Skip to main content

Advertisement

SpringerLink
Log in

Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p < 0.0001); the estimated prevalence in AS was 12.7 % and in axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS–C-reactive protein (CRP) and ASDAS–erythrocyte sedimentation rate (ESR) (p < 0.0001), only ASDAS had sufficient discriminatory ability to assess disease activity. The addition of only one marker of inflammation led to an adequate level of significance (ASDAS–CRP, p = 0.0018; ASDAS–ESR, p = 0.003). FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390

    Article  PubMed  Google Scholar 

  2. Gladman DD (1998) Clinical aspects of the spondyloarthropathies. Am J Med Sci 3:234–238

    Article  Google Scholar 

  3. van der Linden S, van der Heijde D (1998) Ankylosing spondylitis: clinical features. Rheum Dis Clin North Am 24:663–676

    Article  PubMed  Google Scholar 

  4. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 18(7):25

    Article  Google Scholar 

  5. Salaffi F, De Angelis R, Grassi W, MArche Pain Prevalence; INvestigation Group (MAPPING) study (2005) Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 23:819–828

    CAS  PubMed  Google Scholar 

  6. Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P (2011) Chronic widespread pain in the spectrum of rheumatological diseases. Best Pract Res Clin Rheumatol 25:165–171

    Article  PubMed  Google Scholar 

  7. Salaffi F, Sarzi-Puttini P, Girolimetti R, Atzeni F, Gasparini S, Grassi W (2009) Health-related quality of life in fibromyalgia patients: a comparison with rheumatoid arthritis patients and the general population using the SF-36 health survey. Clin Exp Rheumatol 27(5 Suppl 56):S67–S74

    CAS  PubMed  Google Scholar 

  8. Dernis-Labous E, Messow M, Dougados M (2003) Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology 42:1523–1528

    Article  CAS  PubMed  Google Scholar 

  9. Atzeni F, Sallì S, Benucci M, Di Franco M, Alciati A, Sarzi-Puttini P (2012) Fibromyalgia and arthritides. Reumatismo 64:286–292

    Article  CAS  PubMed  Google Scholar 

  10. Wolfe F, Michaud K (2004) Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia. J Rheumatol 31:695–700

    PubMed  Google Scholar 

  11. Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O (2007) Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 27:865–868

    Article  PubMed  Google Scholar 

  12. Almodóvar R, Carmona L, Zarco P, Collantes E, González C, Mulero J et al (2010) Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage. Clin Exp Rheumatol 28(6 Suppl 63):S33–S39

    PubMed  Google Scholar 

  13. Marchesoni A, Atzeni F, Spadaro A, Lubrano E, Provenzano G, Cauli A et al (2012) Identification of the clinical features distinguishing psoriatic arthritis and fibromyalgia. J Rheumatol 39:849–855

    Article  PubMed  Google Scholar 

  14. Magrey MN, Antonelli M, James N, Kahn MA (2013) High frequency of fibromyalgia in patients with psoriatic arthritis: a pilot study. Arthritis. doi:10.1155/2013/762921

    PubMed Central  PubMed  Google Scholar 

  15. Azevedo VF, dos Santos Paiva E, Hiurko Felippe LR, Moreira RA (2010) Occurrence of fibromyalgia in patients with ankylosing spondylitis. Rev Bras Rheumatol 50:646–654

    Article  Google Scholar 

  16. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  17. Rudwaleit M, van der Heijde D, Landewe′ R, Listing J, Akkoc N, Brandt J et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783

    Article  CAS  PubMed  Google Scholar 

  18. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600–610

    Article  Google Scholar 

  19. Garrett SL, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining functional ability in ankylosing spondylitis: the Bath Ankylosing Spondylitis Functional Index (BASFI). J Rheumatol 2:2286–2291

    Google Scholar 

  20. Salaffi F, Stancati A, Silvestri A, Carotti M, Grassi W (2005) Validation of the Italian versions of the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) in patients with ankylosing spondylitis. Reumatismo 57:161–173

    CAS  PubMed  Google Scholar 

  21. Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J et al (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68:18–24

    Article  CAS  PubMed  Google Scholar 

  22. van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J, Landewe R (2008) The ASDAS is a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68:1811–1818

    Article  PubMed  Google Scholar 

  23. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D (2011) Assessment of the SpondyloArthritis International Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70(1):47–53

    Article  PubMed  Google Scholar 

  24. Jones SD, Steiner A, Garrett SL, Calin A (1996) The Bath Ankylosing Spondylitis Patient Global Score (BAS-G). Br J Rheumatol 35:66–71

    Article  CAS  PubMed  Google Scholar 

  25. Swetz JA (1988) Measuring accuracy of diagnostic systems. Science 240:1285–1293

    Article  Google Scholar 

  26. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    Article  CAS  PubMed  Google Scholar 

  27. Staud R (2006) Are patients with systemic lupus erythematosus at increased risk for fibromyalgia? Curr Rheumatol Rep 8:430–435

    Article  PubMed  Google Scholar 

  28. Ostuni P, Botsios C, Sfriso P, Punzi L, Chieco-Bianchi F, Semerano L et al (2002) Fibromyalgia in Italian patients with primary Sjogren’s syndrome. Joint Bone Spine 69:51–57

    Article  PubMed  Google Scholar 

  29. Konno T (2012) Differentiation of the clinical features of psoriatic arthritis and fibromyalgia. J Rheumatol 39:11

    Article  Google Scholar 

  30. Fitzcharles MA, Boulos P (2003) Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Rheumatology 42:263–267

    Article  PubMed  Google Scholar 

  31. Salaffi F, Sarzi-Puttini P, Ciapetti A, Atzeni F (2011) Clinimetric evaluations of patients with chronic widespread pain. Best Pract Res Clin Rheumatol 25:249–270

