Concomitant Fibromyalgia Research Articles

Impact of Fibromyalgia on Disease activity in Inflammatory Arthritis: A Cohort Study Conducted at Tertiary Care Hospital of Peshawar, Pakistan

Objective: To determine the frequency of fibromyalgia in patients with inflammatory arthritis and to evaluate the impact of fibromyalgia treatment on disease activity in these patients. Study Design: Prospective cohort study. Place and Duration of Study: Rheumatology Division, Lady Reading Hospital, Peshawar Pakistan, from Apr to Dec 2021. Methodology: A total of 400 patients were enrolled in the study of which 320 were diagnosed with rheumatoid arthritis, 55 with ankylosing spondylitis and 25 with psoriatic arthritis. The diagnosis of fibromyalgia was made with 2016 American College of Radiology Criteria and patients were classified according to the presence or absence of fibromyalgia. Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS28-ESR), Bath Ankylosing Spondylitis Disease Activity Index and Disease Activity in Psoriatic Arthritis Score-28 were recorded for rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, respectively. Patients of fibromyalgia were treated by either pregabalin or duloxetine with 3-month follow-up. Patients with Widespread Pain Index <7 and Symptoms Severity Scale <5 after treatment for 3 months were labeled as responders. Results: Fibromyalgia was present in 90(28.1%) patients with Rheumatoid Arthritis, 14(25.5%) with ankylosing spondylitis and 8(32%) with Psoriatic arthritis. Fibromyalgia was more common in Rheumatoid Arthritis patients whose disease duration exceeded 5 years (p-value <0.001). Similarly, obesity significantly contributed to Fibromyalgia development in Rheumatoid Arthritis (p-value <0.001) but not in Ankylosing spondylitis and Psoriatic arthritis patients. Disease duration >5 years, obesity, female gender and rising age increased the odds of developing Fibromyalgia in ... Conclusion: Patients with concomitant Fibromyalgia presented higher

The determinants associated with the prescription of a first biologic therapy in patients with axial spondyloarthritis and concomitant fibromyalgia are mostly objective and in line with the recommendations. Results of a cross-sectional survey-based study using a mixed (qualitative and quantitative) approach to help rheumatologists in their daily practice

ObjectivesThere is no consensus on the therapeutic strategy of rheumatologists for patients with spondyloarthritis (SpA) and concomitant fibromyalgia (FM). The main aim of this study was to identify, in a population of rheumatologists practicing in Normandy, France, the determinants associated with their decision to prescribe a first biologic DMARD (bDMARD) in patients with Spa/FM. Specific objectives were to evaluate professional prescribing practices to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists, and to validate the relevance of these criteria. MethodThis is a cross-sectional survey-based study using a mixed (qualitative and quantitative) method. The quantitative approach was web-based and conducted among rheumatologists in Normandy. ResultsThe qualitative study allowed us to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists. In the quantitative study, 54/113 rheumatologists filled the questionnaire. Four criteria were considered by all respondents to contribute to their decision to prescribe a first bDMARD: arthritis on physical examination, extra-articular manifestations, systemic inflammation and structural damage on imaging. ConclusionsThe determinants associated with the decision of rheumatologists to prescribe a first bDMARD in patients with SpA/FM were mostly objective, in line with the recommendations in the literature. Most criteria were more related to an approach aimed at ensuring the diagnosis of SpA than evaluating its activity or severity.

The Prevalence of Fibromyalgia in Rheumatoid Arthritis Patients Using the Fibromyalgia Assessment Screening Tool (FAST 4) Based on the Multidimensional Health Assessment Questionnaire (MDHAQ).

