Background/Purpose: Chronic diseases involve cognitive aspects. Attention deficit hyperactivity disorder (ADHD) is a chronic condition, marked by persistent inattention, impaired concentration, hyperactivity, impulsivity, emotional lability, anxiety and disorganized behavior. Fibromyalgia (FM) includes a range of symptoms affecting memory, attention and concentration. High rates of comorbidity between ADHD and FM have been reported, as well as some evidence that patients with both conditions experience heightened symptom severity. In addition, recent studies suggest that vitamin D deficiency is associated with cognitive impairment.

Methods: Consecutive patients, older than 18 years, with diagnosis of fibromyalgia (2010 ACR criteria) seen at the outpatient Rheumatology Unit between May 2016 and April 2017, were included. During the inclusion visit the following data were collected: Revised Fibromyalgia Impact Questionnaire (FIQ-R), HAQ-A (Health Auto Questionnaire-simplified, Argentine validation); pain (Visual Analogue Scale, VAS), fatigue (VAS) and serum 25 -hydroxyvitamin D (25(OH)D) level. During the Neurology visit, the following tests were performed: Conners Continuous Performance Test II (CPT II), Wender-Utah Rating Scale (WURS) and Structured Clinical Interview for Personality Disorders (SCID-II). Descriptive statistics were calculated. Correlations were calculated between CPT II and pain, fatigue, FIQ-R, HAQ-A and 25(OH)D, using Spearman’s test.

Results: 37 patients with FM were included. Patients’ characteristics are shown in table 1. 73% (n=27) of the patients tested positive for adult ADHD. In 40.7% (11/27) of them, the diagnosis had been missed in childhood. Participants with both FM and a positive adult ADHD screening test did not score significantly higher on the FIQ-R (54.9, SD= 16.3 vs 48.8, SD= 11,3; p= 0.3320) and did not have lower vitamin D levels (27,4 ng/ml, SD= 13,1 vs 36,7 ng/ml, SD= 9,6; p= 0.1050). There was a very good positive correlation between ADHD and fatigue (r= -0.9607; p= 0.0086). No association was found between ADHD and severity of perceived cognitive symptoms (p= 0,673). There was no correlation with pain (r= 0.1688 p=0.3325), HAQ-A (r= 0.1340; p= 0.4429) or vitamin D level (r= -0.3211; p=0.1176). No correlation was observed between vitamin D levels and FIQ-R (r= -0.1848; p= 0.3662). The most frequent personality disorders found were narcissism (32,4%) and obsessive-compulsive disorder (32,4%).

Conclusion: The co-occurrence of adult ADHD in FM was highly prevalent. The diagnosis had been often overlooked in childhood. ADHD was associated with fatigue but not with pain, disease impact or functional capacity. Vitamin D levels were no associated with disease impact or dyscognition. Patients with FM should be assessed for the presence of adult ADHD. More investigations are needed to understand the impact of cognitive disorders in FM.

Table 1.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-attention-deficit-hyperactivity-disorder-among-patients-with-fibromyalgia/