    Article  PubMed  Google Scholar 

  32. Salaffi F, Sarzi-Puttini P, Ciapetti A, Atzeni F (2009) Assessment instruments for patients with fibromyalgia: properties, applications and interpretation. Clin Exp Rheumatol 27(5 Suppl 56):S92–S105

    CAS  PubMed  Google Scholar 

  33. Wolfe F, Clauw DJ, Fitzcharles MA et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610

    Article  Google Scholar 

  34. Salaffi F, Sarzi-Puttini P (2012) Old and new criteria for the classification and diagnosis of fibromyalgia: comparison and evaluation. Clin Exp Rheumatol 30(6 Suppl 74):3–9

    PubMed  Google Scholar 

  35. Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, Filippucci E, Grassi W (2012) Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford) 51:1261–1268

    Article  Google Scholar 

  36. Gutierrez M, Luccioli F, Salaffi F, Bartoloni E, Bertolazzi C, Bini V et al (2012) Ultrasound revealing subclinical enthesopathy at the greater trochanter level in patients with spondyloarthritis. Clin Rheumatol 31(3):463–468

    Article  PubMed  Google Scholar 

  37. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W (2011) Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 70:1111–1114

    Article  PubMed  Google Scholar 

  38. Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 52:1000–1008

    Article  PubMed  Google Scholar 

  39. Salaffi F, Sarzi-Puttini P, Girolimetti R, Gasparini S, Atzeni F, Grassi W (2009) Development and validation of the self-administered Fibromyalgia Assessment Status: a disease-specific composite measure for evaluating treatment effect. Arthritis Res Ther 11:R125

    Article  PubMed Central  PubMed  Google Scholar 

  40. Heikkila S, Ronni S, Kautiainen HJ, Kauppi MJ (2002) Functional impairment in spondyloarthropathy and fibromyalgia. J Rheumatol 29:1415–1419

    PubMed  Google Scholar 

  41. Coates LC, Mumtaz A, Helliwell PS, Mease PJ, Callis-Duffin K, Krueger GG et al (2011) Development of a disease severity and responder index for psoriatic arthritis (PsA)—report of the OMERACT 10 PsA special interest group. J Rheumatol 38:1496–1501

    Article  PubMed  Google Scholar 

  42. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(Suppl 2):ii1–ii44

    Article  PubMed  Google Scholar 

  43. Slobodin G, Reyhan I, Avshovic N, Balbir-Gurman A, Boulman N, Elias M et al (2011) Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis. Clin Rheumatol 30:1075–1080

    Article  PubMed  Google Scholar 

  44. Pedersen SJ, Sorensen IJ, Hermann KG, Madsen OR, Tvede N, Hansen MS et al (2010) Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors. Ann Rheum Dis 69:1065–1071

    Article  PubMed  Google Scholar 

  45. Nas K, Yildirim K, Cevik R, Karatay S, Erdal A, Baysal O et al (2010) Discrimination ability of ASDAS in estimating disease activity status in patient with ankylosing spondylitis. Int J Rheum Dis 13:240–245

    Article  PubMed  Google Scholar 

  46. Mas AJ, Carmona L, Valverde M, Ribas B, the EPISER Study Group (2008) Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: results from a nationwide study in Spain. Clin Exp Rheumatol 26:519–526

    CAS  PubMed  Google Scholar 

  47. Hughes G, Martinez C, Myon E, Taı C, Wessely S (2006) The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis Rheum 54:177–183

    Article  PubMed  Google Scholar 

  48. Kivimäki M, Leino-Arjas P, Kaila-Kangas L, Virtanen M, Elovainio M, Puttonen S et al (2007) Increased sickness absence among employees with fibromyalgia. Ann Rheum Dis 66:65–69

    Article  PubMed Central  PubMed  Google Scholar 

  49. Ofluoglu D, Berker N, Güven Z, Canbulat N, Yilmaz IT, Kayhan O (2005) Quality of life in patients with fibromyalgia syndrome and rheumatoid arthritis. Clin Rheumatol 24:490–492

    Article  PubMed  Google Scholar 

  50. Hawley DJ, Wolfe F (1991) Pain, disability, and pain/disability relationships in seven rheumatic disorders: a study of 1,522 patients. J Rheumatol 18:1552–1557

    CAS  PubMed  Google Scholar 

  51. Boonen A, van den Heuvel R, van Tubergen A, Goossens M, Severens JL, van der Heijde D, van der Linden S (2005) Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis 64:396–402

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Aydin SZ, Can M, Atagunduz P, Direskeneli H (2010) Active disease requiring TNF-alpha antagonist therapy can be well discriminated with different ASDAS sets: a prospective, follow-up of disease activity assessment in ankylosing spondylitis. Clin Exp Rheumatol 28:752–755

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Polytechnic University of Marche, Ospedale “Carlo Urbani”, Via dei Colli 52, 60035, Jesi, Ancona, Italy

    Fausto Salaffi, Rossella De Angelis & Marwin Gutierrez

  2. Department of Radiology, Polytechnic University of the Marche, Ancona, Italy

    Marina Carotti

  3. Rheumatology Unit, “L. Sacco” University Hospital of Milan, Milan, Italy

    Piercarlo Sarzi-Puttini & Fabiola Atzeni

Authors
  1. Fausto Salaffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rossella De Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marina Carotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marwin Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Piercarlo Sarzi-Puttini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabiola Atzeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rossella De Angelis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salaffi, F., De Angelis, R., Carotti, M. et al. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int 34, 1103–1110 (2014). https://doi.org/10.1007/s00296-014-2955-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-014-2955-9

Keywords

Search

Navigation