Introduction Fibromyalgia (FM) is characterized by widespread pain and fatigue, accompanied by symptoms such as decreased concentration, autonomic dysfunction, and abdominal pain. It can be either primary or secondary, notably to rheumatoid arthritis (RA). The Fibromyalgia Assessment Screening Tools (FAST 4), derived from the Multidimensional Health Assessment Questionnaire (MDHAQ), is a composite tool allowing for the rapid screening of FM. Our primary objective is to determine the prevalence of FM among RA patients using the FAST 4 index. Secondary objectives include comparing the FAST 4 index with the FiRST score and describing the correlation between FM and RA activity and different factors associated with FM in RA patients. Methods This was an observational cross-sectional study including patients diagnosed with RA according to the ACR/EULAR criteria. The FAST questionnaire comprises four sections assessing pain and fatigue on a visual analog scale, painful joints reported by the patient, and a list of 60 symptoms. A FAST 4 score of ≥ 3/4 indicates a positive screening for FM. Demographics and disease features were compared using descriptive statistics. Univariate and multivariate analyses using logistic regression models were performed to calculate odds ratios (ORs) with 95% CI. The sensitivity and specificity of the FAST 4 index were evaluated, and Fagan's nomograms were used to illustrate post-test probability. Statistically significant results were considered for p-values less than 0.05. Results The study enrolled 97 patients diagnosed with RA. The mean age of the patients was 56 ± 12.7 years, with a predominance of females (90.7%, N=88). The mean duration of RA was 13.5 ± 8.69 years. RA activity measured by DAS 28-ESR showed that 40.2% (N=39) had high disease activity, 38.1% (N=37) had moderate disease activity, 11.3% (N=11) had low disease activity, and 10.3% (N=10) were in remission. The prevalence of comorbid FM, according to the FAST 4 index, was 30.9% (N=30). Based on the Multidimensional Health Assessment Questionnaire (MDHAQ), depression was observed in 66.7% (N=20) patients with FM, while anxiety was reported in 60% (N=18). Moreover, 30.4% of patients screened positive for FM using the FiRST score. The FAST 4 index detected FM patients defined by FiRST with a sensitivity of 78.6% and a specificity of 87.1%. The positive predictive value (PPV) was 73.3%, and the negative predictive value (NPV) was 90%. Univariate analysis revealed that a positive FAST 4 index was associated with the number of painful and swollen joints (p<0.001 and 0.03, respectively). Additionally, patients with a positive FAST 4 index showed higher DAS 28 scores (p=0.002). No significant association was found with CRP levels (p=0.328), ESR (p=0.499), or the use of biological treatments (p=0.146) or corticosteroids (p=0.940). In multivariate analysis, only depression remained a risk factor, increasing the risk sixfold with an OR of 5.917, 95% CI (1.91-18.3), p=0.002. Conclusion Our study suggests a high prevalence of concomitant FM in our population, highlighting the importance of screening for FM, particularly using the FAST 4 index based solely on the MDHAQ questionnaire.

Comparison of Prevalence of Fibromyalgia in Axial Spondyloarthritis Patients According to ACR 1990 FM, ACR 2010 FM, AAPT 2018 FM Criteria and the Effect of Concomitant Fibromyalgia on Disease Activity, Quality of Life, Functionality and Enthesopathy

Comparison of Prevalence of Fibromyalgia in Axial Spondyloarthritis Patients According to ACR 1990 FM, ACR 2010 FM, AAPT 2018 FM Criteria and the Effect of Concomitant Fibromyalgia on Disease Activity, Quality of Life, Functionality and Enthesopathy

Influence of comorbidities not associated with fibromyalgia on neuropathic pain in patients with psoriatic arthritis: relationship with clinical parameters.

