title: Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis.
abstract: BACKGROUND
  Fibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. With this study we aimed to estimate the prevalence of FM in SpA and to compare the clinical/disease features and TNF inhibitors (TNFi) in patients with/without FM.
  
  
  METHODS
  FM was defined by a score = > 5/6 of the Fibromyalgia Rapid Screening Tool (FiRST). SpA patients (according to the rheumatologist) and consecutively consulting in the day care hospital but also in the outpatient clinic at the rheumatology department of a tertiary care university hospital were included. Demographics, disease characteristics, activity and severity and TNFi treatment were compared in patients with and without FM; retention rate of the first TNFi and associated factors were explored (Kaplan Meier and Cox regression).
  
  
  RESULTS
  Of the 196 enrolled SpA patients, 42 (21.4 %) were positively screened for FM. No statistically significant differences in the prevalence of FM were found with regard to the fulfillment of the ASAS criteria for peripheral/axial SpA, nor with regard to the fulfillment of the imaging vs. clinical arm of the ASAS criteria. However, patients with coexisting FM presented significantly with more enthesitis, higher disease activity (BASDAI and VAS) and poorer function scores (BASFI). No differences were found with regard to the initiation of TNFi treatment (79.0 % vs. 70.0 %, respectively), but the retention rate of the first TNFi after 2 years was shorter in the group of patients with FM (28.1 % (95 % CI 12.5-44.0) vs. 41.7 % (95 % CI 32.2-51.3), p = 0.01).
  
  
  CONCLUSIONS
  This study confirms that coexistent FM in SpA might impact the patient-reported outcome indices for disease activity and function, and the retention rate of TNFi treatment.
authors: Rheumatology Department, Cochin Hospital, AP-HP, París, France. nataliabello84@gmail.com.|Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. nataliabello84@gmail.com.
authors: Natalia
authors: N
authors: Bello
authors: Rheumatology Department, Cochin Hospital, AP-HP, París, France. adrien.etcheto@gmail.com.|INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbornne Paris-Cité, Paris, France. adrien.etcheto@gmail.com.
authors: Adrien
authors: A
authors: Etcheto
authors: Rheumatology Department, Cochin Hospital, AP-HP, París, France. carobeal@gmail.com.
authors: Caroline
authors: C
authors: Béal
authors: Rheumatology Department, Cochin Hospital, AP-HP, París, France. maxime.dougados@cch.aphp.fr.|INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbornne Paris-Cité, Paris, France. maxime.dougados@cch.aphp.fr.
authors: Maxime
authors: M
authors: Dougados
authors: Rheumatology Department, Cochin Hospital, AP-HP, París, France. anna.molto@aphp.fr.|INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbornne Paris-Cité, Paris, France. anna.molto@aphp.fr.
authors: Anna
authors: A
authors: Moltó
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha