Comorbid pain in axial spondyloarthritis, including fibromyalgia

Abstract

The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response. In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

“… 5 7 Widespread pain can be misdiagnosed as fibromyalgia, which is prevalent in patients with axSpA, and can mimic entheseal pain. 8 The results from the Corrona Psoriatic Arthritis (PsA)/SpA registry including 498 patients with axSpA (307 (61.6%) men and 191 (38.4%) women) underline the need of improving the awareness of sex differences in the presentation of axSpA. 5 Authors revealed that the patient journey to diagnosis of axSpA is much longer and more arduous in women, as measured by clinical assessment and in patient-reported outcomes (PROs): women had higher disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index and physician global assessment and had higher tender/swollen joint counts and enthesitis scores.…”

2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

“…Regarding the evaluation of disease activity, the experts underlined the challenges posed by the coexistence of fibromyalgia [36][37][38] or residual pain/disease [39]. This combination creates diagnostic dilemmas and increases the disease activity scores, potentially resulting in over-treatment.…”

Disease activity, health status and quality of life in patients with ankylosing spondylitis associated with fibromyalgia

“…Вважається, що близько 50% пацієнтів з АС мають хоча б один коморбідний стан, а близько 9% пацієнтів страждають на 3 та більше супутніх захворювання [28,31]. Значущою проблемою у хворих на АС є коморбідність з ФМ, яка характеризується високою поширеністю, складністю діагностики та лікування [16,27].…”