Neuropathic pain (NP) may influence disease activity assessment in patients with psoriatic arthritis, this relationship being traditionally based on the presence of concomitant fibromyalgia. We analyzed the influence of other comorbidities on NP and the relationship between pain and various clinical parameters. A cross-sectional study was conducted in patients diagnosed with psoriatic arthritis, excluding patients with a previous diagnosis of fibromyalgia, depression, anxiety, diabetes and/or dyslipidemia under treatment. NP was identified using the painDETECT questionnaire (score > 18). Obesity and related clinical parameters, anxious and depressive symptoms, sleep quality and fatigue were assessed as comorbidities. Disease activity was measured using the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) in peripheral involvement, the ASDAS-PCR in axial involvement, functioning and disease impact were measured using the Health Assessment Questionnaire-Disability Index and 12-item Psoriatic Arthritis Impact of Disease questionnaire, respectively. Overall, 246 patients were included (136 men; 55%). The mean age was 53.4 ± 11.0 years. Forty-two patients had NP (17.1%). Patients with NP had higher leptin levels (OR: 1.03, 95% CI: 1.007-1.056; p < 0.01) and poor sleep quality (OR: 1.20, 95% CI: 1.09-1.297; p < 0.001). Patients with NP also had greater fatigue NRS (6.2 ± 2.2 vs. 2.4 ± 0.19, p < 0.001). Patients with NP had higher cDAPSA score (17.3 ± 5.4 vs. 8.9 ± 6.5, p < 0.001), poorer functioning (1.1 ± 0.5 vs. 0.4 ± 0.5, p < 0.001) and greater disease impact (6.1 ± 1.7 vs. 2.6 ± 1.9, p < 0.001). NP was correlated with sleep quality and serum leptin and may be associated with worse disease activity, functioning and disease impact.

Challenges and insights in managing difficult-to-treat rheumatoid arthritis: real-world clinical perspectives.

The treatment options for rheumatoid arthritis (RA) have expanded with the availability of biological and targeted synthetic disease-modifying anti-rheumatic drugs. Despite all these developments and treatments, an important group of patients remain symptomatic and have not achieved clinical remission. The terminology "difficult-to-treat" (D2T) has been developed to describe this group. This study aimed to determine the frequency of D2T RA among our patients according to the EULAR 2021 definition of D2T RA and to identify the differences in demographic and disease characteristics, contributing factors, and disease burden. The study included 302 consecutive patients diagnosed with RA according to the 2010 ACR criteria. These patients were categorised into the D2T and non-D2T RA groups. Risk factors independently associated with D2T RA were identified using logistic regression analysis. Of the 302 patients (mean age, 56.5 years, 80.1% female, 75% seropositive), 27 (8.9%) had D2T RA. Those with D2T RA had a lower age at diagnosis and longer disease duration and showed significantly higher rates of peripheral erosion, Sjögren's syndrome, extra-articular manifestations, and PtGA-PhGA discordance, together with high disease activity scores. Furthermore, the median number of comorbidities and concomitant fibromyalgia was significantly higher in the D2T RA group. In the multiple regression analysis, D2T RA was independently associated with higher HAQ-DI, RF levels, and concomitant fibromyalgia. D2T RA requires more intensive management, and patients with D2T RA have higher disease activity, poorer functional status, and quality of life than those without D2T RA.

Quantitative sensory testing, psychological profiles and clinical pain in patients with psoriatic arthritis and hand osteoarthritis experiencing pain of at least moderate intensity.

Chronic pain is the hallmark symptom of joint diseases. This study examined the differences in quantitative sensory testing between patients with psoriatic arthritis (PsA), hand osteoarthritis (hand-OA) and a pain-free control group and differences between patients with and without concomitant fibromyalgia (cFM). All patients and pain-free controls were assessed using pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM) and clinical pain intensities. Psychological distress was assessed with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Pittsburgh Sleep Quality Index. Disability was assessed with the Health Assessment Questionnaire and pain quality with the painDETECT questionnaire. cFM was identified using the revised 2016 American College of Rheumatology diagnostic criteria. Patients with hand-OA (n = 75) or PsA (n = 58) had statistically significant lower PPTs and CPM, greater TSP, and higher scores of psychological distress (p < 0.05) than controls (n = 20). Patients with cFM (58%) had higher scores of depression (p = 0.001), anxiety (p = 0.004), catastrophizing (p = 0.012), disability (p < 0.001), higher painDETECT score (p = 0.001), TSP (p = 0.027), and reduced sleep quality (p = 0.021) when compared to patients without cFM. Patients with hand-OA and PsA exhibited signs of pain sensitization and a higher degree of psychological distress and disability than pain-free individuals. Patients with cFM had greater TSP, painDETECT score, disability, catastrophizing, and reduced sleep quality, than patients without, indicating greater degree of pain sensitization, psychological burden, and disability. This paper shows that a significant proportion of patients with hand osteoarthritis and psoriatic arthritis with moderate pain intensity have significantly increased signs of pain sensitization and markers of psychological distress. A large proportion of these patients fulfil the criteria for concomitant fibromyalgia and these patients show even greater propensity towards pain sensitization and psychological distress.

