FORWARD, The National Data Bank for Rheumatic Diseases, Wichita, KS, United States; University of Kansas School of Medicine, Wichita, KS, United States.
Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Semin Arthritis Rheum. 2020 Dec;50(6):1457-1464. doi: 10.1016/j.semarthrit.2020.02.005. Epub 2020 Feb 16.
Studies of the relation of fibromyalgia (FM) and widespread pain (WSP) to mortality have differed as to the presence or absence of an association and the extent of cause-specific mortality. However, no studies have investigated which definitions of FM and WSP associate with mortality, nor of FM mortality in other diseases. We investigated these issues and the meaning of mortality in patients with FM.
We used Cox regression to study 35,248 rheumatic disease patients with up to 16 years of mortality follow-up in all patients and separately in those with diagnoses of rheumatoid arthritis (RA) (N = 26,458), non-inflammatory rheumatic disorders (NIRMD) (N = 5,167) and clinically diagnosed FM (N = 3,659). We applied 2016 FM criteria and other FM and WSP criteria to models adjusted for age and sex as well as to models that included a full range of covariates, including comorbid disease and functional status. We estimated the degree of explained of variance (R2) as a measure of predictive ability.
We found positive associations between al`l definitions of FM and WSP and all-cause mortality, with relative risks (RR)s ranging from 1.19 (95%CI 1.15-1.24) for American College of Rheumatology (ACR) 1990 WSP to 1.38 (1.31-1.46) in age and sex adjusted revised 2016 criteria (FM 2016). However, in full covariate models the FM 2016 RR reduced further to 1.15 (1.09-1.22). The association with mortality was noted with RA (1.52 (1.43-1.61)), NIRMD (1.43 (1.24-1.66)) and clinical FM (1.41 (1.14-1.75) - where 37% of FM diagnosed patients did not satisfy FM 2016 criteria. In the all-patient analyses, the age and sex explained variation (R2) was 0.255, increasing to 0.264 (4.4%) when FM 2016 criteria were added, and to 0.378 in a full covariate model. Death causes related to FM 2016 status included accidents, 1.45 (1.11-1.91); diabetes 1.78 (1.16-2,71); suicide, 3.01 (1.55-5.84) and hypertensive related disorders, 3.01 (1.55-5.84). Cancer deaths were less common 0.77 (0.68-0.88).
FM is weakly associated with mortality within all criteria definitions of FM and WSP examined (3.4% of explained variance), and across all diseases (RA, NIRMD, clinical FM) equally. Clinical and criteria-defined FM had different mortality outcomes. We found no evidence for a positive association of cancer and FM or WSP.
关于纤维肌痛（FM）和广泛疼痛（WSP）与死亡率的关系的研究，在是否存在关联以及特定病因死亡率的程度上存在差异。然而，尚无研究调查哪些 FM 和 WSP 定义与死亡率相关，也没有研究 FM 在其他疾病中的死亡率。我们调查了这些问题以及 FM 患者死亡率的含义。
我们使用 Cox 回归分析了 35248 名风湿性疾病患者，所有患者的死亡率随访时间长达 16 年，分别在患有类风湿关节炎（RA）（N=26458）、非炎症性风湿性疾病（NIRMD）（N=5167）和临床诊断为 FM（N=3659）的患者中进行了研究。我们应用了 2016 年 FM 标准以及其他 FM 和 WSP 标准，对调整了年龄和性别的模型以及包含了包括合并症和功能状态在内的全面协变量的模型进行了分析。我们将方差解释度（R2）估计为衡量预测能力的指标。
我们发现所有 FM 和 WSP 定义与全因死亡率之间存在正相关关系，相对风险（RR）范围从美国风湿病学会（ACR）1990 年 WSP 的 1.19（95%CI 1.15-1.24）到调整年龄和性别后的修订 2016 年标准（FM 2016）的 1.38（1.31-1.46）。然而，在全面协变量模型中，FM 2016 的 RR 进一步降低至 1.15（1.09-1.22）。在 RA（1.52（1.43-1.61））、NIRMD（1.43（1.24-1.66））和临床 FM（1.41（1.14-1.75））中观察到与死亡率的关联，其中 37%的 FM 诊断患者不符合 FM 2016 标准。在所有患者分析中，年龄和性别解释的变异度（R2）为 0.255，当添加 FM 2016 标准时增加到 0.264（4.4%），在全面协变量模型中增加到 0.378。与 FM 2016 状态相关的死亡原因包括意外事故，RR 为 1.45（1.11-1.91）；糖尿病，RR 为 1.78（1.16-2.71）；自杀，RR 为 3.01（1.55-5.84）和高血压相关疾病，RR 为 3.01（1.55-5.84）。癌症死亡较少，RR 为 0.77（0.68-0.88）。
在我们检查的所有 FM 和 WSP 定义（3.4%的解释方差）以及所有疾病（RA、NIRMD、临床 FM）中，FM 与死亡率之间的相关性较弱。临床和标准定义的 FM 具有不同的死亡率结果。我们没有发现 FM 或 WSP 与癌症之间存在正相关关系的证据。
