Frequency of concomitant fibromyalgia in rheumatic diseases: Monocentric study of 691 patients
Introduction
Fibromyalgia (FM) is a syndrome combining cognitive disturbance, sleep disorders, fatigue, and associated chronic widespread pain. Its prevalence is 2% in the general population, higher in rheumatic disease cases, and considerably varying depending on the diagnostic criteria used [1], [2]. FM is diagnosed in 6.6–22.4% of patients with rheumatoid arthritis (RA) [3], [4], [5], with an incidence of 7%, maximal in the first year following RA diagnosis [6]. It has also been reported in association with ankylosing spondylitis (AS) (4–15% of patients) [7], [8], systemic lupus erythematosus (SLE) (6.2–24% of patients) [5], [9], [10], [11], and Sjögren’s syndrome (SS) (12–30%) [12], [13].
In clinical practice, FM is a confounding factor in rheumatic disease cases in terms of both diagnosis and disease activity assessment. Firstly, distinguishing FM from rheumatic disease can be challenging, particularly in non-radiographic axial spondyloarthritis (nr-axial SpA), due to the widespread, primarily axial pain, fatigue, and sleep disorders that are common clinical features of both conditions, as well as the enthesitis sites potentially overlapping with FM tender points. Secondly, concomitant FM disrupts disease activity and functional impairment assessment of RA and spondyloarthritis (SpA). It leads to overestimations in the 28-joint Disease Activity Score, as well as the BASFI and BASDAI indices, and causes non-justified therapeutic intensification [4], [5], [6], [14] with more frequent use of biological therapy [15].
Our study sought to compare frequency of concomitant FM in rheumatic diseases in a rheumatology department in routine practice.
Section snippets
Methods
The study was approved by the local ethics committee (Comité de Protection des Personnes Sud Est VI) (IRB: 00008526), and written consent was obtained from all patients who agreed to participate in the study, in accordance with the Declaration of Helsinki.
Patient characteristics
In total, 691 patients with a rheumatic disease were enrolled between September 2014 and April 2015. The total population consisted of 451 women (65.3%) and 240 men (35.7%), with a mean age of 55.8 ± 15.5 years (Table 1). The population included 325 RA cases, 298 SpA cases (categorized as 59 PsA, 137 AS, 64 nr-axial SpA, and 38 peripheral SpA), and 71 CTD cases (28 SLE, 27 SS, 14 Scl, and 6 myositis).
Frequency of concomitant fibromyalgia in the three inflammatory rheumatic disease groups
The frequency of concomitant FM varied according to the criteria used and the rheumatic disease
Discussion
In our study, 8–14% of rheumatic disease patients (primarily women) were affected with a concurrent FM. The rheumatologist diagnosed more FM cases than the 1990 ACR criteria. Concurrent FM was significantly less common in patients with RA than in those with SpA and CTD. This syndrome is much more common in nr-axial SpA than in AS or PsA.
FM is more common in rheumatic disease populations than in the general population, in which the prevalence does not exceed 2% in France [1], [2]. One possible
Conclusion
FM-like symptoms are commonly associated with rheumatic diseases. The frequency of FM is particularly high in nr-axial SpA and raises questions about the specificity of the ASAS classification criteria.
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This research receives a funding Grant from the University Hospital of Clermont-Ferrand (Grant no. AOI DUBOST 2014).