Fibromyalgia with psoriatic and rheumatoid arthritis: relationship with disease activity and serum vitamin D level

BackgroundThe study of the relationship between the presence of fibromyalgia (FM) with rheumatoid (RA) and psoriatic arthritis (PsA) patients can affect the main disease outcome and the treatment decision. The research aims to assess the associated fibromyalgia and vitamin D level in rheumatoid and psoriatic arthritis patients.ResultsA cross-sectional study included 60 RA, 30 PsA, and 40 healthy controls, all of them were evaluated for the diagnosis of FM and serum vitamin D level, disease activity score 28 (DAS28), and health quality of life. The mean age of RA was 47.75 ± 11.11 SD, for PsA 44.17 ± 10.8 SD, and for the controls 44.35 ± 13.64 with no significant differences. FM was diagnosed in 21.7% of RA, 13.3% of PsA, and 2.5% of healthy controls with a significant difference among the three groups (P value = 0.025). RA and PsA patients with concomitant FM showed statistically significant higher disease activity scores, significantly worse quality of life than those without FM, and significantly lower serum vitamin D than those without FM.ConclusionVitamin D deficiency and the presence of FM can be related to higher disease activity and less response to treatment, early recognition and treatment of FM and vitamin D deficiency in RA and PsA patients could be important to obtain a good response to therapy and achieve remission.

Long COVID in inflammatory rheumatic diseases-what's in a name?

Long COVID in inflammatory rheumatic diseases-what's in a name?

Rheumatoid arthritis with concomitant fibromyalgia: The role of ultrasound in assessing disease activity.

Fibromyalgia (FM) is a chronic painful condition frequently associated with rheumatoid arthritis (RA), which may falsely increase RA activity. The aim of our study was to compare clinical scoring and ultrasound (US) assessment in RA patients with concomitant FM with those without FM. A cross-sectional study including patients with RA according to the ACR/EULAR 2010 criteria was conducted. Patients were divided into two groups: RA patients meeting ACR 2016 FM criteria (cases) and RA patients not meeting FM criteria (controls). Clinico-biological and US assessments of RA activity were performed on the same day for each patient. Eighty patients distributed into 40 patients in each group were recruited. Biologic DMARD prescription was more frequent in RA with FM patients than the control group (p=0.04). DAS28 was significantly greater than DAS28 V3 in RA with FM group (p=0.002). FM group had significantly less US synovitis (p=0.035) and less Power Doppler (PD) activity (p=0.035). Grey scale US score (p=0.87) and DP US score (p=0.162) were similar in the two groups. The correlation between the clinical and the ultrasonographic scores was strong to very strong in both groups with the strongest correlation found between DAS28 V3 and US DAS28 V3 (r=0.95) in RA+FM group. Our study confirms the overestimation of disease activity by the clinical scores in RA with concomitant FM. DAS28 V3 score and US assessment would represent a better alternative.

