Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register

Gary J Macfarlane (Corresponding Author), Ross I R MacDonald, Ejaz Pathan, Stefan Siebert, Karl Gaffney, Ernest Choy, Jon Packham, Kathryn R Martin, Kirstie Haywood, Raj Sengupta, Fabiola Atzeni, Gareth T Jones

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Abstract

ObjectiveTo quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA.MethodsA prospective study recruiting across 83 centres in the UK. 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, QoL and response to TNFis.ResultsA total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component.ConclusionFulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.
Original languageEnglish
Pages (from-to)1982-1990
Number of pages8
JournalRheumatology
Volume57
Issue number11
Early online date20 Jul 2018
DOIs
Publication statusPublished - 1 Nov 2018

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Fibromyalgia
Tumor Necrosis Factor-alpha
Quality of Life
Biological Therapy
Ankylosing Spondylitis
Life Style
Linear Models
Demography
Prospective Studies

Keywords

  • axial spondyloarthritis
  • biologic therapy
  • cohort study
  • co-morbidity
  • disease activity
  • disease register
  • epidemiology
  • fibromyalgia
  • outcome
  • response

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Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis : results from a UK national register. / Macfarlane, Gary J (Corresponding Author); MacDonald, Ross I R; Pathan, Ejaz; Siebert, Stefan; Gaffney, Karl; Choy, Ernest; Packham, Jon; Martin, Kathryn R; Haywood, Kirstie; Sengupta, Raj; Atzeni, Fabiola; Jones, Gareth T.

In: Rheumatology, Vol. 57, No. 11, 01.11.2018, p. 1982-1990.

Research output: Contribution to journalArticle

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title = "Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register",
abstract = "ObjectiveTo quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA.MethodsA prospective study recruiting across 83 centres in the UK. 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, QoL and response to TNFis.ResultsA total of 1757 participants were eligible for analyses, of whom 22.1{\%} met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95{\%} CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95{\%} CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component.ConclusionFulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.",
keywords = "axial spondyloarthritis, biologic therapy, cohort study, co-morbidity, disease activity, disease register, epidemiology, fibromyalgia, outcome, response",
author = "Macfarlane, {Gary J} and MacDonald, {Ross I R} and Ejaz Pathan and Stefan Siebert and Karl Gaffney and Ernest Choy and Jon Packham and Martin, {Kathryn R} and Kirstie Haywood and Raj Sengupta and Fabiola Atzeni and Jones, {Gareth T}",
note = "Funding: This work was supported by Arthritis Research UK (grant 21378) conducted as part of the Fibromyalgia Optimal Management in Axial Spondyloarthritis study.",
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T1 - Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis

T2 - results from a UK national register

AU - Macfarlane, Gary J

AU - MacDonald, Ross I R

AU - Pathan, Ejaz

AU - Siebert, Stefan

AU - Gaffney, Karl

AU - Choy, Ernest

AU - Packham, Jon

AU - Martin, Kathryn R

AU - Haywood, Kirstie

AU - Sengupta, Raj

AU - Atzeni, Fabiola

AU - Jones, Gareth T

N1 - Funding: This work was supported by Arthritis Research UK (grant 21378) conducted as part of the Fibromyalgia Optimal Management in Axial Spondyloarthritis study.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - ObjectiveTo quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA.MethodsA prospective study recruiting across 83 centres in the UK. 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, QoL and response to TNFis.ResultsA total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component.ConclusionFulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.

AB - ObjectiveTo quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA.MethodsA prospective study recruiting across 83 centres in the UK. 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, QoL and response to TNFis.ResultsA total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component.ConclusionFulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.

KW - axial spondyloarthritis

KW - biologic therapy

KW - cohort study

KW - co-morbidity

KW - disease activity

KW - disease register

KW - epidemiology

KW - fibromyalgia

KW - outcome

KW - response

U2 - 10.1093/rheumatology/key206

DO - 10.1093/rheumatology/key206

M3 - Article

VL - 57

SP - 1982

EP - 1990

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 11

ER -