Background/Purpose:

Studies on the relationship between Fibromyalgia (FM), a generalized pain disorder with up to 2% prevelance and Behcet’s Disease (BD), a systemic, inflammatory vasculitis, is limited. We conducted the present study to assess the prevalance of FM in BD diagnosed according to 2010 American College of Rheumatology (ACR) criteria and to evaluate the association of FM with disease activity, disability, depression, anxiety and quality of life (QoL) in BD patients.

Methods:

One hundred-two patients followed as BD (F/M:56/46, mean age: 40.4 years) fullfilling the International Study Group Criteria (ISG,1990), 85 patients with systemic lupus erythematosus (SLE) (F/M:81/4, mean age: 41.4 years) and 51 healthy controls (HC) (F/M: 30/21, mean age: 40.9 years) were enrolled to the study. All patients were examined for FM tender points (according to ACR 1990 criteria for the classification of FM) by two observers (kappa=0.8) and asked to complete new ACR 2010 FM questionnaire for FM (ref1). The clinical activity  score in BD was determined by Behcet’s Syndrome Activity Scale (BSAS) and SLE by SLEDAI. SF–36 and hospital anxiety and depression scales were also used to assess QoL together with health assessment questionnaire (HAQ). 

Results:

Twenty-four (23.5%) BD patients met the ACR 2010 criteria for FM, compared to 18 (21.2%) in SLE and 5 (9.8%) in HC (p=0.1). When we analysed according to 1990 ACR FM criteria, 13(12.7%) in BD group, 6 (7.1%) in SLE and one (2.7%) in HC were classified as FM.

BSAS score correlated with FM (r=0.5, p=0.002), whereas FM and SLEDAI had no correlation (r=0.2,p=0.1). While mean anxiety scores were similar between groups (7.1±4.3, 7.01±4.3 and 5.8±4.6 in BD, SLE and HC, respectively)(p>0.05), mean depression scores were significantly different (5.8±3.4, 6.4±4.8 and 3.9±3.5 in BD, SLE and HC respectively)(p>0.05) between the groups. When anxiety and depression scores were analyzed as possible contibuting factors for FM presence, correlation was observed between anxiety and depression scores with FM (r=0.3, p=0.002 vs r=0.3, p=0.002, respectively) in BD.

Mean SF-36 physical component scores (PCS) were observed significantly lower in BD and SLE  patients [41.7(11.3), 41.6(12.2) and 49.9(8.5) in BD, SLE and HC, respectively]  (p<0.01). Also, SF36-mental components (MCS) were different between BD and HC groups [42.3(9.8), 46.6(10.3) in BD and HC, respectively] (p=0.05). There were negative correlations between SF36 –PCS and -MCS with FM (r=-0.4 and r=-0.1). 

BSAS score (median) was 20 (0-79) in BD and %53.2 (n=50) of the BD group had a mucocutaneous and %46.8 (n=44) had major disease. The presence of FM did not differ significantly between the patients with mucocutenous and major organ involvement (p=0.6). No significant difference were also observed between SF36 parameters, HAQ scores, BSAS score and anxiety-depression scores between the two subsets.

Conclusion:

Fibromyalgia, with new diagnostic criteria, seem to be more prevelant in BD compared to previous studies. Association of BSAS and SF-36 with FM in our study group suggests that disease activity and QoL status seems to influence FM presence in BD.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/fibromyalgia-in-behcets-disease-is-associated-with-disease-activity/