Axial Spondyloarthritis: Factors Associated with Fibromyalgia Development and Recovery

Pavankumar Kamat

Disclosures

September 15, 2021

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.
     

Provan SA, Dean LE, Jones GT, Macfarlane GJ. The changing states of fibromyalgia in patients with axial spondyloarthritis: results from the British Society of Rheumatology Biologics Register for Ankylosing Spondylitis. Rheumatology (Oxford). 2021;60(9):4121-4129. doi: 10.1093/rheumatology/keaa888. PMID: 34469570.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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