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Incidence and predictors of secondary fibromyalgia in an early arthritis cohort
  1. Yvonne C Lee1,
  2. Bing Lu1,
  3. Gilles Boire2,
  4. Boulos (Paul) Haraoui3,
  5. Carol A Hitchon4,
  6. Janet E Pope5,
  7. J Carter Thorne6,
  8. Edward Clark Keystone7,
  9. Daniel H Solomon1,
  10. Vivian P Bykerk1,7
  1. 1Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Division of Rheumatology, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
  3. 3Rheumatology Clinical Research Unit, Notre-Dame Hospital of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
  4. 4Section of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
  5. 5Division of Rheumatology, University of Western Ontario, London, Ontario, Canada
  6. 6The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario, Canada
  7. 7Department of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Yvonne C Lee,  Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA; ylee9{at}partners.org

Abstract

Objectives Secondary fibromyalgia (FM) is common among patients with inflammatory arthritis, but little is known about its incidence and the factors leading to its development. The authors examined the incidence of secondary FM in an early inflammatory arthritis cohort, and assessed the association between pain, inflammation, psychosocial variables and the clinical diagnosis of FM.

Methods Data from 1487 patients in the Canadian Early Arthritis Cohort, a prospective, observational Canadian cohort of early inflammatory arthritis patients were analysed. Diagnoses of FM were determined by rheumatologists. Incidence rates were calculated, and Cox regression models were used to determine HRs for FM risk.

Results The cumulative incidence rate was 6.77 (95% CI 5.19 to 8.64) per 100 person-years during the first 12 months after inflammatory arthritis diagnosis, and decreased to 3.58 (95% CI 1.86 to 6.17) per 100 person-years 12–24 months after arthritis diagnosis. Pain severity (HR 2.01, 95% CI 1.17 to 3.46) and poor mental health (HR 1.99, 95% CI 1.09 to 3.62) predicted FM risk. Citrullinated peptide positivity (HR 0.48, 95% CI 0.26 to 0.88) was associated with decreased FM risk. Serum inflammatory markers and swollen joint count were not significantly associated with FM risk.

Conclusions The incidence of FM was from 3.58 to 6.77 cases per 100 person-years, and was highest during the first 12 months after diagnosis of inflammatory arthritis. Although inflammation was not associated with the clinical diagnosis of FM, pain severity and poor mental health were associated with the clinical diagnosis of FM. Seropositivity was inversely associated with the clinical diagnosis of FM.

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