Background/Purpose: Quality of life (QOL) measures as assessed by Patient Reported Outcome Measurement Information System (PROMIS) can contribute essential information about the status of or a change in the physical, emotional, and social health outcomes of people living with chronic diseases compared with the general population. Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with pain and progressive joint damage resulting in decreased function and changes in mood. The reliability of PROMIS in assessment of RA has been validated. Fibromyalgia (FMS) is a condition characterized by diffuse chronic pain associated with tenderness of joints and muscles along with fatigue, sleep disturbances and often poor mental health. FMS affects 10-20% of patients with RA and thus can negatively affect the pain and depression assessments. The impact of FMS on the quality of life measures as assessed by PROMIS in RA patients is not known.

Purpose: Compare pain, physical function and depression scores as assessed by PROMIS in patients with RA and FMS and assess the effect of coexisting fibromyalgia on these scores in RA patients.

Methods: This is a single center retrospective assessment of prospectively collected PROMIS data in all RA and FMS patients between January 2016 and April 2017 at an academic center RA clinic. The PROMIS t-scores are obtained as standard of care in all patients seen at the rheumatology clinic. ICD-10 diagnosis codes were used to identify patients with RA (M06.9 to M08.00) and FMS (M79.7). The t-scores for pain interference, physical function and depression during their rheumatology visits were retrieved and a mean calculated when more than one score was available. Age, gender, disease duration and medications were also recorded. The mean PROMIS scores were compared between patients with RA, FMS and FMS coexisting with RA.

Results: A total of 392 patients were identified with RA, FMS and coexisting FMS and RA but only 230 patients had complete PROMIS scores: 169 RA, 28 FMS and 33 with both. Mean age was similar between RA and FMS with RA groups, 56.7 (+/- 14.9) and 55.0 (+/- 9.3), respectively. The FMS cohort was slightly younger at 52.3 (+/- 10.7). A larger proportion of females were in the FMS (27/28; 96.4%) and FMS and RA group (31/33; 93.9%) compared with the RA patients (126 /169; 74.6%). The scores for pain (63.7 +/- 5.9) and depression (54.8 +/- 9.6) were significantly (p < 0.05) higher in patients with FMS coexisting with RA patients compared with RA only, (55.0 +/- 8.3) and (46.7 +/- 6.7), respectively. Additionally, the scores for physical function were significantly (p < 0.05) lower among RA and FMS compared to RA only, (37.5 +/- 5.4) and (44.6 +/- 8.9), respectively. Interestingly, FMS patients had scores for pain (64.6 +/- 5.9), physical function (37.4 +/- 6.5) and depression (54.3 +/- 8.6) that were similar to patients with FMS and RA.

Conclusion: These results show that patients with RA have a worse quality of life as assessed by PROMIS than the average US population (t-score =50) but coexistence of FMS in patients with RA negatively impacts PROMIS t-scores for pain, depression and physical function even further. This suggests that treatment aimed at FMS is needed to improve the QOL in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/coexisting-fibromyalgia-in-patients-with-rheumatoid-arthritis-worsens-scores-for-pain-physical-function-and-depression/