Comparison Between Fibromyalgia and Neuropathic Pain in Patients with Established Rheumatoid Arthritis

Yong Gil Hwang¹, Lei Zhu ¹ and Larry Moreland ¹, ¹University of Pittsburgh, PITTSBURGH, PA

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: fibromyalgia and painDETECT, neuropathic pain, Rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 12, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster III: Comorbidities

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Our objectives were (1) to identify similarities and differences of pain symptoms identified by fibromyalgia (FM) and neuropathic pain (NP) screening tool (2) to compare pain qualities and their relationship with rheumatoid arthritis (RA) disease activity.

Methods: 169 RA patients enrolled in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Registry (RACER) underwent a clinical evaluation and fulfilled 3 self-report questionnaires (PainDETECT, Patient-Reported Outcomes Measurement Information System (PROMIS) 29, Widespread Pain Index/Symptom Severity Scale). The results of the clinical evaluation and questionnaires were then compared.

Results: 20 patients (11.8%) met the fibromyalgia criteria, whereas 16 patients (9.6%) were found to have neuropathic pain. However, only three patients were categorized as FM among those patients who were classified as NP. PainDETECT and polysomatic distress score were significantly correlated with pain levels, RA disease activity, and all PROMIS domains. (Figure 1) No significant difference in the swollen joint count was found regardless of the presence or absence of FM or NP. Tender joint count, patient & physician global disease assessment (PtGD, PhyGD), and clinical disease activity index (CDAI) were significantly higher in patients with NP vs those without NP, whereas only PtGD was higher in patients with FM vs those without FM. (Table 1) Significantly higher scores were found for all PROMIS domains and sensory profiles in patients with NP, while anxiety, depression, fatigue, pain interference, and slight pressure-associated pain were increased in patients with FM. (Table 2)

Conclusion: This study highlights the differences between FM and NP in association with RA disease activity and PROMIS29 domains and demonstrates the PainDETECT can be a useful tool in identifying clinical phenotypes of RA patients.

A. Correlation matrix among painDEDECT, polysomatic distress score, and clinical disease activity index B. Correlation matrix among PainDETECT, polysomatic distress score, and patient-reported outcomes measurement information system 29 domains -PDQ: PainDETECT questionnaire, PSD: polysomatic distress score, SJC: swollen joint count, TJC: tender joint count, PhyGD: physician global disease assessment, PtGD: patient global disease assessment, CDAI: clinical disease activity index, Discrepancy: absolute value for discrepancy between PhyGD and PtGD, RA: rheumatoid arthritis, PROMIS: Patient-reported outcomes measurement information system, PFA: physical function, ANX: anxiety, DEP: depression, FTG: fatigue, SLP: sleep disturbance, SRP: Abilities to participate in social role, PIN: pain interference, PAIN: 1-wk average pain level-

Table 1_2019

Table 1 Demographics and comparison of clinical characteristics of subgroups based on the fibromyalgia and PainDETECT categories -Mean -SD–

Disclosure: Y. Hwang, None; L. Zhu, None; L. Moreland, None.

To cite this abstract in AMA style:

Hwang Y, Zhu L, Moreland L. Comparison Between Fibromyalgia and Neuropathic Pain in Patients with Established Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/comparison-between-fibromyalgia-and-neuropathic-pain-in-patients-with-established-rheumatoid-arthritis/. Accessed .

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