Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of the performance of extreme patient-reported outcomes as surrogate markers for fibromyalgia in axial spondyloarthritis

  • Patient Opinion
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Objectives

The aim of the study is to evaluate the performance of extreme patient-reported outcomes (PRO) against definitions of fibromyalgia (FM) in patients with axial spondyloarthritis (axSpA).

Methods

Ancillary analysis of the Predict-SpA trial, an observational study of axSpA patients receiving TNF-α inhibitor, was performed. ‘Extreme PRO’ was defined as a score ≥ 8 on three out of the first five Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questions (scored 0–10). FM was defined by the American College of Rheumatology (ACR) 1990 criteria and the Fibromyalgia Rapid Screening Test (FiRST). Performances of ‘extreme PRO’ for FM were evaluated by the sensitivity, specificity and positive likelihood ratio using the 1990 ACR criteria as gold standard. As secondary analysis, the FiRST was used as the external standard.

Results

The prevalence of ‘extreme PRO’ in this population was 28.8% at baseline and decreased to 9.9% at 12 weeks. ‘Extreme PRO’ had low sensitivity 12 weeks after TNF initiation (0.18, 95% confidence interval [CI] 0.10–0.27 vs 0.60, 95% CI 0.50–0.71, at baseline), but high specificity (0.92, 95% CI 0.89–0.94 vs 0.78, 95% 0.74–0.82, at baseline), using ACR 1990 criteria as gold standard. Performances when tested against FiRST at 12 weeks showed higher sensitivity (0.27, 95% CI 0.20–0.35) and specificity (0.96, 95% CI 0.94–0.98).

Conclusion

The proposed extreme PRO definition showed great specificity for FM recognition in patients with axSpA, suggesting it could be used in observational studies when specific items for FM classification are not available.

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

References

  1. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L (1995) The prevalence and characteristics of fibromyalgia in the general-population. Arthritis Rheum 38(1):19–28

    Article  CAS  PubMed  Google Scholar 

  2. Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M et al (2010) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39(6):448–453

    Article  PubMed  Google Scholar 

  3. Haliloglu S, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A (2014) Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity. Rheumatol Int 34(9):1275–1280

    Article  CAS  PubMed  Google Scholar 

  4. Perrot S, Peixoto M, Dieude P, Hachulla E, Avouac J, Ottaviani S et al (2017) Patient phenotypes in fibromyalgia comorbid with systemic sclerosis or rheumatoid arthritis: influence of diagnostic and screening tests. Screening with the FiRST questionnaire, diagnosis with the ACR 1990 and revised ACR 2010 criteria. Clin Exp Rheumatol 35(3):35–42

    PubMed  Google Scholar 

  5. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33(2):160–172

    Article  CAS  PubMed  Google Scholar 

  6. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS et al (2011) Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 38(6):1113–1122

    Article  PubMed  Google Scholar 

  7. Perrot S, Bouhassira D, Fermanian J (2010) Development and validation of the fibromyalgia rapid screening tool (FiRST). Pain 150(2):250–256

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  9. Almodovar R, Carmona L, Zarco P, Collantes E, González C, Mulero J et al. Fibromyalgia in patients with ankylosing spondylitis: Prevalence and utility of the measures of activity, function and radiological damage. Clin Exp Rheumatol. 2010;28:63.

    Google Scholar 

  10. Baraliakos X, Regel A, Kiltz U, Menne H-J, Dybowski F, Igelmann M et al (2018) Patients with fibromyalgia rarely fulfil classification criteria for axial spondyloarthritis. Rheumatology 57(9):1541–1547

    Article  PubMed  Google Scholar 

  11. Azevedo VF, Paiva Edos S, Felippe LR, Moreira RA (2010) Occurrence of fibromyalgia in patients with ankylosing spondylitis. Rev Bras Reum 50(6):646–650

    Article  Google Scholar 

  12. Bello N, Etcheto A, Beal C, Dougados M, Molto A (2016) Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis Res Ther 18:42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fan A, Pereira B, Tournadre A, Tatar Z, Malochet-Guinamand S, Mathieu S et al (2017) Frequency of concomitant fibromyalgia in rheumatic diseases: Monocentric study of 691 patients. Semin Arthritis Rheum 47(1):129–132

    Article  PubMed  Google Scholar 

  14. 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(8):1103–1110

    Article  PubMed  Google Scholar 

  15. Wach J, Letroublon M-C, Coury F, Tebib JG (2016) Fibromyalgia in spondyloarthritis: effect on disease activity assessment in clinical practice. J Rheumatol 43(11):2056–2063

    Article  CAS  PubMed  Google Scholar 

  16. Moltó A, Etcheto A, Gossec L, Boudersa N, Claudepierre P, Roux N et al (2018) Evaluation of the impact of concomitant fibromyalgia on TNF alpha blockers’ effectiveness in axial spondyloarthritis: results of a prospective, multicentre study. Ann Rheum Dis 77(4):533

    Article  CAS  PubMed  Google Scholar 

  17. van Tuyl LHD, Boers M (2015) Patient-reported outcomes in core domain sets for rheumatic diseases. Nat Rev Rheumatol 11(12):705–712

    Article  PubMed  Google Scholar 

  18. Zochling J (2011) Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Sp. Arthritis Care Res 63:11

    Article  Google Scholar 

  19. Dougados M, Logeart I, Szumski A, Coindreau J, Jones H (2017) Evaluation of whether extremely high enthesitis or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores suggest fibromyalgia and confound the anti-TNF response in early non-radiographic axial spondyloarthritis. Clin Exp Rheumatol 35:50–53

    PubMed  Google Scholar 

  20. Meghnathi B, Etcheto A, Claudepierre P, Dougados M, Moltό A (2017) SAT0386 Extreme patient reported outcome (PRO) in early spondyloarthritis: a surrogate for fibromyalgia? its impact on TNF-ALPHA blockers treatment effect? Ann Rheum Dis 76(Suppl 2):917–918

    Google Scholar 

Download references

Funding

This study was conducted thanks to an unrestricted grant from MSD.

Author information

Authors and Affiliations

  1. Rheumatology Department, Unidade Local de Saúde do Alto Minho (ULSAM), Hospital Conde de Bertiandos, Largo Conde de Bertiandos, 4990-078, Ponte de Lima, Portugal

    Daniela Santos-Faria

  2. Rheumatology Department, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France

    Daniela Santos-Faria, Maxime Dougados & Anna Moltó

  3. INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France

    Maxime Dougados & Anna Moltó

  4. Department of Rheumatology, Pitié-Salpêtrière Hospital, Sorbonne Universités, UPMC Université, AP-HP, Paris, France

    Laure Gossec

  5. Pain Center and INSERM U987, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France

    Serge Perrot

Authors
  1. Daniela Santos-Faria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxime Dougados
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laure Gossec
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Serge Perrot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Moltó
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniela Santos-Faria.

Ethics declarations

Conflict of interest

None of the authors has any conflicts of interest to declare for the present study.

Ethics committee

CPP Île de France 3 - date 24/10/2014. The manuscript has been read and approved by all the authors and we confirm that each individual named as an author meets the journal’s criteria for authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santos-Faria, D., Dougados, M., Gossec, L. et al. Evaluation of the performance of extreme patient-reported outcomes as surrogate markers for fibromyalgia in axial spondyloarthritis. Rheumatol Int 39, 141–146 (2019). https://doi.org/10.1007/s00296-018-4200-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-018-4200-4

Keywords

Search

Navigation