Background/Purpose: Most of the tender points typical for fibromyalgia syndrome (FMS) are also entesis points. Besides, FMS and spondyloartropathy (SpA) can co-exist. Both disease groups have negative effects on the life quality of patients. Our aim is to document the prevalence of SpA in patients diagnosed as FMS by physical therapy specialists and to emphasize evaluation of spondyloartropathy before diagnosing with FMS.

Methods: he patients diagnosed to have FMS in the department of Physical Therapy and Rehabilition at our center between 2006 and 2011 were involved. Patients were called by phone and asked 3 questions about their inflammatory back pain. Questions were about the presence of 1.Non-traumatic pain, swelling and stiffness in any joint 2.Low back pain or back stiffness on awakening, which lasted over a period of at least 3 months and which improved with exercise 3.Heel pain more in the morning which lasted over a period of at least 3 months and improved with activity. The patients who answered positive to at least one of these three questions were invited for further evaluation and to be involved in this study. The study included 71 patients (70 female and 1 male).In all patients, comparative sacroiliac radiographies were taken for sacroiliitis and lateral radiographies of both feet were taken for enthesitis. Patients with stage 1 and stage 1-2 sacroiliitis on direct radiography, were examined with sacroiliac MR. In order to diagnose FMS, 1990 and 2010 ACR Classification were applied while ESSG Criteria were applied to diagnose SpA.

Results: According to 1990 ACR criteria, 23 patients out of 71(32.3%) were diagnosed as FMS however 33 patients (46.4%) were diagnosed as FMS according to 2010 ACR criteria.Fifteeen (21.1%) patients were diagnosed according to both 1990 and 2010 ACR criteria; however 41(57.7%) patients were diagnosed with either 1990 ACR criteria or 2010 ACR criteria.Of our 71 patients, 20 (28.1%) were diagnosed as SpA according to ESSG criteria.Ten (43.4%) FMS patients out of 23 who were diagnosed according to 1990 ACR criteria were rediagnosed as SpA according to ESSG criteria. Eleven (33.3%) patients out of 33 who were diagnosed as FMS with 2010 ACR criteria  were rediagnosed as SpA according to ESSG criteria. We determined 9(39.1%) patients out of 23 patients diagnosed with 1990 ACR criteria and 13 (39.3%) patients out of 33 diagnosed with 2010 ACR criteria were found to have stage 2 and higher sacroiliitis. According to sacroiliac MR examinations of 10 patients, 3 (30.0%) patients had sacroiliitis on MR who had stage 1 and stage 1-2 sacroiliitis on direct radiography who were diagnosed with SpA according to ESSG criteria Twelve (60.0%) out of 20 patients diagnosed as SpA according to ESSG criteria were found to have 2nd stage and higher sacroiliitis. We determined that 14 (60.8%) out of 23 patients diagnosed with ACR’s 1990 and 17 (51.5%) out of 33 patients diagnosed with ACR’s 2010 found to have enthesopathy.

Conclusion: There is a meaningful percentage of patients who have clinically insidiously progressive SpA among the patients who were thought to be diagnosed as FMS or the patients who were diagnosed as FMS according to ACR’s criteria

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevelance-of-spondyloarthropathy-in-fibromyalgia-patients/