Frequency of Fibromyalgianess in Patients With Rheumatoid Arhtritis and Ankylosing Spondylitis:A Multicenter Study of Turkish League Against Rheumatism (TLAR) Network

Erkan Kozanoğlu1, Bayram Kelle1, Gamze Alaylı2, Ömer Kuru3, Sibel Çubukçu Fırat4, Ali Nail Demir5, Mehmet Karakoç6, Şüheda Özçakır7, Zuhal Altay8, İlknur Aktaş9, Feyza Ünlü Özkan9, Fikriye Figen Ayhan10, Erhan Çapkın11, Murat Karkucak11, Taciser Kaya12, Ülkü Uçar13, Akın Erdal14, Nurettin Taştekin15, Esra Gizem Koyuncu16, Elif Aydın17, Ömer Faruk Şendur18, İlker Ünal19, Ayşen Akıncı20

1Cukurova University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Adana, Turkey
2Ondokuz Mayıs University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Samsun, Turkey
3University Of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Physical Medicine and Rehabilitation, İstanbul, Turkey
4Akdeniz University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Antalya, Turkey
5Mersin City Hospital, Faculty Of Medicine, Physical Medicine and Rehabilitation, Mersin, Turkey
6Dicle University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Diyarbakır, Turkey
7Bursa Uludag University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Bursa, Turkey
8Inonu University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Malatya, Turkey
9University Of Health Sciences, Fatih Sultan Mehmet Training And Research Hospital, Physical Medicine and Rehabilitation, Istanbul, Turkey
10Atilim University, School Of Medicine, Physical Medicine and Rehabilitation, Ankara, Turkey
11Karadeniz Technical University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Trabzon, Turkey
12University Of Health Sciences, Izmir Bozyaka Training And Research Hospital, Physical Medicine and Rehabilitation, Izmir, Turkey
13Antalya Training And Research Hospital, Physical Medicine and Rehabilitation, Rheumatology Clinic, Antalya, Turkey
14Atatürk University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Erzurum, Turkey
15Trakya University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Edirne, Turkey
16Tekirdag Dr. İ. Fehmi Cumalıoglu City Hospital, Physical Medicine and Rehabilitation, Tekirdağ, Turkey
17Adnan Menderes University, Faculty Of Medicine, Physical Medicine and Rehabilitation, Aydın, Turkey
18Medicana International Hospital, Physical Medicine and Rehabilitation, Izmir, Turkey
19Cukurova University, Faculty Of Medicine, Biostatistics and Medical Informatics, Adana, Turkey
20Hacettepe University, Faculty Of Medicine, Physical and Rehabilitation Medicine, Ankara, Turkey

Keywords: fibromyalgianess, fibromyalgia syndrome, polysymptomatic distress scale, rheumatoid arthritis, ankylosing spondylitis

Abstract

Objectives: This study was aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS) and widespread pain in patients with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) and their relationship with clinical and demographic parameters.

Patients and Methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye. 661 patients (342 RA, 319 AS) have been recruited for the study. In these cohorts those who did not meet the criteria for FS and had widespread pain (widespread pain index≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index≥7) and RA and AS patients with FS groups. In addition, correlations between Polysymptomatic Distress Scale (PSD) scores and visual analogue scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Disease Activity Score using 28 joint counts (DAS 28) for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed.

Results: Frequencies of patients with FS and patients who had PSD scores≥12 were 34.1% and 44.4% in all RA patients respectively. Moreover, FS and PSD scores ≥12 were found as 29.2% and 36.9% in all AS patients respectively. PSD scores of RA patients with FS were higher than all RA and RA with widespread pain patients’. SDAI and CDAI scores of RA patients with FSwere higher than all RA and RA with widespread pain patients’as well. Similarly,PSD scores of AS patients with FS were higher than all AS and AS with widespread pain patients’. ASDAS-ESR and BASDAI scores of AS patients with FS were found higher than all AS and AS with widespread pain patients’.

Conclusion: Disease activity scores including pain in RA and AS patients’ were seemed higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed in order to reveal causality. Additionally, in order to reduce overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who had inflammatory diseases like RA and AS especially with intractable widespread pain.