THU0455 DIFFERENCES IN PSYCHIATRIC COMORBIDITIES AND LIFE ADVERSITIES BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS ASSOCIATED WITH FIBROMYALGIA AND PATIENTS WITH PRIMARY FIBROMYALGIA

Abstract

Background:Patients with rheumatic arthritis (RA) continue to report significant pain despite apparent disease control by immunosuppressive drugs (1), leading to the hypothesis that central sensitisation (CS) plays a role in the chronic musculo-skeletal pain defining fibromyalgia (FM).Objectives:The aim of our study was to evaluate the differences in psychiatric comorbidities and life adversities between patients with AR+FM and patients with primary FM (PFM).Methods:In a observational cross- sectional study patients with PFM and AR+FM were consecutively recruited. The inclusion criteria were an age of 18-70 years; a diagnosis of RA according to the 2010 ACR classification criteria and FM according to the 1990 ACR criteria and 2016 ACR criteria. Lifetime diagnoses of major depression disorder (MDD), panic disorder (PD) and post-traumatic stress disorder (PTSD), three of the most frequently described psychiatric disorders among FM patients, were made with the Structured Clinical Interview for DSM-5. Depressive symptoms were measured using the Zung Self-rating Depression Scale (ZSDS). Childhood trauma was measured using the short form of the Childhood Trauma Questionnaire (CTQ) and stressful events were assessed using the Paykel’s Interview for Recent Life Events. Pain was assessed using a visual analogue scale (VAS). The Fibromyalgia Impact Questionnaire (FIQ) was also used.Results:Seventy-seven patients were originally screened, but seven were excluded because of current depressive episode or having a ZSDS of ≥60 or categorized as minimizers of childhood maltreatment at CTQ. The final analysis therefore involved 70 patients, all Caucasians: 30 with PFM and 40 with AR+FM. All patients with PFM and 38 (95%) of the 40 with AR+FM were treated for FM symptoms (antidepressants, pregabalin). The lifetime rates of MDD were significantly higher in PFM vs AR+FM (76.7 % and 40% respectively, p =0.003), as well as the rates of PD (50 % and 15% respectively, p =0.003), whereas there was no difference in PTSD rates. The PFM patients reported significantly higher levels of physical (p=0.020) and sexual abuse (p=0.011) and physical neglect (p<0.001), whereas there was no between-group difference in the levels of emotional abuse (p=0.912) and neglect (p=0.542); consistently, the proportion of sexually abused (p=0.005) or physically neglected patients was also higher in the PFM group (p=0.023). The rates of emotional neglect were high in both groups, without any significant difference between them. The vast majority of AR+FM patients (90%) said that only event occurring in the year preceding the onset of FM was RA, whereas the PFM patients mainly reported non-physical events (36%, particularly the ending of a relationship, or working or financial problems) or no event at all (40%), (p<0.001). Binary logistic regression used to identify the factors predicting association of PFM/AR+FM status, showed an association with lifetime major depression, life events preceding the development of FM, and BMI (p<0.05 at all).Conclusion:PFM and SFM differ in psychiatric co-morbidities and environmental adversities, suggesting that the putative common pathogenetic condition of CS may develop through different pathways.