The rheumatology month in review highlights the significance of early diagnosis and innovative treatments in managing fibromyalgia, the prevalence of sexual dysfunction in patients with arthritis, and the impact of physical activity on arthritis symptoms despite anxiety-related avoidance.

The Importance of Early Intervention in Fibromyalgia

Delayed Fibromyalgia Diagnosis Linked to Worse Disease Severity

Investigators obtained data on the time to diagnosis and collected data on the revised Fibromyalgia Impact questionnaire, the modified Fibromyalgia Assessment Status, and the Polysymptomatic Distress Scale which contained the Widespread Pain Index and the Symptom Severity Scale.

The study included 616 patients with fibromyalgia, with 92.2% female, a mean age of 52.36 years, a mean disease duration of 6.46 years, and a mean time to diagnosis of 3.45 years. In the sample 169 participants had an early diagnosis, 320 had a late diagnosis, and 127 had a very late diagnosis.

Investigators observed a significant difference in disease severity between patients with an early, late, and very late diagnosis. The longer it took to diagnose fibromyalgia, the greater the disease severity (P = .000001).

The Role of Hyperbaric Oxygen Therapy for Treating Fibromyalgia, with Shai Efrati, MD

In an interview with HCPLive, Shai Efrati, MD, co-investigator and founder and director of the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center, discussed his recent study evaluating hyperbaric oxygen therapy (HBOT) compared with pharmacological treatment among adults with fibromyalgia related to childhood sexual abuse (CSA).

Results of this trial revealed showed significantly better results among patients receiving HBOT, promoting neuroplasticity and long-term recovery by repairing brain tissue rather than merely alleviating symptoms. This approach treats the core malfunction in the brain, offering lasting benefits.

Sexual Dysfunction Prevalent in Patients with Arthritis

Sexual Dysfunction Common Among Patients with Psoriatic Arthritis

Patients with rheumatic disease are 3 times more likely to develop sexual dysfunction compared with healthy individuals, which can be caused by the disease itself, related comorbidities, and/or medication.

To evaluate sexuality and the prevalence of sexual dysfunction among patients with PsA, investigators assessed 23 adult subjects using 2 male questionnaires (the International Index of Erectile Function [IIEF] and Male Sexual Quotient [MSQ]) and 2 female questionnaires (the Female Sexual Function Index [FSFI] and Female Sexual Quotient [FSQ]), validated for Brazilian Portuguese. Eligible patients were recruited from the rheumatology department of a university hospital in northeastern Brazil between October to December 2020.

Most (91.7%) men exhibited sexual dysfunction according to the IIEF questionnaire, although most cases were characterized as mild. The prevalence of sexual dysfunction among women was 72.7%, with low domain scores, and the mean FSQ score was 64.9.

Study Reveals Strong Link Between Arthritis and Erectile Dysfunction

Erectile dysfunction (ED) is a common condition affecting 46.1% of American men aged 40 – 70 years and between 42.1% – 52.5% of European men aged 40 – 70 years. Although the condition is not life-threatening, it greatly impacts a person’s quality of life. A variety of psychological, environmental, and lifestyle, and medical factors, such as diabetes and hypertension, have been identified as contributing influences to the development of the disorder.

“There is an urgent need to raise awareness and conduct additional research on the reasons behind this association in order to implement more scientific and rational treatment programs for patients with ED and arthritis,” wrote a group of investigators.

In total, 3646 patients were included in the analyses. Of these patients 1012 (27.8%) had a history of ED and 795 (18.5%) had a history of arthritis. Patients with ED reported higher rates of arthritis (P <.001) and were more likely to be married, socioeconomically disadvantaged, less educated, older, and physical inactive. Similarly, patients with arthritis had higher rates of ED (P <.001), were married, socioeconomically disadvantaged, less educated, physically inactive, older, and were predominantly White.

Exercise Alleviates Arthritis Symptoms, Despite Fear of Activity

Anxiety Plays a Significant Role in Physical Activity Avoidance Among Patients with PsA

To assess the prevalence of physical activity avoidance, and any relevant variables linked to avoidance, such as psychological domains, investigators conducted a single-center, cross-sectional, observational study on patients with PsA. The FABQ physical activity (FABQ PA) focused on how a patient’s fear of pain may impact their inclination to avoid exercise. A score of ≥ 15 indicated high levels of fear-avoidance believes related to physical activity. Univariate and multivariable linear regressions were performed to determine any psychometric, pathology-related, or demographic factors. Eligible patients met the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria.

Results showed patients with psoriatic arthritis (PsA) were more likely to avoid physical activity based on anxiety symptoms and physical function, as opposed to disease activity.

Physical Activity Improves Depression, Fatigue in Patients with Arthritis

“The adequate level of physical activity is considered beneficial for disease activity, muscle strength, flexibility and aerobic capacities of the patients,” wrote a team of investigators led by Sretko Lukovic, an internal medicine resident at the Institute of Rheumatology Belgrade. “In addition, exercise helps to enhance energy and stamina by decreasing fatigue and improving sleep. The need for optimizing mental and physical health in patients could be met by exercising. Due to chronic illness, lower level of fitness, pain and biomechanical abnormalities as well as the fear of arthritis relapse or worsening by exercising, many patients avoid this activity.”

Data presented at the 2024 European Congress of Rheumatology (EULAR) conference revealed patients with inflammatory arthritis who exhibited moderate and high physical activity were shown to have better control of disease activity in addition to lower levels of depression and fatigue. However, investigators noted an omnipresent kinesiophobia, which is indicative of a strong need for continuous education about the benefits of physical activity and the way in which patients can properly exercise.