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Abstract Number: 1317

A Large Agreement Between the Pain Points of the ACR 1990 Fibromyalgia Criteria and the MASES Enthesitis Score Is Observed in Patients with Axial Spondylitis, Including in Patients Without Concomitant Fibromyalgia

Faten Hamitouche1, Clementina Lopez-Medina2, Laure Gossec3, Serge Perrot4, Maxime Dougados5 and Anna Molto6, 1Rheumatology Department, Cochin Hospital, Paris, Ile-de-France, France, 2Rheumatology Department, Cochin Hospital, Paris, Paris, France, 3Sorbonne Université and Hôpital Universitaire Pitié Salpêtrière, Paris, France, 4Paris Descartes University, Paris, Ile-de-France, France, 5Université de Paris, Department of Rheumatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France, 6Rheumatology Department, Cochin Hospital, APHP, Paris, France, Paris, France

Meeting: ACR Convergence 2020

Keywords: fibromyalgia, pain, spondyloarthritis

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Session Information

Date: Sunday, November 8, 2020

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II: Extra-MSK & Comorbidities

Session Type: Poster Session C

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

Background/Purpose: Enthesitis is the hallmark lesion in Spondyloarthritis (SpA). The Maastricht Ankylosing Spondylitis Enthesitis score (MASES), which assesses 13 enthesitic sites, is the most widely used. Fibromyalgia (FM) is characterized by chronic diffuse musculoskeletal pain and diffuse pain points assessed by the tender points of the ACR 1990 criteria. Coexistence of FM represents a difficulty in the evaluation of enthesitis due to a possible overlap between the tender points of the MASES and the ACR criteria for FM. 

To assess the agreement between the MASES and the tender points of the ACR 1990 FM criteria in a population of patients with axial spondyloarthritis (axSpA).

Methods: Ancillary cross-sectional analysis of the French Predict-SpA study. Patients had a diagnosis of axSpA according to their rheumatologist and an indication to start a TNF blocker (TNFb). All patients were screened for FM according to the FiRST questionnaire, and all patients underwent a physical examination : 18 tender points of the ACR 1990 criteria and the 13 enthesitic sites of the MASES were evaluated in a random order. Analysis: the overlap/agreement between the MASES and the ACR/FM tender points was assessed by the intraclass correlation coefficient (ICC). The agreement for “high” values in both scores (i.e. >6 for MASES and >9 for ACR) was evaluated by the PABAK (Prevalence-Adjusted Kappa). The same analysis was performed in the group of patients with and without concomitant FM. The characteristics of patients with high ACR and MASES scores were compared with the rest of the population by univariate and multivariate analyses.

Results: The study involved 526 patients with axSpA diagnosis, and among them, 202 were screened as FM by the FiRST questionnaire (by a score ≥ 5/6) but only 86/526 (16.3%) fulfilled the 1990 ACR FM criteria. Among the 526 patients, 446 (84.8%) had at least one ACR 1990 point, 423 (80.4%) had a MASES ≥1 and 404 (76.8%) had both at least one ACR 1990 point and a MASES ≥1. The ICC between both scores was 0.7 (95%CI [0.6-0.8]). A total of 77/526 (14.6%) patients had high ACR and MASES scores simultaneously. The agreement for high scores, assessed by PABAK, was 0.7 (95%CI [0.6-0.7]).

Among the 202 patients with concomitant FM, 179 (88.6%) had at least one ACR 1990 point and a MASES ≥1, whereas this was the case for 225/324 (69.4%) of patients without FM. The ICC between both scores was 0.6 (95%CI [0.3-0.8]) and 0.7 (95%CI [0.6-0.8]) for patients with and without FM, respectively. The agreement for high scores assessed by PABAK was 0.5 (95%CI [0.4-0.7]) in patients with FM and 0.8 (95%CI [0.7 – 0.8]) in those without.

Patients with concomitantly high ACR and MASES scores were more often HLAB27 negative (OR (95%CI) = 2.4 [1.3-4.4]), had more often a history of talalgia (OR (95%CI) = 1.9 [1.0-3.5]), a BASDAI at inclusion >4 (OR (95%CI) = 4.2 [1.2-26.6]) and a FM (OR (95%CI) = 3.38 [1.87-6.29]).

Conclusion: These results suggest a great overlap between both scores in patients with axSpA, including in those without concomitant FM. However, the coexistence of FM was associated with the presence of many pain points (both in MASES and ACR). Additional studies assessing the metrological performance of MASES in axSpA patients with concomitant FM seem necessary.


Disclosure: F. Hamitouche, None; C. Lopez-Medina, None; L. Gossec, Sandoz, 1, AbbVie, 5, 8, Amgen Inc., 5, 8, Biogen, 5, 8, Janssen, 5, 8, Celgene, 5, 8, Eli Lilly, 1, 5, 8, Novartis, 5, 8, Pfizer, 1, 5, 8, UCB Pharma, 5, 8, Sanofi, 5, 8; S. Perrot, Pfizer, 8, Grunenthal, 8, MSD, 8, UPSA, 8, Menarini, 8; M. Dougados, Pfizer, 5, 8, AbbVie, 5, 8, Roche, 5, 8, Bristol-Myers Squibb, 5, 8, Eli Lilly, 5, 8, Novartis, 5, 8, Sanofi, 5, 8, Biogen, 5, 8, Merck Sharp & Dohme, 5, 8, UCB Pharma, 5, 8; A. Molto, ABBVIE, 5, BMS, 5, 8, LILLY, 5, NOVARTIS, 5, 8, UCB, 5, 8, GILEAD, 5.

To cite this abstract in AMA style:

Hamitouche F, Lopez-Medina C, Gossec L, Perrot S, Dougados M, Molto A. A Large Agreement Between the Pain Points of the ACR 1990 Fibromyalgia Criteria and the MASES Enthesitis Score Is Observed in Patients with Axial Spondylitis, Including in Patients Without Concomitant Fibromyalgia [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/a-large-agreement-between-the-pain-points-of-the-acr-1990-fibromyalgia-criteria-and-the-mases-enthesitis-score-is-observed-in-patients-with-axial-spondylitis-including-in-patients-without-concomitant/. Accessed May 26, 2022.
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