Abstract
Objectives
To identify factors associated with FM development and recovery in patients with axial SpA (axSpA).
Methods
The British Society of Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) recruited patients with axSpA from 83 centres in a prospective study. FM was diagnosed using the self-reported Fibromyalgia Survey Diagnostic Criteria from 2015. Measures of axSpA disease activity and clinical findings were recorded at regular intervals. We identified predictors for FM development and recovery between yearly visits using uni- and multivariable logistic regression models.
Results
A total of 801 participants, 247 (30.8%) female, had two or more visits and were eligible for inclusion. A total of 686 participants did not have FM at baseline, of whom 45 had developed FM at follow-up, while 115 participants had FM at baseline, of whom 77 had recovered at follow-up. A high baseline BASDAI score [odds ratio (OR) 1.27 (95% CI 1.08, 1.49)] and Widespread Pain Index (WPI) [OR 1.14 (95% CI 1.02, 1.28)] were significantly associated with FM development in the final multivariable model. A low baseline BASFI score [OR 0.68 (95% CI 0.53, 0.86)] and WPI [OR 0.84 (95% CI 0.720, 0.97)] and starting a TNF inhibitor [OR 3.86 (95% CI 1.54, 9.71)] were significantly associated with FM recovery.
Conclusion
High levels of disease activity and the presence of widespread pain is associated with the development of FM in patients with axSpA, while low levels of the same variables and starting a TNF inhibitor are associated with recovery from FM. The presence of comorbid FM should be considered in patients with persistent high axSpA disease activity and widespread pain.
To identify factors associated with FM development and recovery in patients with axial SpA (axSpA).
Methods
The British Society of Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) recruited patients with axSpA from 83 centres in a prospective study. FM was diagnosed using the self-reported Fibromyalgia Survey Diagnostic Criteria from 2015. Measures of axSpA disease activity and clinical findings were recorded at regular intervals. We identified predictors for FM development and recovery between yearly visits using uni- and multivariable logistic regression models.
Results
A total of 801 participants, 247 (30.8%) female, had two or more visits and were eligible for inclusion. A total of 686 participants did not have FM at baseline, of whom 45 had developed FM at follow-up, while 115 participants had FM at baseline, of whom 77 had recovered at follow-up. A high baseline BASDAI score [odds ratio (OR) 1.27 (95% CI 1.08, 1.49)] and Widespread Pain Index (WPI) [OR 1.14 (95% CI 1.02, 1.28)] were significantly associated with FM development in the final multivariable model. A low baseline BASFI score [OR 0.68 (95% CI 0.53, 0.86)] and WPI [OR 0.84 (95% CI 0.720, 0.97)] and starting a TNF inhibitor [OR 3.86 (95% CI 1.54, 9.71)] were significantly associated with FM recovery.
Conclusion
High levels of disease activity and the presence of widespread pain is associated with the development of FM in patients with axSpA, while low levels of the same variables and starting a TNF inhibitor are associated with recovery from FM. The presence of comorbid FM should be considered in patients with persistent high axSpA disease activity and widespread pain.
| Original language | English |
|---|---|
| Pages (from-to) | 4121–4129 |
| Number of pages | 9 |
| Journal | Rheumatology |
| Volume | 60 |
| Issue number | 9 |
| Early online date | 6 Jan 2021 |
| DOIs | |
| Publication status | Published - 1 Sept 2021 |
Bibliographical note
We are grateful to the staff of the BSRBR-AS register, Claudia Zabke, Elizabeth Ferguson-Jones, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at:https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011.
The BSRBR-AS is funded by the British Society for Rheumatology, who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments but made none in relation to this manuscript. They have no input in determining the topics for analysis or work involved in undertaking it. SP received a travel grant from the South Eastern Health Authority of Norway.
SP had the idea for the study and with GJM planned the analysis. SP undertook the analysis and drafted the manuscript. The results were discussed by all authors, who also commented on the draft manuscript.
Funding: No specific funding was received from any funding agency in the public, commercial or not-for-profit sectors to carry out the work described in this article.
Keywords
- spondyloarthritis
- fibromyalgia
- trajectories
- disease activity