Study Shows High Fibromyalgia Prevalence or Symptoms in Rheumatic Patients

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A study suggests the high prevalence of fibromyalgia and fibromyalgia-related symptoms in rheumatic patients may affect medication adherence.¹ The research, led by M. Rapisara, from the University Hospital A.O.U “G. Martino” in Messina, Italy, was presented at the 2024 European Alliance of Association for Rheumatology (EULAR) from June 12 – June 15, 2024, in Vienna, Austria.

Rheumatic patients often struggle with treatment adherence, especially those with fibromyalgia. Studies reported patients with fibromyalgia have frequent medication discontinuation, irregular scheduling, and switching.² A 2017 study found tricyclic antidepressants had the highest discontinuation rate (91%) and SSRI/SNRI antidepressants had the lowest (73.7%) in 3932 patients with fibromyalgia.³

Since fibromyalgia is the rheumatic disease most strongly associated with poor treatment adherence, screening of fibromyalgia or fibromyalgia-related symptoms can help identify patients who are more likely to be medication non-adherent.¹ That way, these patients could be treated instead with tighter control or personalized therapeutic strategies.

Investigators sought to assess treatment adherence in patients with rheumatic diseases, as well as how the prevalence of fibromyalgia or fibromyalgia-related symptoms impacted adherence. The team also aimed to identify risk factors linked to poor medication compliance.

Rapisara and colleagues conducted a cross-sectional cohort study of participants diagnosed with a rheumatic disease from the Rheumatology Unit of the University Hospital “G. Martino” in Messina. Participants were consecutively enrolled by face-to-face or telephone interviews and were screened for primary or associated fibromyalgia based on the American College of Rheumatology (ACR) 2016 criteria.

Investigators also assessed for fibromyalgia disease activity, quality of life, and physical and psychological symptoms using the Revised Fibromyalgia Impact Questionnaire (FIQR), the Fibromyalgia Assessment Status (FAS), Beck Depression Inventory (BDI), and 36-Item Short Form Survey (SF-36) questionnaires. Additionally, treatment adherence was measured with the 8-Item Morisky Medication Adherence Scale (MMAS-8) questionnaire; an MMAS-8 < 6 indicated low adherence, and an MMAS-8 > 6 indicated medium to high adherence. The team also collected demographic and clinical data.

The study included 100 patients with a mean age of 56.8 ± 12. 7 years. More than half (n = 54) had primary or associated fibromyalgia. Among those participants, 28 had primary fibromyalgia.

Aside from fibromyalgia, other rheumatic diseases participants had included osteoarthritis and inflammatory conditions such as arthritis and connective tissue diseases. For participants without primary or associated fibromyalgia, adherence to pharmacologic treatment such as immunosuppressants, steroids, analgesics, NSAIDs, muscle relaxants, antiepileptics, antidepressants, and nutritional supplements was good. The MMAS-8 score was 8 in 69% of cases.

However, after categorizing patients based on the 2016 ACR FM criteria, the team observed a significant difference in the mean MMAS-8 score. Participants with fibromyalgia had a mean MMAS-8 score of 6.2 ± 2.1 and participants without fibromyalgia had a score of 7.3 ± 1.2 (P < .001).

The team also noted significant differences between patients with fibromyalgia versus no fibromyalgia in the scores of the Revised Fibromyalgia Impact Questionnaire 76.9 ± 13.4 vs 52.1 ± 20.2, respectively), Fibromyalgia Assessment Status (21.7 ± 4.6 vs 10.9 ± 3.4, respectively), Symptom Severity Scale (9.8 ± 2.0 vs 5.9 ± 2.4, respectively), Widespread Pain Index (11.5 ± 3.1 vs 5.08 ± 1.9, respectively), 36-Item Short Form Survey (85.0 ± 10.5 vs 88.3 ± 15.7, respectively), and Beck Depression Inventory (29.6 ± 9.0 vs 17.8 ± 9.5, respectively) (all P < .001).

Ultimately, fibromyalgia and a worse Widespread Pain Index (11.2 ± 3.6; P = .001), Symptom Severity Scale (9.7 ± 1.6; P < .001), Fibromyalgia Assessment Status (21.4 ± 5.4; P < .001), FIQR (75.8 ± 14.8; P = .002), and Beck Depression Inventory (29.2 ± 8.1; P = .006) scores were linked to a risk of low medication adherence.

“The results of this study show a high prevalence of [fibromyalgia] and [fibromyalgia-related symptoms in rheumatic patients, which may affect medication adherence,” investigators concluded. “Questionnaires can help to identify individuals at higher risk of discontinuing therapy.”

References

1. ^{Rapisarda M, Sangari D, Miceli G, et alAB0132 THE IMPACT OF FIBROMYALGIA AND FIBROMYALGIA-RELATED SYMPTOMS ON TREATMENT ADHERENCE IN A COHORT OF PATIENTS WITH RHEUMATIC DISEASES: RESULTS OF A PILOT CROSS-SECTIONAL STUDYAnnals of the Rheumatic Diseases 2024;83:1300.}
2. ^{Häuser W, Fitzcharles MA. Adherence to Clinical Guidelines for Fibromyalgia: Help or Hindrance?. Can J Pain. 2023;7(1):2255070. Published 2023 Nov 10. doi:10.1080/24740527.2023.2255070}
3. ^{Ben-Ami Shor D, Weitzman D, Dahan S, et al. Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization [published correction appears in J Rheumatol. 2017 Nov;44(11):1762. doi: 10.3899/jrheum.170098.C1]. J Rheumatol. 2017;44(10):1499-1506. doi:10.3899/jrheum.170098}