RA patients with fibromyalgia (FM) have higher disease activity, greater medical costs and worse quality of life compared to without FM

1. FIBROMYALGIA IMPACT ON
RHEUMATOID ARTHRITIS
Farhan Tahir MD
Rheumatologist

2. http://ard.bmj.com/content/early/2017/07/2
0/annrheumdis-2017-211476

3. Chronic Widespread Pain Patients
More Likely to Die Early
• Lifestyle may explain excess mortality in fibromyalgia
and other chronic pain patients
• UK Biobank, a cohort study of 0.5 million people aged 40–
69 years, recruited throughout Great Britain in 2006–2010
• Objective: Whether persons with chronic widespread pain
(CWP) experience premature mortality

4. Lifestyle to blame
• 7130 participants reported CWP and they experienced
excess mortality (mortality risk ratio 2.43
• Cancer (1.73), cardiovascular (3.24, respiratory (5.66)
• Excess risk was substantially reduced after adjustment
for
1. low levels of physical activity
2. high body mass index
3. poor quality diet
4. Smoking

5. Conclusions
• Evidence is now clear that persons with CWP
experience excess mortality
• UK Biobank results considerably reduce uncertainty
around the magnitude of excess risk
• Excess mortality being explained by adverse lifestyle
factors
• Should be targeted in the management of such patients.

7. Fibromyalgia in RA over 2 Years
• RA patients with fibromyalgia (FM) have higher disease
activity, greater medical costs and worse quality of life
compared to without FM
• To determine the impact of FM on 2-year changes in
functional status of RA patients in a prospective study
• Brigham Rheumatoid Arthritis Sequential Study enrolled
in a sub study of the effects of pain in RA

8. FMS on RA 2 year impact
• 56 included RA subjects, 16.7% had FM, while 83.3%
did not
• Baseline MDHAQ score
• Disease duration, rheumatoid factor (RF)/cyclic
citrullinated peptide antibody (CCP) seropositivity,
disease activity
• Psychological distress
• MDHAQ
• Polysymptomatic Distress (PSD) Scale, semi-annually

9. FMS on RA 2 year impact
• RA patients with FM had a 14% ( 0.14) greater 2-year
increase in MDHAQ score
• FM and increasing number of FM symptoms predicted
worsening of functional status
• Magnitude of the difference in changes in MDHAQ was 4
to 7-fold higher than typical changes in MDHAQ
score in RA patients
• RA patients with fibromyalgia (FM) have higher disease
activity, greater medical costs and worse quality of life
compared to RA patients without FM

11. Resistance Exercise Lifts Fatigue
in Fibromyalgia
• To examine the effects of a person-centered
progressive resistance exercise program
• Multiple dimensions of fatigue in women with FM
• A total of 130 women with FM (age 22–64 years) in
assessor-blinded randomized controlled multicenter trial

12. progressive resistance
exercise
• Twice a week for 15 weeks. Outcomes were five
dimensions of fatigue measured with the
Multidimensional Fatigue Inventory (MFI-20)
• A higher improvement was found at the post-treatment
examination for change in the resistance exercise group
• Female patients benefit from being involved in treatment
planning

13. Sleep and Shorter workdays
• Sleep efficiency was the strongest predictor of change in
fatigue (beta = −0.54, p = 0.031, R 2 = 0.05)
• Participating in resistance exercise (beta = 1.90,
p = 0.010)
• Working fewer hours per week (beta = 0.84, p = 0.005)
• Independent significant predictors of change in physical
fatigue (R 2 = 0.14)

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