Quality of life of patients with rheumatoid arthritis and comorbid fibromyalgia

Objective: to evaluate the impact of comorbid fibromyalgia (FM) on the quality of life (QoL) of patients with rheumatoid arthritis (RA). Material and methods. The study involved 90 patients with confirmed RA who complained of chronic pain. All patients underwent general clinical and laboratory examination. FM was diagnosed according to the 2016 ACR criteria. The questionnaires assessed the presence and severity of fatigue (FSS), anxiety and depression (HADS), sleep disorders (PSQI), cognitive impairment (DSST), symptoms of central sensitization (CSI) and the neuropathic component of pain (DN4, PD). The severity of pain syndrome (PS) was assessed by 10-cm VAS at rest. QoL was assessed using the EQ-5D questionnaire. Results. In the main (FM+) and control (FM-) groups, the average severity of PS according to VAS at rest was 7 and 4 cm (p&lt;0.001), the average score on the CSI questionnaire was 50 and 38.5 (p&lt;0.001), and according to the PD questionnaire – 17 and 11 (p&lt;0.001), respectively. Analysis of the severity of comorbid disorders revealed significant differences between the groups in terms of such parameters as fatigue (p=0.003), anxiety (p=0.001), sleep quality (p&lt;0.001) and cognitive impairment (p=0.021). The QoL of patients (according to EQ-5D) in the main group was significantly lower (0.52 vs. 0.59; p=0.003). Significant correlations were found between the QoL index according to EQ-5D and VAS, FSS and PD values in both groups, CSI, DN4, HADS-T parameters and the number of painful joints – only in the main group. Conclusion. Concomitant FM significantly reduces the QoL of patients with RA. The main factors affecting QoL in patients with RA and comorbid FM were the intensity and neuropathic phenotype of PS, increased fatigue and anxiety. Patients with FM are also significantly more likely to have sleep and cognitive impairments.

Fibromyalgia among patients presenting to a rheumatology clinic: prevalence and diagnosis

Introduction: Fibromyalgia (FM) syndrome is a chronic musculoskeletal disorder with extensive symptoms. Its most characteristic manifestation is the presence of persistent and diffuse chronic pain. The prevalence of this disease is 1% to 6% in different studies. Its exact nature and manifestations are not fully known; hence the empirical diagnosis of doctors and the proposed diagnostic criteria may differ in diagnosis. Objectives: This study aims to investigate the prevalence of FM symptoms among rheumatology patients, identify components of symptom and laboratory markers, and determine the interrater agreement between clinician judgment and diagnostic criteria. Patients and Methods: During one year, all patients referred to the rheumatology clinic were selected by simple sampling and underwent medical history collecting and physical examination by a single experienced rheumatologist, and the clinician’s judgment on the diagnosis of FM in the patients was recorded. Also, the American College of Rheumatology (ACR) standard questionnaire was used to evaluate the diagnosis of FM. Results: Between May 2018 and May 2019, 1762 patients were recruited, of whom 1428 (81%) were female, and 334 (19%) were male, with a mean age of 48.4±13.4 years. According to the rheumatologist and ACR criteria, 620 (35.1%) and 491 (27.8%) were diagnosed with FM respectively. Analysis indicated a lower agreement between the two in patients with underlying rheumatologic conditions of a mechanical origin. Younger age in patients with FM (P&lt;0.001). A higher prevalence of FM was found among women (P&lt;0.001). There was a significant correlation between concomitant rheumatologic conditions and FM occurrence (P=0.0004). Symptoms were clustered into 10 components with the component including fatigue explaining 22.18% of the variance in the results. Laboratory markers were clustered into 5 components. Conclusion: Fibromyalgia is a widespread disease among women that is frequently comorbid with other rheumatologic conditions. Agreement between ACR criteria and rheumatologist judgment is acceptable but can be improved by examining the symptoms in clusters rather than individually.

Determinants of health-related quality of life across the spectrum of connective tissue diseases using latent profile analysis: results from the LEAP cohort.

