Background A number of clinical studies documented that fibromyalgia (FM) can frequently accompany connective tissue diseases (CTD) as a concomitant syndrome. There is a lack of data about differencies in FM impact on individual CTD.
Objectives To compare the impact of concomitant FM on CTD in terms of pain intensity, disease activity, function disability and quality of life (QOL) in a regional, monocentric, cross-sectional study.
Methods 120 consecutive adult patients (pts) with rheumatoid arthritis (RA), 91 pts with systemic lupus (SLE), 30 pts with polymyositis/dermatomyositis (PM/DM) and 30 pts with systemic sclerosis (SSc) were examined in our outpatient rheumatology department on the presence of FM (ACR criteria,1990). Standard Manual Tender Point Survey was used for the examination of FM tender points. The following data were recorded: demographic data, tender point count (TPC), pain, fatigue and stiffness intensity on a 100 mm visual analog scale (VAS), Fibromyalgia Impact Questionnarie (FIQ) score and disease activity indices according to individual CTD representatives (DAS-28, SLEDAI, serum muscle enzymes). Health Assessment Questionnarie (HAQ) and Short Form 36 items (SF-36) were used for evaluation of functional disability and QOL, respectively. Statistical analysis was based on Kruskal-Wallis nonparametric tests comparing mutually all the CTD cohorts with and without FM. Patient file with SSc and FM was not included into the analysis due to small quantity.
Results FM diagnosis was established in 25 (20.8%) pts with RA, 10 (11.0%) pts with SLE, 4 (13.3%) pts with PM/DM and 1 patient with SSc (3.6%). CTD groups with concomitant FM were shown to have significantly higher levels of pain, fatigue, stiffness, TPC and FIQ (p <0.05). RA/FM pts reached the highest average intensity of pain (VAS pain 63.7 mm), the worst disability level (HAQ 1.832) and the most reduced QOL nearly in all domains of SF-36. Disease activity assessment was significantly influenced only in RA pts (DAS-28 in RA with and without FM 5.35 ± 1.1 vs. 3.67 ± 1.4; p < 0.0001).
Conclusions Concomitant FM appears most frequently in pts with RA in comparison to other CTD. RA patients are also mostly influenced by FM at the level of pain perception, disability and QOL. This impact of FM contributes to significant difficulties in RA disease activity assessment unlike other CTD.
Disclosure of Interest None Declared