Department of Rheumatology, Polytechnic University of Marche, Ancona, Italy.
Clin Exp Rheumatol. 2009 Sep-Oct;27(5 Suppl 56):S67-74.
OBJECTIVES: To compare health-related quality of life (HRQL) in fibromyalgia (FM) patients with that of patients with rheumatoid arthritis (RA) and the general population, and investigate if the factors are associated with the greater impact of FM. METHODS: This cross-sectional study involved 380 patients with FM, 693 patients with RA and 1579 healthy controls. HRQL was evaluated using the Medical Outcome Study Short-Form 36 (SF-36), and the measures included disease-related characteristics, demographic variables and comorbidities. S-scores were calculated for comparisons with the norm, and multivariate analyses were used to assess the relationships between HRQL and clinical and demographic variables. RESULTS: In comparison with the general population, the FM patients showed significant impairment in relation to all of the eight scales of the SF-36 (p<0.0001), as well as the physical and mental component summary scores (PCS and MCS) (p<0.0001). The mean PCS and MCS of the FM patients were 38.5 (SD=6.9) and 32.8 (SD=10.9), whereas those of the RA patients were 33.5 (SD=6.4) (p<0.01) and 40.2 (SD=11.9) (p<0.001). The dimensions typically affected by FM were vitality (s-score -1.61), mental health (s-score -1.46) and general health (s-score-1.47), whereas physical functioning (s-score-1.63) and role limitations due to physical function (s -score -0.94) were more impaired in the RA patients; the bodily pain scores were similar in the two groups. The PCS was lower than the MCS in the RA patients (s-scores -1.80 vs. -0.62), but the two scores were similar in the FM patients (s-scores -1.20 vs. -1.08). Multiple regression models showed that the physical component of the SF-36 was associated with widespread pain (the SAPS score) (p<0.0001), educational level (p=0.0017), and the body mass index (p=0.007), and the mental component was associated with the widespread pain (p=0.0005), sleep abnormalities (p=0.0033), physical function (p=0.015), fatigue (p=0.029), gender (p=0.014) and a low educational level (p=0.0007). CONCLUSION: Patients with FM see the disease as having a worse health than RA patients and the general population, especially in terms of mental health.
目的：比较纤维肌痛（FM）患者与类风湿关节炎（RA）患者和普通人群的健康相关生活质量（HRQL），并探讨是否存在与 FM 更大影响相关的因素。
方法：本横断面研究纳入了 380 名 FM 患者、693 名 RA 患者和 1579 名健康对照者。采用健康调查简表 36 项（SF-36）评估 HRQL，评估指标包括疾病相关特征、人口统计学变量和合并症。计算 S 评分以与常模进行比较，并采用多变量分析评估 HRQL 与临床和人口统计学变量之间的关系。
结果：与普通人群相比，FM 患者在 SF-36 的所有 8 个维度（p<0.0001）以及生理和心理综合评分（PCS 和 MCS）（p<0.0001）上均显著受损。FM 患者的平均 PCS 和 MCS 分别为 38.5（标准差=6.9）和 32.8（标准差=10.9），而 RA 患者的分别为 33.5（标准差=6.4）（p<0.01）和 40.2（标准差=11.9）（p<0.001）。通常受 FM 影响的维度为活力（s 评分-1.61）、心理健康（s 评分-1.46）和一般健康（s 评分-1.47），而身体机能（s 评分-1.63）和因身体机能受限的角色（s 评分-0.94）在 RA 患者中受损更严重；两组的躯体疼痛评分相似。RA 患者的 PCS 低于 MCS（s 评分-1.80 比-0.62），但 FM 患者的两个评分相似（s 评分-1.20 比-1.08）。多元回归模型显示，SF-36 的生理成分与广泛性疼痛（SAPS 评分）（p<0.0001）、教育程度（p=0.0017）和体重指数（p=0.007）相关，心理成分与广泛性疼痛（p=0.0005）、睡眠异常（p=0.0033）、身体功能（p=0.015）、疲劳（p=0.029）、性别（p=0.014）和低教育程度（p=0.0007）相关。
结论：FM 患者认为疾病对健康的影响比 RA 患者和普通人群更严重，尤其是在心理健康方面。
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