Objective
The classic conception of pain etiology in rheumatologic disease is nociceptive pain—tissue injury and inflammation signaling through peripheral and central nerve fibers. But this can be mixed with other pain etiologies, including nociplastic, which is augmented pain experience due to central sensitization. The pain of fibromyalgia is nociplastic, occurs in 10% to 30% of patients with rheumatic disease, and its presence can influence disease severity assessment. The objective of our study was to 1) ascertain the prevalence of fibromyalgia and widespread pain in the CorEvitas psoriatic arthritis (PsA) registry as assessed by the Widespread Pain Index and Symptom Severity Scale questionnaires; 2) characterize the demographic and clinical factors associated with fibromyalgia and widespread pain; and 3) ascertain the association of fibromyalgia and widespread pain on the Clinical Disease Activity in Psoriatic Arthritis score and other disease activity measures.
Methods
Patients with PsA in the registry who had completed the Widespread Pain Index/Symptom Severity Scale questionnaires since May 2020 were analyzed at their most recent visit recorded in the registry.
Results
The analysis included 1,823 patients with PsA; 11.1% fulfilled the fibromyalgia definition and 20.6% fulfilled the widespread pain definition. Several factors were associated with the fibromyalgia definition, including female sex, depression and/or anxiety, impaired function, increased body mass index and increased number of comorbidities. Clinical Disease Activity in Psoriatic Arthritis score, patient pain and global assessment, and tender joint count were twice as severe in patients with fibromyalgia than in those without.
Conclusion
The prevalence of fibromyalgia is elevated in PsA and is associated with elevated disease measures, confounding reliable disease assessment for treat-to-target goals. Identification of fibromyalgia as an influential contextual factor in disease assessment is recommended.
Philip Mease,1 George Reed,2 Alexis Ogdie,3 Dimitrios A. Pappas,4 and Joel M. Kremer5
- University of Washington School of Medicine, Seattle
- UMass Chan Medical School, Worcester, Mass.
- University of Pennsylvania, Philadelphia
- Columbia University, New York
- Albany Medical College, Albany, New York
Disclosures: Philip Mease: CorEvitas, LLC; Corrona Research Foundation; George Reed: CorEvitas, LLC; Corrona Research Foundation; Alexis Ogdie: AbbVie, Amgen, Bristol Myers Squibb, Novartis, Janssen, Pfizer, Celgene, CorEvitas LLC, Eli Lilly, Gilead, GlaxoSmithKline, UCB; Dimitrios A. Pappas: CorEvitas, LLC; Corrona Research Foundation; Joel M. Kremer; CorEvitas, LLC; Corrona Research Foundation.
Citation
Mease P, Reed G, Ogdie A, Pappas DA, Kremer JM. Prevalence of fibromyalgia and widespread pain in psoriatic arthritis: Association with disease severity assessment in a large US registry [abstract]. Arthritis Care Res (Hoboken). 2024 Sep;76(9):1313–1321.
