Department of Rheumatology, Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt.
Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Curr Rheumatol Rev. 2021;17(3):331-341. doi: 10.2174/1573397117666210114110823.
Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease that specifically affects the spine and sacroiliac joint. AS diagnosis is often delayed in the clinical practice and this delay may cause the patients to miss the chance of early treatment. Fibromyalgia (FM) is a frequently encountered clinical syndrome, fibromyalgianess is a term used when patients who are diagnosed with inflammatory arthropathies meet the criteria for FM syndrome as shown in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome, and AS.
We aimed primarily to assess the frequency of concomitant diagnosis of FM syndrome in AS patients and study its impact on clinical disease aspects. Secondary, our aim extended as a preliminary pilot study to assess the Plasma Pentraxin-3(PTX-3) as a potential marker for the diagnosis of FM syndrome in AS patients.
Plasma PTX-3 in 61 AS patients was compared to 60 matched controls. FM was diagnosed by FM Rapid Screening Tool. Bath AS disease activity index (BASDAI) and AS disease assessment score using C- reactive protein (ASDAS-CRP), Bath AS functional impairment index (BASFI), Bath AS metrology index (BASMI), AS quality of life (ASQoL) scale, Beck Depression Inventory, and Bath AS Radiology Index (BASRI) were assessed.
The patients were categorized into two groups according to the concomitant diagnosis of FM syndrome. Group I included 14 (22.9%) AS patients who fulfilled the clinical diagnosis of FM syndrome. Group II included 47 (77.1%) AS patients without FM syndrome. AS patients with FM (Group I) had significantly(p<0.001) increased an average of ages, disease duration, diagnostic delay of AS, switching of bDMARDs, morning stiffness duration, ASDAS-CRP, BASFI, ASQoL score, BASDAI (p=0.008), and BDI score (p=0.005) compared to AS patients without FM (Group II). PTX-3 levels were significantly (p<0.001) higher in Group I (p<0.001) (median, 0.23; IQR, 0.15-0.41 ng/ml) than Group II (median, 0.13; IQR, 0.035-0.21ng/ml) which showed no significant differences (p>0.05) compared to the controls. PTX-3 levels had significant positive correlations (p<0.05) with disease duration, BASFI, and ASQOl. Age, female sex, switch of biologic, ASDAS - CRP, and PTX-3 were significant predictors of FM in AS patients.
These results indicate that concomitant FM is a significant problem in patients with AS and its presence is associated with higher disease activity, impaired function as well as an overall negative impact on QoL. Easy scanning of suspicious cases of FM with FiRST questionnaire can be done in daily practice. PTX-3 is more or less accurate as the clinical features to improve the diagnostic certainty of FM in the presence of AS with a proven sensitivity of 62.3%, a specificity of 90%, a positive predictive value of 82.75%, and a negative predictive value of 73.9%.
强直性脊柱炎（AS）是一种慢性全身性炎症性风湿性疾病，主要影响脊柱和骶髂关节。AS 的临床诊断经常被延误，这种延误可能导致患者错过早期治疗的机会。纤维肌痛（FM）是一种常见的临床综合征，当诊断为炎症性关节炎的患者符合纤维肌痛综合征的标准时，如类风湿关节炎（RA）、系统性红斑狼疮（SLE）、干燥综合征和 AS 中，会使用纤维肌痛 ness 一词。
我们的主要目的是评估 AS 患者同时诊断纤维肌痛综合征的频率，并研究其对临床疾病方面的影响。其次，我们的目标扩展为初步试点研究，以评估血浆 Pentraxin-3（PTX-3）作为 AS 患者纤维肌痛综合征诊断的潜在标志物。
将 61 例 AS 患者的血浆 PTX-3 与 60 例匹配的对照组进行比较。通过纤维肌痛快速筛查工具诊断 FM。评估 Bath AS 疾病活动指数（BASDAI）和基于 C 反应蛋白的 AS 疾病评估评分（ASDAS-CRP）、Bath AS 功能障碍指数（BASFI）、Bath AS 计量指数（BASMI）、AS 生活质量（ASQoL）量表、贝克抑郁量表和 Bath AS 放射学指数（BASRI）。
根据同时诊断 FM 综合征的情况，患者分为两组。第 I 组包括 14 名（22.9%）符合纤维肌痛综合征临床诊断的 AS 患者。第 II 组包括 47 名（77.1%）无 FM 综合征的 AS 患者。患有 FM 的 AS 患者（第 I 组）的平均年龄、疾病持续时间、AS 的诊断延迟、bDMARD 的转换、晨僵持续时间、ASDAS-CRP、BASFI、ASQoL 评分、BASDAI（p<0.001）和 BDI 评分（p=0.005）均显著高于无 FM 的 AS 患者（第 II 组）。与第 II 组（中位数 0.13；IQR 0.035-0.21ng/ml）相比，第 I 组（中位数 0.23；IQR 0.15-0.41ng/ml）的 PTX-3 水平显著升高（p<0.001），但与对照组相比无显著差异（p>0.05）。PTX-3 水平与疾病持续时间、BASFI 和 ASQOl 呈显著正相关（p<0.05）。年龄、女性、生物制剂的转换、ASDAS-CRP 和 PTX-3 是 AS 患者发生 FM 的显著预测因素。
这些结果表明，同时患有 FM 是 AS 患者的一个重大问题，其存在与更高的疾病活动度、功能受损以及对 QoL 的整体负面影响有关。在日常实践中，可以使用 FiRST 问卷轻松扫描可疑 FM 病例。PTX-3 作为一种或多或少准确的临床特征，可提高 AS 患者 FM 的诊断确定性，其灵敏度为 62.3%，特异性为 90%，阳性预测值为 82.75%，阴性预测值为 73.9%。