Poor health-related quality of life (HRQoL) is well recognized in patients with CTD. We hypothesized that subgroups of patients across the spectrum of CTD experience different HRQoL patterns and aimed to determine patient-level characteristics associated with these different subgroups. Using the eight continuous domains of the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire we performed data-driven clustering to derive latent profiles (LPs) of patients with distinct HRQoL patterns. Multivariable ordinal logistic regression was used to determine patient-level characteristics associated with each HRQoL subgroup identified. A total of 309 CTD patients completed the SF-36 questionnaire. The most impaired SF-36 domains in each disease group were vitality, general health and bodily pain. The physical component of the SF-36 was consistently more impaired compared with the mental component, with similar scores across disease groups. Three LPs were identified with poor [n = 89 (29%)], average [n = 190 (61.4%)] and excellent [n = 30 (9.7%)] HRQoL. LPs were not associated with diagnostic grouping or autoantibody profiles. Black background [odds ratio (OR) 0.22 (95% CI 0.08, 0.63)], Indo-Asian background [OR 0.39 (95% CI 0.19, 0.78)], concomitant fibromyalgia [OR 0.40 (95% CI 0.20, 0.78)], sicca symptoms [OR 0.56 (95% CI 0.32, 0.98)] and multimorbidity [Charlson Comorbidity Index; OR 0.81 (95% CI 0.67, 0.97)] were associated with the 'poor' HRQoL LP. Distinct HRQoL subgroups exist that are not primarily driven by a specific diagnosis or autoantibody profiles. We identified a number of key demographic and clinical factors associated with poor HRQoL. These factors need to be addressed across the whole CTD spectrum as part of a holistic management approach aimed at improving overall patient outcomes.

Tender to touch-Prevalence and impact of concomitant fibromyalgia and enthesitis in spondyloarthritis: An ancillary analysis of the ASAS PerSpA study.

The primary objective was to evaluate the co-existence of fibromyalgia (FM) & enthesitis in individuals with spondyloarthritis (SpA). Secondary objectives were to identify clinical features associated with the presence of FM in enthesitis and analyse sex-specific differences. This was an ancillary analysis of the Assessment of SpondyloArthritis International Society Peripheral Involvement in SpA (PerSpA) study. Enthesitis was defined as the presence of enthesitis ever. Clinical FM was defined as the rheumatologist's confirmation of the presence of FM. A score of≥5/6 on the Fibromyalgia Rapid Screening Test (FiRST) defined a positive screening test for FM. Enthesitis ever and FM (EFM) co-existed in 10.3% (n=425) of the cohort using FiRST criteria and 5.3% using clinical diagnosis of FM. More individuals with FM by clinical diagnosis had imaging-confirmed enthesitis ever than by FiRST criteria. More females had EFM than males, defined clinically (76.9% vs 23.1%) or by FiRST criteria (62.6% vs 37.4%). Individuals with EFM had more severe disease across all measures compared to those with enthesitis only, with no significant difference between sexes. EFM was significantly associated with age, female sex, BMI, BASDAI and region. FM is an important comorbidity in the setting of enthesitis in SpA. While EFM is more common in females, it is not a rare condition in males. EFM is associated with worse disease severity measures in SpA in both males and females. Recognition of FM in the setting of enthesitis is essential to prevent overtreatment and optimise patient outcomes.

Analgesics in rheumatic diseases – a necessary component of therapy aimed at improving the quality of life

Control of chronic pain is one of the main elements of the complex therapy of rheumatic diseases (RD). The use of analgesics is of fundamental importance for the management of patients with osteoarthritis (OA), since a unified system of pathogenetic therapy has not yet been developed for this disease. In immunoinflammatory rheumatic diseases (IRDs), such as rheumatoid arthritis, effective pathogenetic therapy can successfully control inflammatory activity. However, in many cases, in patients with IRDs, unpleasant symptoms (pain, fatigue, poor general well-being, etc.) persist even during remission and low inflammatory activity. This is associated with persistent structural changes, “secondary” OA, central sensitization, and concomitant fibromyalgia. Therefore, approximately 50% of patients with IRDs receiving modern pathogenetic therapy require additional use of analgesics. Therapy for musculoskeletal pain in RD should be complex, include drugs with different mechanisms of action and non-drug methods. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line therapy, they have good analgesic and anti-inflammatory potential. The choice of a specific NSAID should be based on an individual assessment of the clinical situation and the presence of risk factors for possible complications. Among NSAIDs, aceclofenac should be singled out – an effective drug with a favorable safety profile, which is confirmed by a large number of clinical studies and real clinical practice.

