Takeaway
- In patients with axial spondyloarthritis (axSpA), high levels of axSpA disease activity and the presence of widespread pain were associated with the development of fibromyalgia (FM).
- Patients with low levels of axSpA disease activity and widespread pain and those initiating a tumour necrosis factor (TNF) inhibitor were more likely to recover from FM.
Why this matters
- Findings suggest that patients with a history of severe axSpA disease activity and widespread pain should be evaluated for the presence of comorbid FM.
Study design
- The British Society of Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) is a prospective cohort study of 801 patients with axSpA.
- FM was diagnosed using the self-reported Fibromyalgia Survey Diagnostic Criteria (FSDC) from 2015.
- Disease activity and widespread pain were measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Widespread Pain Index (WPI).
- Funding: British Society for Rheumatology.
Key results
- Of 801 patients with axSpA:
- 686 were not diagnosed with FM at baseline, of whom 45 were diagnosed at the first follow-up.
- 115 were diagnosed with FM at baseline, of whom 77 had recovered from FM at the first follow-up.
- A high baseline BASDAI (adjusted OR [aOR], 1.27; 95% CI, 1.08-1.49) and WPI (aOR, 1.14; 95% CI, 1.02-1.28; P<.05 for both) scores were significantly associated with the development of FM.
- A low baseline BASFI (aOR, 0.68; 95% CI, 0.53-0.86) and WPI (aOR, 0.84; 95% CI, 0.72-0.97) scores and initiating a TNF inhibitor (aOR, 3.86; 95% CI, 1.54-9.71; P<.05 for all) were significantly associated with FM recovery.
Limitations
- Neither the 2016 FSDC nor the Assessment of SpondyloArthritis international Society classification criteria were ‘gold standard’ instruments with a high level of specificity.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
