Fibromyalgia in Axial Spondyloarthritis: A Meta-analysis

This study aimed to compare the demographic characteristics, disease activity, functional status, and quality of life between patients with axial spondyloarthritis and fibromyalgia and patients with axial spondyloarthritis without fibromyalgia.

We searched MEDLINE via PubMed, Cochrane, Scopus, and Embase databases, from the earliest available indexing date to March 30, 2019, for comparative studies evaluating fibromyalgia in patients with axial spondyloarthritis. Two authors extracted data independently, and all discrepancies were resolved through consensus.

Seven comparative studies were identified. No statistically significant differences were observed in terms of age, levels of inflammatory markers, and prevalence of extra-articular manifestations such as uveitis, psoriasis, and inflammatory bowel disease between patients with Axial spondyloarthritis fibromyalgia and those without it. Sex ratios (female to male) were approximately 3:2 and 1:3 in patients with and without fibromyalgia, respectively. The ratios concerning human leukocyte antigen B27-positive patients with and without fibromyalgia were 45.1% and 65.6%, respectively. Patients with fibromyalgia had significantly higher Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life scores.

Our meta-analysis showed that patients with Axial spondyloarthritis fibromyalgia had considerably higher pain severity, disease activity, and worse quality of life than patients without fibromyalgia. The sex ratios (female to male) were approximately 3:2 and 1:3, and ratios for human leukocyte antigen B27-positive patients were 45.1% and 65.6% in patients with and without fibromyalgia, respectively. Further well-designed studies are needed to substantiate our results.