Evaluation of Fibromyalgia Syndrome and Its Effect on Quality of Life in Rheumatoid Arthritis
Condition: Rheumatoid Arthritis; Fibromyalgia; Fibromyalgia, Secondary
MeSH terms: Arthritis; Arthritis, Rheumatoid; Fibromyalgia; Myofascial Pain Syndromes
Study type: Observational

Summary: 
      Rheumatoid arthritis is a chronic, autoimmune, systemic inflammatory disease with a
      prevalence of approximately 1%. With a lifetime development rate of 3.6%, rheumatoid
      arthritis is seen 1.7% more in women than in men. Although there are no diagnostic criteria
      for rheumatoid arthritis, ACR / EULAR 2010 classification criteria are frequently used in
      diagnosis. Symptom duration, number of swollen joints, acute phase reactants and serology are
      used in these criteria. Fibromyalgia syndrome is characterized by chronic widespread pain,
      fatigue, exercise disorders and cognitive impairment. Although the prevalence of fibromyalgia
      syndrome in the general population is between 2-4%, it is one of the most common conditions
      encountered by rheumatologists. A treat to target strategy is recommended in rheumatoid
      arthritis disease management. This approach suggests close monitoring of disease activity and
      treatment change in cases where the goal is not achieved. The prevalence of fibromyalgia in
      rheumatoid arthritis patients was found to be 5-52% in meta-analyzes due to the heterogeneity
      of fibromyalgia criteria used in studies. This study, it was aimed to evaluate the effect of
      secondary fibromyalgia syndrome, which is frequently found in rheumatoid arthritis and
      characterized by symptoms such as fatigue and widespread pain, on rheumatoid arthritis
      disease activation and patients' quality of life.
    

Detailed description: 
      Rheumatoid arthritis is a chronic, autoimmune, systemic inflammatory disease with a
      prevalence of approximately 1%. With a lifetime development rate of 3.6%, rheumatoid
      arthritis is seen 1.7% more in women than in men. Synovial joints are the primary involvement
      site of the disease, and due to insufficient control of the disease, irreversible joint
      damage and disability may develop. Although there are no diagnostic criteria for rheumatoid
      arthritis, ACR / EULAR 2010 classification criteria are frequently used in diagnosis. Symptom
      duration, number of swollen joints, acute phase reactants and serology are used in these
      criteria.

      Fibromyalgia syndrome is characterized by chronic widespread pain, fatigue, exercise
      disorders and cognitive impairment. Although the prevalence of fibromyalgia syndrome in the
      general population is between 2-4%, it is one of the most common conditions encountered by
      rheumatologists. The prevalence of fibromyalgia increases with age and is more common in
      women, with a female: the male ratio between 2:1 to 30:1, depending on which diagnostic
      criteria are applied.

      The first approved classification criteria for fibromyalgia syndrome was developed in 1990 by
      the American College of Rheumatology (ACR). These criteria include chronic widespread pain
      for more than 3 months and evaluation of 18 sensitive points. Although it was developed for
      classification, it was also used as a diagnostic criterion by most rheumatologists. Updated
      diagnostic criteria excluding sensitive point evaluation were published by ACR in 2010.
      Common pain index and symptom severity score were used in these criteria. In 2011, these
      criteria were modified with criteria including the physician's assessment of somatic
      symptoms. The 2010 and 2011 criteria evaluate symptom severity and 'being fibromyalgia' using
      the common pain index and symptom severity scale.

      There are 2 main groups in fibromyalgia, these are; primary fibromyalgia and secondary
      fibromyalgia due to a comorbid disease. Primary fibromyalgia is more common and characterized
      by local pain that initially spreads later. Differential diagnosis is difficult in these
      individuals because of the common symptoms of rheumatological diseases such as pain and
      fatigue. Centralized pain may develop with inflammatory arthritis or as a result of the
      disease. Chronic inflammation can mediate central pain from peripheral pain that can cause
      symptoms in fibromyalgia. In animal models, pro-inflammatory cytokines such as Tumor Necrosis
      Factor and Interleukin-6 have been associated with abnormal central pain processing and
      widespread pain sensitivity.

      In Rheumatoid Arthritis(RA) patients, the presence of fibromyalgia syndrome was found 2.1
      times more frequently in patients who were Rheumatoid Factor negative than those who were
      positive, and 3.0 times more frequently in patients who were positive in anti-citrullinated
      protein antibody (ACPA) seronegative. It is thought that in seronegative patients, clinicians
      may be less likely to diagnose RA or attribute the RA prodroma symptom as fibromyalgia
      syndrome. Also alternatively, fibromyalgia syndrome may be the underlying diagnosis in some
      seronegative cases. In another study investigating the presence of secondary fibromyalgia
      syndrome in patients with early inflammatory arthritis; it was found that ACPA negative
      patients had fibromyalgia syndrome more frequently than seropositive patients. The authors
      hypothesized that this might be caused by ACPA-positive patients were treated more
      aggressively and disease control was reached earlier, or clinicians were more likely to
      diagnose fibromyalgia in ACPA-negative patients.

      A treat to target strategy is recommended in RA disease management. This approach suggests
      close monitoring of disease activity and treatment change in cases where the goal is not
      achieved. In randomized studies, with a treat to target strategy, patients have been found to
      have a decrease in radiological progression, in disease activity, an increase in physical
      function and quality of life.

      The prevalence of fibromyalgia in rheumatoid arthritis patients was found to be 5-52% in
      meta-analyzes due to the heterogeneity of fibromyalgia criteria used in studies.When the
      2010/2011 criterion was used, the prevalence was found to be higher than the 1990 criteria.
      (24% vs 18%)Despite this heterogeneity, a strong relationship was found between DAS28 and
      comorbid fibromyalgia. As DAS28, disease activity index such as SDAI( simplified disease
      activity index) and CDAI (clinical disease activity index) were found to be correlated with
      comorbid fibromyalgia.

      This study, it was aimed to evaluate the effect of secondary fibromyalgia syndrome, which is
      frequently found in rheumatoid arthritis and characterized by symptoms such as fatigue and
      widespread pain, on rheumatoid arthritis disease activation and patients' quality of life.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Rheumatoid arthritis patients
      
Keywords: fibromyalgia; rheumatoid arthritis; fibromyalgia, secondary