Background The occurrence of fibromyalgia (FM) with other rheumatologic diseases has been estimated with the following frequencies; Psoriatic arthritis 24%, rheumatoid arthritis 25%, systemic lupus erythematosus 30% and Chron’s disease 49%. The diagnosis of FM is essentially made on clinical data, with the presence of trigger points, sleep disorders, some dysautonomic findings and the lack of evidence of inflammatory or degenerative disease. The clinical syndrome of FM and the spondyloarthritis (SpA) share some signs and symptoms such as fatigue, lower back pain, unspecific urinary disorders and sleep disturbances.
Objectives The purpose of this study was to determine the frequency of FM in patients with spondyloarthritis and to describe the clinical findings that are shared in both diseases.
Methods Forty patients from the outpatient clinic in the Rheumatology service with spondyloarthritis according to ESSG classification criteria were included. We reviewed medical files; the clinical evaluation was done by two independent rheumatologists, clinical assessments included BASDAI and BASFI for SpA group and FIQ for FM patients. Current drug treatment, ESR, CRP, RF, HLA-B27 antigen were done. X ray of sacroiliac joints and lumbosacral were made in all patients. Statistical analysis on the program SPSS v 17, using arithmetic mean, standard deviation and correlation with Pearson’s test.
Results Out of 40 patients, 90% (36/40) were women and 10% (4/40) men. The mean age was 48±9.7, all the patients had some kind of SpA and fifty-seven percent (23/40) had FM. Eighty percent (32/40) of the patients with diagnosis of undifferentiated SpA, ankylosing spondylitis in 7.5% (3/40) and psoriatic arthritis in 7.5% (3/40). ESR was abnormal in 47.5% (19/40), CRP abnormal in 15% (6/40). The clinical scales BASDAI and BASFI were abnormal in 75% and 37% respectively; the functional index questionnaire for FM was abnormal in 42%. The most frequent painful enthesis were as follow: first costochondral joint 72%, seventh costochondral joint 60%, medial condyle of femur 70% and plantar fascia 70%. The positive trigger points were: inter-transverse lower neck space C4-C5 and C5-C6 62%, second chondrocostal joint 67%; Knee medial fat pad proximal to the joint line 72% and gluteal at upper outer quadrant 72%. No statistical correlation between BASDAI and FIQ r =0.101.
Conclusions In our work the frequency of FM in patients that are classified as SpA was fifty percent. We hypothesized that in some patients with SpA, the initial clinical picture could have been signs and symptoms of FM, because they share signs and symptoms. We suggest investigating specific clinical data, such achillea and plantar enthesitis, in patients that are classified as primary FM.
Azevedo V, Paiva E, Hiurko LR, Amorim R. Occurrence of fibromyalgia in patients with ankylosing spondylitis. Bras J Rheumatol 2010; 50 (6): 646-54
Disclosure of Interest None Declared
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