FRI0226 How Fibromyalgia Impacts Clinical and Treatment Aspects in Spondyloarthritis Patients: Results of the Fispa Study
Authors: N. Bello Vega, C. Béal, A. Etcheto, M. Dougados, A. Molto
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Fibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. The Fibromyalgia Rapid Screening Tool (FiRST) is a self-reported questionnaire, independent from tender points, which can be used for FM screening<sup>1</sup>. <h3>Objectives</h3> To estimate the prevalence of FM in a SpA cohort according to the FiRST, to compare the prevalence of FM with regard to the fulfilment of the ASAS classification criteria, to compare the clinical/disease features and TNFi treatment in terms of initiation and first TNFi retention rate, in patients with/without FM respectively. <h3>Methods</h3> <i>Patients:</i> SpA patients (according to the rheumatologist) consecutively consulting on a tertiary care hospital. <i>FM definition:</i> according to the FiRST questionnaire, patients answering “yes” at ≥5/6 questions were considered FM+. <i>Data collection:</i> All patients completed the FiRST questionnaire. Demographics, patients/disease characteristics, activity/severity and TNFi initiation as well as the retention of the first TNFi treatment, were collected. <i>Statistical analysis:</i> The percentage of FM+ according to the FiRST was calculated in the global population and in the different arms of the ASAS criteria. Demographics, disease characteristics, activity and severity were compared in FM+ and FM- groups. The percentage of patients ever initiating a TNFi was compared in both groups. The retention rate of the first TNFi in both groups was estimated by Kaplan-Meier curves and tested by the Log-rank test. Predisposing factors for first TNFi retention rate were estimated by Cox models. <h3>Results</h3> Of the 222 patients who completed the FiRST questionnaire, 195 were included for the analysis, among them 42 (21.5%) fulfilled the FM definition. From the total, 185 (94.8%) met the ASAS criteria with a similar % of FM in the different subgroups [e.g imaging (21.5%) and clinical (18.7%), <i>p</i>=NS]. Patients fulfilling the FM definition presented with more enthesitis (59.5% vs.39.5%, <i>p</i>=0.02), more frequent history of depression (41.0% vs.18.4%, <i>p</i>&lt;0.01), higher total BASDAI [4.6 (±2.3) vs. 2.6 (±2.0), <i>p</i>&lt;0.01] and BASFI [4.8 (±3.7) vs. 2.0 (±1.5), <i>p</i>&lt;0.01]. Furthermore, patients in this group reported more frequently analgesics (92.7%vs.72%, <i>p</i>&lt;0.01) and psychotropic medications (e.g. myorelaxant or antidepressants or anxiolytic or strong opioids) (66.7%vs.35.9%,<i>p&lt;</i>0.01). Regarding TNFi treatment, TNFi were initiated in 79%vs.70% in FM+ and FM- groups, respectively (<i>p</i>=NS). The retention rate of the first TNFi was significantly shorter in the FM+ group. After 1 and 2 years, 55%vs.50% and 28.1%vs.41.2% of patients were still under treatment in the FM+vs.FM- groups, respectively,(Cox <i>p</i>=0.03). <h3>Conclusions</h3> Our study suggests the following:1) the similar percentage of FM in the imaging and clinical arms of the ASAS criteria is an argument in favor of the validity of these criteria; 2) the coexistance of FM might impact the score of the instrument used to evaluate disease activity and also the retention rate of the TNFi treatment. <h3>References</h3> Perrot S, Bouhassira D, Fermanian J. Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain 150,250–256 (2010). <h3>Acknowledgements</h3> N.B wishes to acknowledge to the Spanish Rheumatology Foundation (FER) for a training bursary. <h3>Disclosure of Interest</h3> None declared