The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia.

This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria. This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria. In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively). Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.

The frequency of fibromyalgia in familial Mediterranean fever and its impact on the quality of life.

Concomitant fibromyalgia syndrome (FMS) has been known to be more frequent in patients with several rheumatic diseases. In this study, our aim was to investigate the prevalence of FMS in patients with familial Mediterranean fever (FMF), to analyze the possible factors related to this frequency, and to evaluate the impact of FMS on the functionality and quality of life (QoL) of the patients with FMF. One hundred cases with FMF and 100 controls were included to this case-control study. FMS coincidence was investigated in all participants according to revised 2016 classification criteria. Demographic features, FMF disease duration, FMF gene mutations, drugs used, attack frequency per year, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum fibrinogen levels were recorded. FMF disease severity was assessed by International Severity Scoring System for Familial Mediterranean Fever (ISSF). For the assessments of QoL and functioning, FMF-QoL, Short form 36 (SF-36), and Health Assessment Questionnaire-Disability Index (HAQ-DI) were used, and for the assessment of FMS impact, the fibromyalgia impact questionnaire (FIQ) were used. We found an FMS frequency of 33% in patients with FMF in our study using the current FMS classification criteria. This result was significantly higher than in age- and gender-similar controls (6% FMS frequency; P < 0.05). The number of woman patients and FMF disease duration were significantly higher in patients with FMF + FMS than in patients with only FMF (P < 0.001). There was no significant difference in ISSF scores, ESR, CRP, and fibrinogen levels, management regimens, and FMF gene mutation distributions between FMF + FMS and FMF groups. FMF attack frequency was reported as significantly higher in FMF + FMS patients than in others (P < 0.000). In spite of similar FMF-QoL scores, there were significant differences in HAQ-DI and SF-36 scores between groups (P < 0.05). Higher impact of FMS presented negative correlation with functioning and general health, and positive correlation with QoL in FMF + FMS (P < 0.05). Concomitant FMS was a common clinical problem in patients with FMF regardless of the severity and characteristics of FMF. The FMS impact may affect function and QoL in patients of FMF. Considerations of the FMS component in the management of FMF may contribute to the holistic approach to FMF.

Maladie de Sjögren, syndrome asthénie polyalgie sécheresse (SAPS) et fibromyalgie

The combination of dry eyes and mouth, fatigue and pain in the limbs suggests Sjögren's syndrome, a systemic autoimmune disease. The association also characterizes the sicca, asthenia, polyalgia syndrome (SAPS), which is considered to be an equivalent of fibromyalgia and is common in fibromyalgia. These 2 entities have a high prevalence unlike Sjögren's syndrome. The distinction between these pathologies is made by applying the ACR/EULAR criteria for Sjögren's syndrome which require the presence of anti-SSA or a focus score≥1 on the labial salivary gland biopsy (LSGB). In the absence of anti-SSA and when the diagnostic probability is low, the salivary gland ultrasonography, which shows a high negative predictive value, could be an intermediate step before deciding on the LSGB, which is a little more aggressive. About 20% of patients with Sjogren's syndrome have concomitant fibromyalgia. These patients have a higher ESSPRI score (EULAR Sjögren's Syndrome Patient Related Index) (assessment by a VAS of pain, fatigue and dryness), while the ESSDAI score (EULAR Sjögren’ Syndrome Disease Activity Index) which measures systemic impairment, is no different from patients without fibromyalgia. In this population, unlike primary fibromyalgia, agreement between the fibromyalgia criteria is not good. The symptoms of fibromyalgia and Sjogren’ syndrome are very similar, and fibromyalgia criteria have difficulty discriminating between them.

