Background/Purpose: Secondary Fibromyalgia is seen in 15% of patients with rheumatoid arthritis (RA). Neurotrophins are elevated in patients with active arthritis and BDNF is elevated in primary Fibromyalgia. We did a cross sectional and longitudinal study to evaluate the association of FMS and tender points with RA disease activity, depression and neurotrophins in patients with RA. 

Methods: Female patients of RA with and without Fibromyalgia (ACR 1990 criteria) were recruited.  RA disease activity was assessed by DAS28-3v, depression by BPHQ and health related quality of life by WHO HRQoL Bref. Plasma neurotrophins NGF, BDNF, NT3 and NT4 were tested by ELISA. Longitudinal analysis was done using linear mixed model analysis using a fixed effects model adjusting for covariates. 

Results: We recruited 40 female patients with RA and secondary FMS and 43 with RA and no FMS. Mean age was 42.2 yrs (20- 66), duration of RA 5.9 yrs (0.6- 22) and mean age of onset was 36.4 yrs (16-59). Of these 38 patients had two or more visits and 14 had 3 visits.  At baseline, patients with FMS had more depression by BPHQ (12.8 vs 8) and tender points (14.8 vs 3.4) compared to those without FMS while HAQ, DAS28, age and ESR were similar.

FMS status, DAS28-3v, swollen joints, and HAQ-DI were independent predictors of fibromyalgia tender points with standardized regression coefficients of 0.75 (p<0.001), 0.13 (p<0.05), 0.16 ( p<0.005) and 0.14 (p<0.05) respectively. Quality of life was significantly decreased in physical, psychological, social and environmental domains in patients with fibromyalgia even after controlling for disease activity, HAQ-DI and depression with mean differences of 5.71 (p<0.001), 6.06 (p<0.001), 9.19 (p<0.001) and 2.99 (p<0.001) respectively.

At baseline patients with RA and FMS had higher mean  BDNF (49.8 +/- 18.2 ng/ml) compared those without FMS (41.5 +/- 17.5; p<0.05). On multivariate analysis, the estimated means were  54.5 ng/ml (SE 2.1) and 43.5 ng/ml(SE 2.3) respectively with p<0.001 and. NGF, NT3 and NT4 were detectable in 3, 14 and 4 patients at baseline.  

Conclusion: Rheumatoid arthritis disease activity and disability influences the severity of fibromyalgia. BDNF is elevated in secondary FMS associated with RA. Elevated BDNF may be contributing to FMS in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/brain-derived-neurotrophic-factor-is-elevated-in-patients-with-rheumatoid-arthritis-and-secondary-fibromyalgia/