Background/Purpose: The Accelerating Medicines Partnership Autoimmune and Immune-Mediated Diseases (AMP AIM) network seeks to understand the cellular and molecular interactions that lead to inflammation and autoimmune diseases. Pain is among the most common symptoms in patients with these diseases, and up to one third have concomitant fibromyalgia. Little is known about how the experience of chronic pain differs across rheumatic diseases and whether it impacts patients with these conditions similarly or differently. The objective of this study was to examine differences in pain intensity, pain interference, pain distribution, pain catastrophizing, and the prevalence of fibromyalgia (FM) among patients with RA, SLE, PsA, Psoriasis (PsO), Sjögren’s disease (SjD), and sicca symptoms without SjD (sicca).

Methods: A common set of patient-reported outcomes was administered to participants in 6 AMP AIM cohorts: RA, SLE (most with nephritis), PsA, PsO, SjD, and Sicca symptoms without SjD. We report demographics and differences among the disease states in the following measures: Pain intensity (0-10) and pain interference (T-score range 41.1-76.3) from the PROMIS-29; Widespread pain index (WPI) as a continuous measure (range 0-19); Symptom Severity Score (SSS) as a continuous measure (range 0-12); FM survey score (sum of WPI and SSS, range 0-31); Pain catastrophizing scale (PCS) (0-52 total score); Presence of FM defined using the 2016 criteria: chronic pain for 3 months or more, pain in 4/5 regions, (WPI ≥ 7 and SSS ≥ 5) or (4 ≤ WPI ≤ 6 and SSS ≥ 9). We examined the differences in each of these PROs by disease and the presence or absence of FM.

Results: Among individuals enrolled in the AMP AIM study (Table 1), 39 participants with RA, 38 with SLE, 27 with PsA, 31 with PsO (without PsA), 55 with SjD, 66 with sicca symptoms but no SjD and 22 healthy controls completed the pain questionnaires. Mean age among the 6 groups varied by disease and ranged from 45 years old in SLE to 60 years in SjD. Sex was predominantly female (80% overall though 49% and 35% in PsA and PsO, respectively). 72% of participants were white, and 61% had a college education or higher. The prevalence of FM was 20% across the various cohorts, highest in participants with RA (31%) and participants with sicca symptoms but no SjD (30%), 22% in SjD, 11% in SLE, 22% in PsA, 5% in healthy controls and not observed in PsO. WPI and SSS scores varied among the groups but were also highest in participants with sicca symptoms but no SjD (Figure 1). PCS was lowest in healthy controls and PsO and similar among the other groups. Across all disease groups, PROMIS 29 scores were worse for participants with FM compared to those without FM (Figure2).

Conclusion: FM prevalence differed among these conditions and was associated with reduced quality of life and greater disease impact. Those with FM had worse PROMIS 29 scores. Patients with RA and those with sicca without SjD had the worst PROs and highest prevalence of FM. This trans-disease study emphasizes the importance of capturing chronic pain and leveraging AMP-AIM to address molecular and cellular mechanisms underlying this health burden.

Table 1. Patient Demographics and Prevalence of Chronic Pain

Figure 1. Pain measures across conditions

Five pain measures across the enrolled diseases. (A) Pain intensity (0-10); (B) PROMIS Pain Interference scale; (C) WPI; (D) SSS; (E) PCS. Dotted line represents the general population norm (T-score 50) for PROMIS Pain Interference, the cut offs for the 2016 Fibromyalgia criteria for WPI and SSS, and the cut-off for catastrophizing for PCS.

Abbreviations: RA = rheumatoid arthritis; SLE = systemic lupus erythematosus (predominantly those with kidney disease in this cohort); PsA = psoriatic arthritis; PsD = psoriasis without PsA; SjD = Sjogren’s Disease; Sicca = sicca symptoms without SjD; HC = healthy control

Figure 2. PROMIS29 by 2016 Fibromyalgia criteria

The dotted line represents the population norm (50). For social roles and activities and physical function, lower number represent worse outcomes whereas for sleep disturbance, pain interference, fatigue, depression and anxiety, higher numbers represent worse outcomes. Abbreviation: FMS = fibromyalgia syndrome

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-and-fibromyalgia-across-autoimmune-and-inflammatory-diseases-in-the-amp-aim-cohort/