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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Availability of data and material (data transparency)
All authors declare that all data and materials support their published claims and comply with field standards.
Bodur H (2014) Treatment of early axial spondyloarthritis. Turk Klinikleri J PM&R-Spec Top 7:9–15
Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, Van den Bosch F, Olivieri I, Roussou E, Scarpato S, Sørensen IJ, Valle-Oñate R, Weber U, Wei J, Sieper J (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell JI, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hobok) 62:600–610
Wolfe F, Egloff N, Häuser W (2016) Widespread pain and low widespread pain index scores among fibromyalgia-positive cases Assessed with the 2010/2011 Fibromyalgia Criteria. J Rheumatol 43:1743–1748
Pathan EMI, Inman RD (2017) Pain in spondyloarthritis: a neuro-immune interaction. Best Pract Res Clin Rheumatol 31:830–845
Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O (2007) Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 27:865–868
Macfarlane GJ, MacDonald R, Pathan E, Siebert S, Gaffney K, Choy E, Packham J, Martin KR, Haywood K, Sengupta R, Atzeni F, Jones GT (2018) 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. Rheumatol (Oxf, Engl) 57:1982–1990
Macfarlane GJ, Barnish MS, Pathan E et al (2017) Co-Occurrence and characteristics of patients with axial spondyloarthritis who meet criteria for fibromyalgia: results from a UK national register. Arthritis Rheumatol 69:2144–2150
Macfarlane GJ, Pathan E, Siebert S et al (2019) AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS). BMC Rheumatol 3:19. https://doi.org/10.1186/s41927-019-0066-7
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
Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N (2005) A Turkish version of the bath ankylosing spondylitis disease activity index: reliability and validity. Rheumatol Int 25:280–284
Lukas C, Landewé R, Sieper J et al (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68:18–24
Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick WC (1987) Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis 46:197–202
Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698
Yanik B, Gürsel YK, Kutlay S, Ay S, Elhan AH (2005) Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 24:41–47
Ozcan E, Yilmaz O, Tutoglu A, Bodur H (2012) Validity and reliability of the Turkish version of the Health Assessment Questionnaire for the Spondyloarthropathies. Rheumatol Int 32:1563–1568
Sarmer S, Ergin S, Yavuzer G (2000) The validity and reliability of the Turkish version of the fibromyalgia impact questionnaire. Rheumatol Int 20:9–12
Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A (1999) [Kısa Form–36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği]. İlaç ve Tedavi Dergisi 12:102–106
Wach J, Letroublon MC, Coury F, Tebib JG (2016) Fibromyalgia in spondyloarthritis: effect on disease activity assessment in clinical practice. J Rheumatol 43:2056–2063
Fan A, Pereira B, Tournadre A et al (2017) Frequency of concomitant fibromyalgia in rheumatic diseases: monocentric study of 691 patients. Semin Arthritis Rheum 47:129–132
Almodóvar R, Carmona L, Zarco P 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:S33–S39
Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi-Puttini P, Atzeni F (2014) Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int 34:1103–1110
Heidari F, Afshari M, Moosazadeh M (2017) Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int 37:1527–1539
Rencber N, Saglam G, Huner B, Kuru O (2019) Presence of fibromyalgia syndrome and its relationship with clinical parameters in patients with axial spondyloarthritis. Pain physician 22:E579–E585
Mease PJ (2017) Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment. Curr Opin Rheumatol 29:304–310
The authors would like to thank Enago (www.enago.com) for English language review.
This study was not funded.
Conflicts of interest
Author Selim Sayın, Fatma Gül Yurdakul, Filiz Sivas and Hatice Bodur declare that they have no conflict of interest.
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).
Informed consent was obtained from all individual participants included in this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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). https://doi.org/10.1007/s00296-020-04670-w