001MASES3.8 ± 3.40.8 ± 20.07BASDAI5.1 ± 1.71.8 ± 1.7<0.001BASFI2 ± 1.40.6 ± 1.2<0.001FIQa0.6 ± 0.60.3 ± 0.80.176FIQb4.2 ± 2.31.1 ± 1.8<0.001FIQc1.9 ± 2.40.4 ± 1.30.044FIQd38.9 ± 13.516.2 ± 13.9<0.001SpAFM+ pts more frequently reported an history of enthesitis [75% vs 23.3% p=0.011 OR 9.9 (95% CI 1.6 – 60.2) and buttock pain [75% vs 33.3% p=0.034 OR 6 (95% CI 1.02 – 35.3)] when compared with SpAFM-, whereas no significant differences in LEI, MASES, joint count, and inflammatory back pain (IBP), as well as in sex, age and BMI were observed.BASDAI, FIQb and FIQd were increased in SpAFM+ (6±1.1 vs 3.4±1.8 p<0.001, 4.3±2.1 vs 1.7±2.2 p= 0.005 and 43.6±11.4 vs 24.6±15.5 p=0.003 respectively).Abnormal US findings were detected in 35/38 SpA pts (92.1%), without significant differences in elementary lesions and structural damage between SpAFM+ and SpAFM-. At patient-level, a significantly higher percentage of SpAFM+ pts had at least one active enthesitis, as compared with SpAFM- (25% vs 3.4%, p = 0.048).ConclusionComorbid FM was frequent in SpA associated with AANGU, affecting both clinical presentation and outcome measures, whereas no FM patients were found in the AAGU group. In our cohort the role of ultrasonography in discriminate SpAFM- from SpAFM+ is not clear.