The impact of fibromyalgia in disease activity assessment and treatment response in axial spondyloarthritis

Yıl 2021, Cilt: 11 Sayı: 2, 130 - 133, 25.03.2021

Orhan Zengin

https://doi.org/10.16899/jcm.836852

Öz

Aim: Spondyloarthritis represents a group of diseases with common clinical features. When axial symptoms are predominant, the disease is called axial SpA (axSpA). Fibromyalgia frequently accompanies rheumatological diseases and affects the evaluation of disease activity measurements and treatment responses. In this study, we aimed to compare axSpA patients with and without accompanying fibromyalgia syndrome (FS).
Material and Method: The patients with axSpA were retrospectively reviewed according to the Assessment of Spondyloarthritis international Society classification criteria. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate, and C-reactive protein data were used to evaluate disease activity. The Bath Ankylosing Spondylitis Functional Index (BASFI) was used to evaluate the functional status of the patients.
Results: The study included a total of 300 patients, including 162 (54%) males and 138 (46%) females. The median age of the patients (25%-75% IQR) was 35 (30-46) years. In the comparison of the two axSpA groups with and without FS, age, BASFI, ESR and CRP levels, and the rate of receiving biological therapy were similar. In the FS group, female gender was dominant (n = 46, 92%; p = 0.000) and the rates of peripheral arthritis and BASDAI were significantly higher (p = 0.024 and p = 0.004, respectively).
Conclusion: AxSpA is frequently accompanied by FS, especially in women. The symptoms of FS cause an increase in disease activity scores. Therefore, it is evaluated as low treatment response. The disease activity of FS and axSpA should be carefully evaluated to lower treatment costs and apply more accurate treatment.

Anahtar Kelimeler

axial spondyloarthritis, fibromyalgia, disease activity, treatment response

Aksiyal Spondiloartritte Fibromiyaljinin Hastalık Aktivitesi Değerlendirilmesine ve Tedavi Yanıtına Etkisi

Öz

Amaç: Spondiloartritler, ortak klinik özellikleri olan bir grup hastalığı temsil eder. Aksiyal semptomların baskın olduğu aksiyal SpA (axSpA) olarak tanımlanır. Fibromiyalji sıklıkla romatolojik hastalıklara eşlik eder ve hastalık aktivitesi ölçümleri ve tedavi yanıtlarının değerlendirilmesini etkiler. Bu çalışmada, axSpA'da eşlik eden fibromiyalji sendromu olan hastaları, axSpA hastaları ile karşılaştırmayı amaçladık.
Gereç ve Yöntem: Aksiyel spondiloartritli hastalar, Assessment of Spondylo Artritis International Society sınıflandırma kriterlerine göre geriye dönük olarak incelendi. Bath AS Hastalık Aktivite Endeksi (BASDAI), eritrosit sedimantasyon hızı ve c-reaktif protein verileri hastalık aktivitesine erişmek için kullanıldı. Hastaların fonksiyonel durumlarını değerlendirmek için Bath AS Fonksiyonel İndeks (BASFI) kullanıldı.
Bulgular: Çalışmaya 162 (% 54) erkek ve 138 (% 46) kadın olmak üzere toplam 300 hasta dahil edildi. Hastaların ortanca yaşı (25-75 IQR) 35 (30-46) idi. İki grubun karşılaştırılmasında: axSpA ve FM + axSpA; yaş, BASFI, ESR ve CRP seviyeleri ve biyolojik tedavi alan hastaların oranı benzerdi. AxSPA + FM grubunda kadın cinsiyet dominant 46 (% 92) (p = 0.000), periferik artrit ve BASDAI anlamlı olarak yüksekti (p = 0.024, p = 0.004).
Sonuç: AxSpA'ya özellikle kadınlarda sıklıkla FM eşlik eder. FM semptomları hastalık aktivite skorlarında artışa neden olur. Bu nedenle düşük tedavi yanıtı olarak değerlendirilir. FM ve axSpA'nın hastalık aktiviteleri, daha düşük tedavi maliyetleri ve daha doğru tedavi için dikkatlice değerlendirilmelidir.

Anahtar Kelimeler

aksiyel spondilartrit, fibromyalji, hastalık aktivitesi, tedavi yanıtı

Kaynakça

• 1. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68 (Suppl 2), ii1-ii44.
• 2. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med 2016; 374(26): 2563-2574.
• 3. Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken) 2012; 64(9):1415-1422.
• 4. Deodhar A, Strand V, Kay J, Braun J. The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis 2016; 75(5): 791-794.
• 5. Goldenberg DL. Fibromyalgia syndrome: an emerging but controversial condition. JAMA 1987; 257 (20):2782-2787.
• 6. Clauw DJ. Fibromyalgia: A clinical review. JAMA 2014; 311(15):1547-1555.
• 7. Wolfe F, Walitt B, Rasker JJ, Häuser W. Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress. J Rheumatol 2019; 46(2):204-212.
• 8. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009;68(6):777-783.
• 9. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62 (5):600-610.
• 10. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21(12):2286-91.
• 11. Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994;21(12):2281-5.
• 12. Ehrenfeld M. Spondyloarthropathies. Best Pract Res Clin Rheumatol 2012;26(1):135–45.
• 13. Moltó A, Paternotte S, Comet D, et al. Performances of the Assessment of SpondyloArthritis International Society axial spondyloarthritis criteria for diagnostic and classification purposes in patients visiting a rheumatologist because of chronic back pain: results from a multicenter, cross-sectional study. Arthritis Care Res 2013;65(9):1472–81.
• 14. Roussou E, Ciurtin C. Clinical overlap between fibromyalgia tender points and enthesitis sites in patients with spondyloarthritis who present with inflammatory back pain. Clin Exp Rheumatol 2012;30(6 Suppl 74):24–30.
• 15. Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi-Puttini P, Atzeni F. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatology international 2014; 34(8), 1103-1110.
• 16. Azevedo VF, dos Santos Paiva E, Hiurko Felippe LR, Moreira RA. Occurrence of fibromyalgia in patients with ankylosing spondylitis. Rev Bras Rheumatol 2010;50(6):646–654.
• 17. Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O. Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 2007; 27(9):865–868 12.
• 18. Almodóvar R, Carmona L, Zarco P, et al. Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage. Clin Exp Rheumatol 2010; 28(6 Suppl 63):S33–S39.
• 19. Bello N, Etcheto A, Béal C, Dougados M, Moltó A. Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis research & therapy 2016; 18(1): 1-7.