Background/Purpose: The aim  was to evaluate the differences in depression-, anxiety- and stress-related events and trauma between patients with rheumatoid arthritis + Fibromyalgia [AR+FM] (SFM) and those with primary FM (PFM).

Methods: Study design: observational cross- sectional.  Patients were consecutively recruited. The inclusion criteria were an age of 18-70 years; a diagnosis of RA according to the  2010 ACR  criteria and FM according to the 1990 and 2016 ACR criteria. Lifetime diagnoses of major depression disorder (MDD), panic disorder (PD) and post-traumatic stress disorder (PTSD), three of the most frequently described psychiatric disorders among FM  patients were made by a senior psychiatrist using the Structured Clinical Interview for DSM-5 Axis I Disorders-Clinician Version and a single, cross-sectional assessment. Depressive symptoms were measured using the Zung Self-rating Depression Scale (ZSDS).  Childhood trauma was measured using the short form of the Childhood Trauma Questionnaire (CTQ).  Stressful events were assessed using the validated Italian version of Paykel’s Interview for Recent Life Events, a semi-structured interview investigating 64 life events. Pain was assessed using a VAS. The Italian version of the FIQ  was  used. Two-sided Fisher or T-test and multivariable logistic regression were performed.

Results: Seventy-seven patients were originally screened, but six were excluded.  The final analysis therefore involved 70 patients, all Caucasians: 30 with PFM and 40 with AR+FM. All patients with PFM and 38 (95%) of the 40 with AR+FM were treated for FM symptoms (antidepressants, pregabalin). The rates of lifetime MDD and PD were significantly higher in the PFM patients vs RA+FM (76.7% vs 40%, p =0.003), whereas there was no between-group difference in the rates of PTSD (50% in PFM vs 15% in SFM, p.003).  The PFM patients reported significantly higher levels of physical (p=0.020) and sexual abuse (p=0.011) and physical neglect (p< 0.001), whereas there was no between-group difference in the levels of emotional abuse (p=0.912) and  neglect (p=0.542); consistently, the proportion of sexually abused  (p=0.005 ) or phsically neglected patients was also higher in the PFM group (p=0.023). The rates of emotional neglect were high in both groups, without any significant difference between them. The vast majority  of AR+FM patients (90%) said that only event occurring in the year preceding the onset of FM was RA, whereas the PFM patients mainly reported non-physical events (36%, particularly the ending of a relationship, or working or financial problems) or no event at all (40%), (p< 0.001). Multivariable logistic regression used to identify the factors predicting association of PFM/AR+FM status, showed and association with lifetime major depression, life events preceding the development of FM, and BMI (p < 0.05 for all).

Conclusion:  

The study indicate that psychiatric co-morbidities and predisposing and precipitating environmental factors are different in patients with PFM from those in AR+FM patients, thus suggesting that the putative common pathogenetic condition of sensitisation may develop through different pathways. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-with-fibromyalgia-associated-with-rheumatoid-arthritis-and-patients-with-primary-fibromyalgia-differ-in-depression-anxiety-stress-related-disorders-and-events-a-cross-sectional-study/