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<p>To estimate prevalence and associated factors of comorbid fibromyalgia in axial spondyloarthritis (axSpA), and to explore discriminative capacity (for discerning fibromyalgia) of algometry-assessed pain sensitivity measures. AxSpA patients from the population-based SPARTAKUS cohort evaluated for fibromyalgia (1990 ACR criteria) were included (<i>n</i> = 243; r-axSpA/nr-axSpA = 165/78). Factors associated with fibromyalgia were cross-sectionally analyzed by logistic/linear regression, and discriminative potential of algometry-assessed measures estimated by ROC-curve analysis. A fibromyalgia prevalence of 9% was demonstrated, with a higher frequency in female than male patients (17%/2%;adjusted <i>p</i> &lt; 0.001) and more than a doubling in frequency per 5-unit BMI increase (adjusted <i>p</i> &lt; 0.002). Fibromyalgia was associated with several disease/work outcomes, including higher disease activity, lower quality-of-life, and less employment although without association to swollen joints/CRP. Additionally, patients with (versus without) fibromyalgia had higher bDMARD exposure (19%/5% had tried ≥ 3 bDMARDs; adjusted <i>p</i> = 0.009), and were more often on opioids (62%/16%;adjusted <i>p</i> &lt; 0.001). Algometry-assessed measures displayed a sensitivity/specificity of 79%/70% (pain threshold) and 71%/83% (pain tolerance) for fibromyalgia differentiation (positive/negative predictive values 16%/99% and 23%/98%, respectively). Fibromyalgia is a frequent comorbidity in axSpA, more common in female patients/patients with higher BMI, and associated with worse levels of patient-reported disease/work outcomes. Our findings highlight the challenge of assessing axSpA disease activity when fibromyalgia is present and suggest a role for algometry as a complementary, evaluator-independent assessment tool, potentially useful for fibromyalgia rule-out but less so for rule-in. The results further suggest that fibromyalgia may be associated with DMARD overtreatment, reflecting a need for earlier and more precise targeting.</p>

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Axial spondyloarthritis patients with comorbid fibromyalgia feel worse, work less and more often try multiple biological therapies: results from a population-based, cross-sectional study investigating the discriminative capacity of pressure algometry

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  • 发表日期：

    2026年5月23日

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  • Annie Brink,
  • Elisabeth Mogard,
  • Elisabet Lindqvist,
  • Jonas Sagard,
  • Carmen Roseman,
  • Mats Geijer,
  • Jack Kvistgaard Olsen,
  • Johan K. Wallman,
  • Tor Olofsson

摘要

To estimate prevalence and associated factors of comorbid fibromyalgia in axial spondyloarthritis (axSpA), and to explore discriminative capacity (for discerning fibromyalgia) of algometry-assessed pain sensitivity measures. AxSpA patients from the population-based SPARTAKUS cohort evaluated for fibromyalgia (1990 ACR criteria) were included (n = 243; r-axSpA/nr-axSpA = 165/78). Factors associated with fibromyalgia were cross-sectionally analyzed by logistic/linear regression, and discriminative potential of algometry-assessed measures estimated by ROC-curve analysis. A fibromyalgia prevalence of 9% was demonstrated, with a higher frequency in female than male patients (17%/2%;adjusted p < 0.001) and more than a doubling in frequency per 5-unit BMI increase (adjusted p < 0.002). Fibromyalgia was associated with several disease/work outcomes, including higher disease activity, lower quality-of-life, and less employment although without association to swollen joints/CRP. Additionally, patients with (versus without) fibromyalgia had higher bDMARD exposure (19%/5% had tried ≥ 3 bDMARDs; adjusted p = 0.009), and were more often on opioids (62%/16%;adjusted p < 0.001). Algometry-assessed measures displayed a sensitivity/specificity of 79%/70% (pain threshold) and 71%/83% (pain tolerance) for fibromyalgia differentiation (positive/negative predictive values 16%/99% and 23%/98%, respectively). Fibromyalgia is a frequent comorbidity in axSpA, more common in female patients/patients with higher BMI, and associated with worse levels of patient-reported disease/work outcomes. Our findings highlight the challenge of assessing axSpA disease activity when fibromyalgia is present and suggest a role for algometry as a complementary, evaluator-independent assessment tool, potentially useful for fibromyalgia rule-out but less so for rule-in. The results further suggest that fibromyalgia may be associated with DMARD overtreatment, reflecting a need for earlier and more precise targeting.