Fibromyalgia and the Prediction of Two‐Year Changes in Functional Status in Rheumatoid Arthritis Patients

Abstract

Background/Purpose Previous cross sectional studies have shown that rheumatoid arthritis (RA) patients with fibromyalgia (FM) have higher disease activity, greater medical costs and worse quality of life compared to RA patients without FM. We determined the impact of FM on 2-year changes in functional status of RA patients in a prospective study. Methods Subjects included participants in the Brigham Rheumatoid Arthritis Sequential Study enrolled in a substudy of the effects of pain in RA. Subjects completed questionnaires, including the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and Polysymptomatic Distress (PSD) Scale, semi-annually and underwent physical examination and laboratory tests yearly. Results Of the 156 included RA subjects, 16.7% had FM, while 83.3% did not. In a multivariable linear regression model adjusted for age, gender, race, baseline MDHAQ score, disease duration, rheumatoid factor (RF)/cyclic citrullinated peptide antibody (CCP) seropositivity, disease activity and psychological distress, RA patients with FM had a 0.14 greater 2-year increase in MDHAQ score than RA patients without FM (P = 0.021). In secondary analyses examining the association between continuous PSD Scale score and change in MDHAQ, higher PSD Scale scores were significantly associated with greater 2-year increases in MDHAQ score (β-coefficient 0.013; P = 0.011). Conclusion Both the presence of FM and increasing number of FM symptoms predicted worsening of functional status among individuals with RA. Among individuals with RA and FM, the magnitude of the difference in changes in MDHAQ was 4 to 7-fold higher than typical changes in MDHAQ score among individuals with established RA.

Clinical and Psychological Assessment of Patients With Rheumatoid Arthritis and Fibromyalgia

“…Our study shows that patients with RA and FM had a poor functional condition with higher SF-36 and HAQ scores, which is consistent with the results of previous studies [7,15]. Literature shows that the concomitant presence of FM and severity of FM symptoms are independent predictors of physical deterioration in patients with RA [16]. We should be cautious that patients with RA may have concomitant FM if their disease activity ratings are rather high while their objective in ammatory markers, such as CRP and ESR, are not elevated, especially when complaining of tender joints that are not related to synovitis, fatigue, or quality of life disability due to high HAQ scores.…”

The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia

“…7,18,33 The prevalence of FM differs between 4.9 and 52.4%, according to different studies. [6][7][8][9][10][11][12][13][14][15][16]34 Some studies had similar results. 14,18 Shresher et al 14 compared the 1990 and 2016 ACR FM criteria in RA patients and reported the prevalence of FM as 31.5% and 40%, respectively.…”

“…The sample size was calculated according to the global prevalence of RA in the population (0.24%) and the frequency of FM in RA (16.7%) with a 95% confidence interval. [ 13 ] A p value of <0.05 was considered statistically significant.…”

Is the relationship between deprivation and outcomes in rheumatoid arthritis mediated by body mass index? A longitudinal cohort study

“…It is therefore also possible that our sample size for men was too small to find an effect. It is also possible that FM may play a role; obesity is associated with FM [ 27 ], it is generally more common among women [ 28 ] and it has been associated with worse RA outcomes [ 29 ]. However, this needs further investigation.…”