Impact of Fibromyalgia on DAS28 in Patients with Rheumatoid Arthritis

Aman Sharma¹, Ashish Aggarwal², Eyal Kedar³, Mary Bach⁴ and Shounak Lahiri⁵, ¹Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, ²PGIMER, Chandigarh, Chandigarh, India, ³St. Lawrence Health System, Potsdam, NY, ⁴VA Puget Sound Health Care System, Seattle, WA, ⁵Twistle Inc., Albuquerque, NM

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: fibromyalgia and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes - Poster II: Clinical Focus

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: To estimate the prevalence of secondary fibromyalgia (FM) in patients with RA and its effect on the disease activity score (DAS28) in a tertiary care teaching hospital.

Methods: Patients aged above 18 years who had been diagnosed with rheumatoid arthritis (RA) as per the ACR/EULAR criteria 2010 were included in the study. Fibromyalgia (FM) was diagnosed using the ACR 1990 criteria. Patients with incomplete clinical data and above 75 years were excluded. Laboratory and clinical findings were entered in a structured format. DAS28 was assessed using ESR and supplemented with CRP, only if ESR was not available. Statistical analyses were performed using SPSS v16 software. The study was approved by the Institutional Ethics Committee of PGIMER, Chandigarh.

Results: A total of 371 subjects were recruited with a mean age of 46 (±12.3) years. The study population followed normal distribution in age with a median of 46 years and mode of 45 years. The male to female ratio was 1:5.4. The prevalence of FM was 18.1% amongst RA patients (67/372). In patients with secondary FM 92.5% were female compared to 82.6% without FM. 65.7% patients with FM had a disease duration of greater than 5 years compared to 46.9% patients without FM. 71.6% of patients with FM had high disease severity compared with only 43.9% patients without FM. The average DAS28 score was significantly higher [(p<0.001); 95% CI: 1.2 – 3.7] in patients with secondary FM (5.68±1.49) compared to those without FM (4.92±1.62). In sub-analyses of independent variables of DAS28, tender joint counts were significantly higher [(p<0.001); 95% CI: 3 – 8.8] in patients with FM (17.90) as compared to RA patients without FM (11.98). Also, the patients’ global health scores were worse [p<0.001; 95% CI: 5.5 – 21.6] in RA patients with FM. Swollen joint count and ESR values were comparable in both the groups.

Conclusion: The present study reports that 18.1% of the RA patients had associated FM. TJC and GH of patients are affected by the co-existing FM. The study advocates the development of new outcome measures that are more objective and depend upon reliable laboratory biomarkers/ultrasound evidence of synovitis for assessing the disease activity of RA patients.

Disclosure: A. Sharma, None; A. Aggarwal, None; E. Kedar, None; M. Bach, None; S. Lahiri, None.

To cite this abstract in AMA style:

Sharma A, Aggarwal A, Kedar E, Bach M, Lahiri S. Impact of Fibromyalgia on DAS28 in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/impact-of-fibromyalgia-on-das28-in-patients-with-rheumatoid-arthritis/. Accessed .

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