School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
School of Medicine, Trinity College Dublin, Dublin, Ireland; Department of Rheumatology, St. James's Hospital, Dublin, Ireland.
Joint Bone Spine. 2022 Nov;89(6):105420. doi: 10.1016/j.jbspin.2022.105420. Epub 2022 May 27.
The primary objective was to evaluate the co-existence of fibromyalgia (FM) & enthesitis in individuals with spondyloarthritis (SpA). Secondary objectives were to identify clinical features associated with the presence of FM in enthesitis and analyse sex-specific differences.
This was an ancillary analysis of the Assessment of SpondyloArthritis International Society Peripheral Involvement in SpA (PerSpA) study. Enthesitis was defined as the presence of enthesitis ever. Clinical FM was defined as the rheumatologist's confirmation of the presence of FM. A score of≥5/6 on the Fibromyalgia Rapid Screening Test (FiRST) defined a positive screening test for FM.
Enthesitis ever and FM (EFM) co-existed in 10.3% (n=425) of the cohort using FiRST criteria and 5.3% using clinical diagnosis of FM. More individuals with FM by clinical diagnosis had imaging-confirmed enthesitis ever than by FiRST criteria. More females had EFM than males, defined clinically (76.9% vs 23.1%) or by FiRST criteria (62.6% vs 37.4%). Individuals with EFM had more severe disease across all measures compared to those with enthesitis only, with no significant difference between sexes. EFM was significantly associated with age, female sex, BMI, BASDAI and region.
FM is an important comorbidity in the setting of enthesitis in SpA. While EFM is more common in females, it is not a rare condition in males. EFM is associated with worse disease severity measures in SpA in both males and females. Recognition of FM in the setting of enthesitis is essential to prevent overtreatment and optimise patient outcomes.
主要目的是评估纤维肌痛（FM）与脊柱关节炎（SpA）患者附着点炎的共存情况。次要目标是确定附着点炎中存在 FM 的相关临床特征，并分析性别特异性差异。
这是评估脊柱关节炎国际学会外周 SpA 累及研究（PerSpA）的辅助分析。附着点炎定义为曾经存在附着点炎。临床 FM 定义为风湿病医生确认存在 FM。纤维肌痛快速筛查测试（FiRST）得分为≥5/6 定义为 FM 的阳性筛查测试。
使用 FiRST 标准，10.3%（n=425）的队列存在附着点炎和纤维肌痛（EFM）共存，而使用临床诊断 FM 的比例为 5.3%。通过临床诊断 FM 存在影像学证实的附着点炎的患者多于通过 FiRST 标准的患者。通过临床诊断 FM 确定的 EFM 女性多于男性（76.9%比 23.1%），而通过 FiRST 标准确定的 EFM 女性多于男性（62.6%比 37.4%）。与仅有附着点炎的患者相比，患有 EFM 的患者在所有指标上的疾病严重程度都更高，但男女之间无显著差异。EFM 与年龄、女性、BMI、BASDAI 和地区显著相关。
在 SpA 的附着点炎中，FM 是一种重要的合并症。虽然 EFM 在女性中更为常见，但在男性中也并非罕见。EFM 与 SpA 中更严重的疾病严重程度指标相关，无论性别如何。在附着点炎的情况下识别 FM 对于避免过度治疗和优化患者结局至关重要。
