Macfarlane, Gary J., MacDonald, Ross I. R., Pathan, Ejaz, Siebert, Stefan, Gaffney, Karl, Choy, Ernest, Packham, Jon, Martin, Kathryn R., Haywood, Kirstie L., Sengupta, Raj, Atzeni, Fabiola and Jones, Gareth T. (2018) Influence of co-morbid fibromyalgia on disease activity measures and response to TNF inhibitors in axial spondyloarthritis : results from a UK national register. Rheumatology, 57 (11). pp. 1982-1990. doi:10.1093/rheumatology/key206 ISSN 1462-0324.

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Abstract

Objective

To quantify the extent to which co-morbid fibromyalgia (FM) is associated with higher disease activity, worse quality of life and poorer response to TNF inhibition (TNFi) in patients with axSpa.

Method

A prospective study recruiting across 83 centres in the United Kingdom. Clinical information and patient reported measures were available, including 2011 criteria for FM. Multivariable linear regression was used to model the effect of meeting the FM criteria on disease activity, quality of life and response to TNFi.

Results

1757 participants were eligible for analyses of whom 22.1% met criteria for FM. Those with comorbid FM criteria had higher disease activity (BASDAI average difference FM+ve - FM-ve 1.04; 95% CI 0.75, 1.33) and worse quality of life (ASQoL difference 1.42; 95% CI 0.88, 1.96) after adjusting for demographic, clinical and lifestyle factors. Amongst 291 participants who commenced biologic therapy, higher BASDAI scores in those with co-morbid FM reduced from 2.0 at baseline to 1.1 at 12 months and there was only a 3% difference (not significant) in likelihood of meeting ASAS20 criteria at 12 months. Less improvement in disease activity and quality of life over three months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity (SSS) component.

Conclusion

Fulfilling criteria for FM has a modest impact on assessment of axSpa disease activity and quality of life, and does not significantly influence response to biologic therapy. Those with high SSS on FM assessment, may benefit from specific management for FM.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Warwick Research in Nursing
Library of Congress Subject Headings (LCSH):	Fibromyalgia, Spondyloarthropathies
Journal or Publication Title:	Rheumatology
Publisher:	Oxford University Press
ISSN:	1462-0324
Official Date:	October 2018
Dates:	Date Event October 2018 Published 20 July 2018 Available 8 May 2018 Accepted
Volume:	57
Number:	11
Page Range:	pp. 1982-1990
DOI:	10.1093/rheumatology/key206
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	9 May 2018
Date of first compliant Open Access:	4 October 2018
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 21738 Arthritis Research UK http://dx.doi.org/10.13039/501100000341
Related URLs:	Publisher

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