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Patients with fibromyalgia rarely fulfil classification criteria for axial spondyloarthritis

Xenofon Baraliakos1, Andrea Regel1, Uta Kiltz1

  • 1Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.

Rheumatology (Oxford, England)
|October 3, 2017
PubMed
Abstract

Insights

The Assessments of Spondyloarthritis international Society (ASAS) criteria rarely identify fibromyalgia (FM) patients, but some axial spondyloarthritis (axSpA) patients meet FM criteria. This suggests axSpA assessment tools may lack specificity for chronic pain conditions.

Area of Science:

  • Rheumatology
  • Clinical Immunology
  • Pain Medicine

Background:

  • The Assessments of Spondyloarthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA) face criticism for inadequate differentiation from fibromyalgia (FM).
  • Comparing the performance of existing classification criteria in axSpA and FM patients is crucial for diagnostic clarity.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of ASAS axSpA criteria against established FM classification criteria.
  • To determine the overlap in criterion fulfillment between axSpA and FM patient cohorts.

Main Methods:

  • Prospective inclusion of 300 patients diagnosed with axSpA or FM by their rheumatologist.
  • Evaluation of ASAS axSpA criteria and ACR FM criteria (1990/2010) by an independent examiner.
  • Stratification of axSpA patients into non-radiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS), with symptom severity assessment.

Main Results:

  • Nearly all FM patients (100% 2010 ACR, 98% 1990 ACR) met FM criteria, while only 2% met ASAS axSpA criteria.
  • All axSpA patients met ASAS axSpA criteria, but a significant proportion also met FM criteria (24% 2010 ACR, 13.5% 1990 ACR).
  • Fulfillment of FM criteria was higher in AS patients (29% 2010 ACR, 19% 1990 ACR) compared to nr-axSpA patients (19% 2010 ACR, 8% 1990 ACR).

Conclusions:

  • FM patients infrequently meet axSpA classification criteria, but axSpA patients sometimes meet FM criteria, particularly those with AS.
  • The overlap suggests that current axSpA assessment instruments may not be disease-specific, potentially due to central pain sensitization.
  • Further research into central pain sensitization in rheumatic diseases is warranted.

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