Is fibromyalgia frequency increasing in axial spondyloarthritis? Association with fibromyalgia and biological therapies


Fibromyalgia (FM) is known a common painful syndrome and its frequency is increased in inflammatory rheumatic diseases. We aimed to assess FM frequency in axial spondyloarthritis (AxSpA) patients and age- and sex-matched healthy controls with the 2011 ACR FM criteria. We evaluated the association between receiving biologic disease-modifying antirheumatoid drugs (bDMARD) and presence of FM. 127 patients with Ax-SpA and 73 age- and sex-matched controls were included. Individuals were assessed according to modified 2011 ACR diagnostic criteria for FM. The pain was evaluated by visual analog scale (VAS). Disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activation Score (ASDAS). Spinal limitation, quality of life, and functionality were assessed. Drug therapies were noted. AxSpA and control group had similar FM rates. 43 (33.9%) patients in AxSpA group and 22 (30.1%) patients in control group had FM diagnosis (p = 0.589). Age, gender, BMI, and CRP values were similar in the AxSpA patients with and without FM, while global VAS and ASDAS scores were higher in patients with FM. Biologic DMARD use was higher in the AxSpA patients with FM; however, the difference was not statistically significant. In conclusion, FM frequency does not increase in AxSpA patients as compared to healthy controls. FM awareness is one of the key points to determine the appropriate treatment due to the influence on disease activity.

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All authors contributed to the study conception and design, material preparation, and data collection. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Criterion 1: (a) Substantial contributions to study conception and design: Hatice Bodur, Fatma Gül Yurdakul, Filiz Sivas. (b) Substantial contributions to acquisition of data: Selim Sayın. (c) Substantial contributions to analysis and interpretation of data: Selim Sayın, Fatma Gül Yurdakul, Filiz Sivas, Hatice Bodur. Criterion 2: Drafting the article or revising it critically for important intellectual content: Selim Sayın, Fatma Gül Yurdakul, Filiz Sivas, Hatice Bodur. Criterion 3: Final approval of the version of the article to be published: Selim Sayın, Fatma Gül Yurdakul, Filiz Sivas, Hatice Bodur. Authors are responsible for correctness of the statements provided in the manuscript. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Fatma Gül Yurdakul.

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Author Selim Sayın, Fatma Gül Yurdakul, Filiz Sivas and Hatice Bodur declare that they have no conflict of interest.

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All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (Ethic committee approval no; date:20796219-Bil.Kom-1071/2016; 20/01/2016).

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Sayın, S., Yurdakul, F.G., Sivas, F. et al. Is fibromyalgia frequency increasing in axial spondyloarthritis? Association with fibromyalgia and biological therapies. Rheumatol Int 40, 1835–1841 (2020).

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  • Therapeutics
  • Spondylitis
  • Fibromyalgia
  • Pain