SAT0399 Headache as a clinical complaint at initial presentation and during the disease course in patients with spondyloarthritis indicates concomitant / secondary fibromyalgia

Abstract

ObjectivesTo evaluate the symptom of headache as being able to clinically distinguish associated secondary fibromyalgia in patients with spondyloarthropathies (SpA). To compare the incidence of MSK complaints (related to SpA) in patients with headache to those that did not. To assess headache during the SpA disease course.MethodsRegistry data from 776 patients seen in clinic with SpA were analysed with reference to headache as symptom at presentation. The data of those patients presented with headache were compared with data of those patients who did not report headache with regards to demographics and disease characteristics. In addition, other MSK complaints, fatigue and pain during disease course were also analysed.ResultsFrom a total of 776 patients (m: f=265:508) age 48.3 ( SD +14.1), 13 were excluded as no answer was recorded. 117/ 763 patients (15.08%) representing 28 males and 89 females (23.9% vs 76.1% ratio 1:3.1) reported headache at disease onset.During the disease course, 13 patients out of the initial 117 did not record an answer to the question and were excluded. From remaining 104 patients, 95 patients (91.3%) continued to describe headache as a symptom.From those not reporting headache as initial symptom, (n=659) 148 did not record an answer and were excluded. From the remaining 511 patients, 194 (37.9%) reported headache during the disease course.On the data obtained from these 2 sub-groups, comparison took place using paired sample t-test.Table shows demographics and disease characteristics as well as differences between the 2 SpA sub-groups. Those presenting with headache describe worse disease, more fatigue and a greater percentage describe pain at pressure points and MSK system.Headache at presentationNo headache at presentationStatistical significanceCI (n=117)(n=656)(p) Age (mean ± SD)47.7 (13.16)48.3 (14.3)0.1-5.757 to 0.912Gender (M:F) ratio28:89 (1:3.1)219:419 (1:1.9)0.3-0.025 to 0.077Disease duration (y) (mean ± SD)11.4 (12.1)10.9 (10.8)0.4-1.905 to 4.470Delay in diagnosis (y) (mean ± SD)6.43 (8.9)6.3 (8.1)0.7-3.151 to 2.151ESR (mean ± SD) mmHg15.5 (14.8)18.2 (18)0.07-11.064 to 0.582CRP (mean ± SD) mg/dL10.4 (36)8.2 (9.8)0.4-6.106 to 12.536BASDAI score (mean ± SD)7.31 (3.7)6.06 (2.08)<0.0050.783 to 2.624BASFI score (mean ± SD)5.6 (2.7)5.04 (2.7)0.09-0.143 to 1.626Buttock pain (%)31.612.80.0010.083 to 0.293Back pain (%)82.958.8<0.0050.125 to 0.337Neck pain (%)72.624.4<0.0050.340 to 0.583Knee pain (%)63.230.6<0.0050.284 to 0.520Shoulder (%)70.923<0.0050.312 to 0.559Foot (%)57.222<0.0050.279 to 0.524Hip (%)55.519.9<0.0050.217 to 0.467Eye (%)234.3<0.0050.102 to 0.274Fatigue77/116 (66.4%)340/608 (55.9%)0.0180.029 to 0.299Pain with pressure71/117 (61.2%)257/807 (42.4%)0.0000.122 to 0.378Headache as co-morbidity95 (109) 87.2%195/509 (38.3%)0.0000.808 to 0.935ConclusionsHeadache can clinically represent secondary FM among SpA patients. A proportion of patients (representing 15%) report headache at presentation. The majority of those patients (>90%) continue to describe headache during the dis...