Concomitant fibromyalgia in patients with rheumatoid arthritis
Authors:
J. Tomš; T. Soukup; P. Bradna; Z. Hrnčíř
Authors‘ workplace:
Oddělení revmatologie a klinické farmakologie, 2. interní klinika Lékařské fakulty UK
a Fakultní nemocnice Hradec Králové
Published in:
Čes. Revmatol., 17, 2009, No. 3, p. 120-126.
Category:
Original Papers
Overview
Objective:
The aim of the study was to evaluate the impact of concomitant fibromyalgia (FM) on patients with rheumatoid arthritis (RA), and to find out differences in clinical manifestations, laboratory parameters, quality of life and functional disability.
Methods:
120 patients with RA were examined for the presence of FM according to the criteria of American College of Rheumatology, and subsequently, the group of RA patients with FM was compared to the group of RA patients without FM. The following parameters were recorded or examined: demographic data, comorbidities and current antirheumatic therapy, selected laboratory parameters, X-ray of hand and foot joints and 28-joints Disease Activity Score (DAS-28). Each of the patients filled in several questionnaires: Health Assessment Questionnaire, Short Form-36 Health Survey, Fibromyalgia Impact Questionnaire and Zung self-rating depression scale.
Results:
Twenty-five (20.8%) patients with RA met the classification criteria for FM (4 males, 21 females), in 88% of cases, it was a newly determined diagnosis of FM. Patients with RA and associated FM had a significantly worse quality of life, a higher level of disability, increased RA activity according to DAS-28 index, and were treated with a higher dose of glucocorticoids. Inflammatory laboratory markers, the presence of joint erosion, and disease modifying antirheumatic drugs were comparable in both groups. FM was significantly more frequent in patients with RA, and with a negativity of serum rheumatoid factor (RF).
Conclusion:
FM is a relatively frequent, albeit underdiagnosed disease associated with RA. It results in significant worsening of quality of life and disability; moreover, it influences the clinical assessment of RA activity.
Key words:
fibromyalgia, rheumatoid arthritis, activity assessment, quality of life, disability
Sources
1. Hrnčíř Z, Dvořák Z. Fibromyalgie a chronický únavový syndrom. In: Pavelka K, Rovenský J et al. Klinická revmatologie, Galén, Praha, 2003, s. 679-84.
2. Staud R. Neurobiology of chronic musculoskeletal pain (including chronic regional pain). In: Wallace DJ, Clauw DJ (ed). Fibromyalgia & other central pain syndromes. 1st edition, Lippincott Williams & Wilkins, Philladelphia, 2005, pp. 45–62.
3. Wolfe F, Smythe A, Yunus MB, Bennet RM, Bombardier C, Goldenberg D, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160–72.
4. Pavelka K, Rovenský J, Szilasiová A, Rovenská E, Buc M, et al. Revmatoidní artritida. In: Pavelka K, Rovenský J et al. Klinická revmatologie, Galén, Praha, 2003, s. 181–215.
5. Walker EA, Keegan D, Gardner G, Sullivan M Katon WJ, et al. Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: Psychiatric diagnosis and functional disability. Psychosom Med 1997; 56: 565–71.
6. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American College Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–24.
7. Prevoo ML, vanęt Hof MA, Kuper HH, Van Leeuwen MA, van de Putte LB, et al. Modified disease activity scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44–8.
8. Okifuji A, Turk DC, Sinclair JD, Starz TW, Marcus DA. A standardized manual tender point survey. I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome. J Rheumatol 1997; 24: 377–83.
9. Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 1983; 36: 1346–53.
10. Ware J, Sherbourne C. The MOS 36-item short-form health survey (SF-36). Med Care 1992; 30: 473–81.
11. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991; 18: 728–33.
12. Dunn VK, Sacco WP. Psychometric evaluation of the Geriatric Depression Scale and the Zung Self-Rating Depression Scale using an elderly community sample. Psychol Aging 1989; 4: 125–6.
13. Wolfe F, Cathey MA, Kleinhexel SM. Fibrositis (fibromyalgia) in rheumatoid arthritis. J Rheumatol 1984; 11: 814–8.
14. Naranjo A, Ojeda S, Francisco F, Erausquin C, Rúa-Figueroa I, et al. Fibromyalgia in patients with rheumatoid arthritis is associated with higher scores of disability. Ann Rheum Dis 2002; 61: 660–1.
15. Coury F, Rossat A, Tebib A, Letroublon MC, Gragnard A, et al. Rheumatoid arthritis and fibromalgia: A frequent unrelated association complicating disease management. J Rheumatol 2009; 36: 58–62.
16. Vencovsky J, Machacek S, Sedova L, Kafkova J, Gatterova J, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003; 62: 427–30.
17. Wolfe F, Michaud K. Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia. J Rheumatol 2004; 31: 695–700.
18. Birtane M, Uzunca K, Tastekin N, Tuna H. The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey. Clin Rheumatol 2007; 26: 679–84.
19. Waylonis GW, Heck W. Fibromyalgia syndrome. New associations. Ann J Phys Med Rehabil 1992; 71: 347–8.
20. Jurell KC, Zanetos MA, Orsinelli A, et al. A study of thyroid function and symptoms. J Musculoskel Pain 1996; 4: 49–60.
21. Halleugua DS. Fibromyalgia in inflammatory and endocrine disorders. In: Wallace DJ, Clauw DJ (ed). Fibromyalgia & other central pain syndromes. 1st edition, Lippincott Williams & Wilkins, Philladelphia, 2005, pp. 187–95.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2009 Issue 3
Most read in this issue
- Treatment of patients with proximal femoral fractures. I. Orthopaedic care. Guidelines of the Czech Rheumatological Society and the Czech Society for Metabolic Bone Diseases
- Vascular endothelial growth factor in inflammatory rheumatic diseases
- Safety of biological therapy – Guidelines of the Czech Society for Rheumatology
- Concomitant fibromyalgia in patients with rheumatoid arthritis