Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register
Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register
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DOI：
10.1093/rheumatology/key206
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发表时间：
2018-11-01
期刊：
影响因子：
5.5
通讯作者：
Jones, Gareth T.
中科院分区：
文献类型：
--
作者：
Macfarlane, Gary J.;MacDonald, Ross I. R.;Jones, Gareth T.
目标。量化轴向spa患者共病性FM与较高的疾病活动性、较差的生活质量（QoL）和较差的TNF抑制剂（TNFis）反应相关的程度。一项在英国83个中心招募的前瞻性研究。临床信息和患者报告的措施是可用的，包括2011年FM标准。采用多变量线性回归模型对满足FM标准对疾病活动性、生活质量和对tnfi的反应的影响进行了建模。共有1757名参与者符合分析条件，其中22.1%符合FM标准。合并FM标准的患者在调整人口统计学、临床和生活方式因素后，疾病活动性较高[BASDAI平均差值FM+ - FM- 1.04 (95% CI 0.75, 1.33)]，生活质量较差[强直性脊柱炎生活质量评分差值1.42 (95% CI 0.88, 1.96)]。在开始生物治疗的291名参与者中，合并FM的BASDAI评分在基线时高出2.0，但在12个月时下降到1.1。在12个月时，满足国际脊椎关节炎协会20标准评估的可能性没有显著差异。在3个月的TNFi治疗中，疾病活动性和生活质量的改善较少与FM标准症状严重程度量表分量的高分密切相关。满足FM标准对轴向SpA疾病活动性和生活质量的评估有适度影响，对生物治疗的反应没有显著影响。那些在FM评估中症状严重程度较高的患者可能受益于FM的额外特定管理。
Objective. To quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA.Methods. A prospective study recruiting across 83 centres in the UK. Clinical information and patient-reported measures were available, including 2011 criteria for FM. Multivariable linear regression was used to model the effect of meeting the FM criteria on disease activity, QoL and response to TNFis.Results. A total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with comorbid FM criteria had higher disease activity [BASDAI average difference FM+ - FM- 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component.Conclusion. Fulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.