The prevalence of fibromyalgia in axial spondyloarthritis
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Rheumatology International https://doi.org/10.1007/s00296-020-04621-5
INTERNATIONAL
SYSTEMATIC REVIEW
The prevalence of fibromyalgia in axial spondyloarthritis Gareth T. Jones1 · Bhadra Mallawaarachchi2 · Joanna Shim1 · Jonathan Lock1 · Gary J. Macfarlane1 Received: 2 April 2020 / Accepted: 2 June 2020 © The Author(s) 2020
Abstract Comorbid fibromyalgia, in axial spondyloarthritis (axSpA) has been shown to influence disease activity and function, and quality of life. Although several papers exist, there is no comprehensive and robust systematic review to determine the prevalence of fibromyalgia in this patient group. Thus, the aim of the current study was to provide a definitive estimate of prevalence of fibromyalgia in axSpA, and in axSpA sub-classifications. A systematic literature search was conducted in Ovid MEDLINE, EMBASE, Evidence Based Medicine (EBM), and Cochrane Library, updated to April 2020, combining keywords and relevant MeSH headings, to identify papers reporting the prevalence of fibromyalgia in axSpA, or data from which this could be computed. This was then combined in a meta-analysis with data from the Scotland Registry for Ankylosing Spondylitis (SIRAS), a national axSpA register in Scotland. Data was pooled using random or fixed effects models where heterogeneity was greater or lesser than 75%. From 3401 manuscripts initially identified, 15 papers were included in the final review, plus SIRAS, giving data from 16 separate sources. The prevalence of fibromyalgia, among a total of 5214 patients, was 16.4% (95% CI 12.3–20.5%). Prevalence varied with axSpA sub-classification: ankylosing spondylitis: 13.8% (9.1–18.6%); MRI positive non-radiographic axSpA 20.3% (6.5–34.1%); and ‘clinical’ disease: 11.1% (6.0–16.2%). Overall, around 1 in 6 patients with axSpA also meet criteria for fibromyalgia. While estimates from individual studies vary, comorbid fibromyalgia represents a considerable burden across all sub-classifications of axSpA. This emphasises that focusing management solely on inflammatory disease in this patient group is unlikely to yield optimal improvements in quality of life. Keywords Axial spondyloarthritis · Fibromyalgia · Prevalence · Meta-analysis
Introduction Comorbid fibromyalgia, in persons with axial spondyloarthritis (axSpA), is of considerable and controversial interest. Several years ago, the US Food and Drug Administration expressed concern that patients with commonly occurring pain conditions, such as fibromyalgia, may be incorrectly diagnosed with non-radiographic axSpA (nr-axSpA), which in turn may lead to inappropriate treatment with biologic medications. We have previously shown that, among patients with axSpA, patients meeting the research criteria for fibromyalgia [1] report higher disease activity, poorer function and quality of life, and were more likely to report * Gareth T. Jones [email protected] 1
Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
Ministry of Health, Colombo, Sr
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