Session Information
Date: Tuesday, November 15, 2016
Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Concomitant fibromyalgia syndrome (FMS) is a common problem in ankylosing spondylitis (AS) and its recognition is important for optimal management. BASDAI, a disease activity measures for AS has been shown to have poor specificity for AS and was reported to be high in patients with fibromyalgia. Hypothesis guiding our study was that the validated tools of disease activity in AS measure fibromyalgia pain. We studied the association of validated instruments of disease activity in AS with widespread pain index (WPI) and symptom severity score (SS) used in FMS.
Methods: Study was approved by our IRB. We prospectively recruited 62 AS patients ≥18 years of age and meeting the modified New York criteria with grade 3 or 4 sacroiliItis. Demographic and clinical data were collected and stored in Redcap data base. Various questionnaires to assess disease activity and patient reported outcomes in AS were administered to these patients. The frequency of FMS was determined using validated 2010 ACR diagnostic criteria for fibromyalgia. Patient met the fibromyalgia criteria if (i) WPI of ≥ 7 & SS ≥ 5 or WPI 3–6 & SS score ≥ 9,(ii) symptoms were present at a similar level for at least 3 months and (iii) the pain was not attributed to AS by the clinician. ESR and CRP was measured using routine laboratory methods. Descriptive analysis included continuous variables (mean ± SD) and the categorical variables (%). Data were compared by Student’s t-test for continuous variables and chi-square for categorical variables. Linear regression analysis was performed to assess the association between BASDAI, BASMI, ASDAS, Rapid 3, ESR, CRP, WPI and SS scores.
Results: 27/62 (43.5%) patients with AS satisfied the ACR diagnostic criteria for fibromyalgia. Patient demographics and clinical characteristics Table 1.The patients with FMS had significantly higher disease activity as compared to patients without FMS (Table 2). There was no significant relationship of BASDAI, RAPID 3, ASDAS-CRP, physician’s global and patient global scores, ESR, CRP when tested individually with the WPI and SS scores (Table 3).
Conclusion: Despite 43% prevalence of fibromyalgia in our patients with active AS and high disease activity, the validated tools of disease activity in AS did not measure fibromyalgia related pain and symptom severity.
Table 1- Demographics and Clinical Characteristics of Patients
| Patients who fulfilled the ACR Diagnostic Criteria for Fibromyalgia N= 27/62 | Patients who did not fulfill the ACR Diagnostic Criteria for Fibromyalgia N=35/62 | p- value | |
| Mean age in years ± SD | 48.9 ± 11.2 | 48.7 ± 13.2 | 0.94 |
| % African-Americans | 63.16 | 36.84 | 0.02 |
| % Females | 45 | 55 | 0.60 |
| % HLA-B27 positivity | 77.7 | 74.2 | 0.75 |
| % Acute anterior uveitis | 27.2 | 72.73 | 0.03 |
| % TNF-i use | 51.8 | 48.5 | 0.79 |
Table 2- Comparison of Disease Activity Scores between the two groups
| Mean values ± SD | Patients with Fibromyalgia | Patients without Fibromyalgia | p-value |
| BASDAI | 6.8 ± 1.9 | 3.8 ± 2.2 | < 0.0001 |
| RAPID 3 | 18.1 ± 6.2 | 10.3 ± 6.7 | < 0.0001 |
| ASDAS-crp | 4.2 ± 0.9 | 2.8 ± 0.8 | < 0.0001 |
| Physician global | 6.5 ± 2.3 | 4.1 ± 2.1 | 0.0002 |
| Patient global | 7.3 ± 2.2 | 4.4 ± 2.5 | <0.0001 |
| ESR mm/hr | 29.5 ± 27.7 | 15.42 ± 16.3 | 0.01 |
| CRP mg/dl | 2.3 ± 3.5 | 0.8 ± 0.8 | 0.01 |
Table 3- Linear Regression modelling with SS scale and WPI as dependent variable
| Variable | BASDAI | RAPID 3 | ASDAS-CRP | ESR | CRP |
| Widespread Pain Index | P=0.30 | P=0.77 | P=0.59 | P=0.18 | P=0.83 |
| Symptom Severity Scale | P=0.15 | P=0.64 | P=0.86 | P=0.82 | P=0.96 |
To cite this abstract in AMA style:
Magrey MN, Diomampo S, Khan MA. Do Validated Tools of Disease Activity in Ankylosing Spondylitis Measure Fibromyalgia Pain? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/do-validated-tools-of-disease-activity-in-ankylosing-spondylitis-measure-fibromyalgia-pain/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-validated-tools-of-disease-activity-in-ankylosing-spondylitis-measure-fibromyalgia-pain/