Self-Reported Anxiety and Depression in a Monocentric Cohort of Patients With Systemic Lupus Erythematosus: Analysis of Prevalence, Main Determinants, and Impact on Quality of Life.

Aims of the studyTo analyze the prevalence of self-reported anxiety and depression in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE); to study the main determinants and the impact on quality of life (QoL).MethodsA cross-sectional observational study including adult outpatients with SLE. Demographic and clinical data were analyzed: indices of disease activity (SELENA-SLEDAI); damage (SLICC-DI); comorbidities and concomitant therapies. The definitions for remission (DORIS) and “Lupus Low Disease Activity State” (LLDAS) were applied. At enrollment, each patient completed the following questionnaires: SF-36, FACIT-Fatigue, Lupus Impact Tracker (LIT), Systemic Lupus Activity Questionnaire (SLAQ), and the Hospital Anxiety and Depression Scale (HADS) in order to self-assess anxiety and depression symptoms. The Student t-test and Chi2 tests were conducted for univariate analysis. The Spearman test was used for linear correlation between continuous data. Multivariate analysis was performed by multiple linear and logistic regression.ResultsOne hundred fifty-four consecutive patients with SLE were enrolled, the majority female and Caucasian with a mean age = 43.3 ± 13.7 years. 79.9% were in LLDAS or remission. 36.4% had a SDI > 1. 13.7% of patients had concomitant fibromyalgia. 37.4% had symptoms indicating anxiety and 25% of depression according to the HADS questionnaire. In the multivariate analysis, patients with active disease were significantly more anxious and depressed (p < 0.01) compared to patients in LLDAS or remission. Fibromyalgia and older age were independently associated with anxiety and depression, respectively (p < 0.05). Active skin involvement was significantly linked to depression (p < 0.05). Higher scores on the HADS questionnaire (higher levels of anxiety and depression) were found to be significantly linked to patients’ perception of higher disease activity and worse quality of life, irrespective of disease activity, age and fibromyalgia.ConclusionSymptoms of anxiety and depression are frequent in SLE patients, including outpatients with mild/moderate disease. Such symptoms have a significant negative impact on QoL and perception of disease activity, regardless of other factors. Moreover, disease activity, advanced age and fibromyalgia appear to be significantly linked to mood disorders. Assessing symptoms of the anxious-depressive spectrum in patients with SLE could lead to improvement in patients’ perception of health status and quality of life.

Fibromyalgia: transformation of views

Fibromyalgia (FM) is a mystery of modern rheumatology. Despite the high prevalence of FM according to special epidemiological studies, clinicians make this diagnosis rarely. The modern concept of fibromyalgia was created by Smythe and Moldofsky in the mid-70s. They introduced a new term «fibromyalgia», thereby emphasizing that this condition is more due to pain syndrome than inflammation of connective tissue. A disturbance of sensory information processing in the central nervous system (dysfunction of the pain system with the formation of central sensitization, CS) plays a key role in the pathogenesis of FM. Clinical manifestations of FM include chronic widespread pain associated with a wide range of psychosomatic disorders (sleep disorders, cognitive disorders [fibro fog], anxiety, depression, fatigue, morning stiffness, etc.). The diagnostic criteria for fibromyalgia have undergone significant changes. The latest FM diagnostic criteria were developed by the American College of Rheumatology (ACR) in 2016. According to the ACR (2016) FM criteria, a diagnosis of FM does not exclude the presence of other clinically important illnesses. Concomitant FM among patients with rheumatic diseases (RD) occurs 2–3 times more often than in the general population. Diagnostics and treatment of FM are extremely difficult for clinicians, it is especially difficult with comorbidity of FM with RD. Therefore, FM requires a multidisciplinary approach within a biopsychosocial model of pain syndrome: the treatment of a patient with RD and FM should combine anti-inflammatory therapy with a complex of methods (medications and nondrug therapy) used for FM therapy. The diagnostics of comorbid FM in patients with RD will allow for personalized and more effective analgesic therapy.