Diagnosis of Fibromyalgia and Psoriatic Arthritis Impacts Treatment Decisions

Spine Community News:

Fibromaylgia (FM) is a disorder of the central nervous system that is associated with chronic widespread pain, fatigue, sleep disturbance, irritable bowel syndrome, and interstitial cystitis.  FM can occur alone (primary) or in conjunction with other disorders (secondary).

In the general population, FM occurs in between 2 and 8% of people.1 In my study of the spectrum of individuals with back pain attending a spine center clinic, about 15% of individuals had primary or secondary FM.2

A recent review calculated the prevalence of FM in patients with spondyloarthritis, including those with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).3 In this report, between 4 to 25% of AS and 16 to 22% of PsA patients had the comorbidity of FM.

This is an important finding because it has a significant impact on therapy. In a proportion of spondyloarthritis patients, immunomodulating therapy that is directed solely at decreasing inflammation will be inadequate in improving the patient’s condition.  The patients with FM may continue to experience pain that is not improved with anti-inflammatory therapy.  In those individuals, the addition of therapy that treats FM (duloxetine, pregabalin) may be necessary to improve the symptoms and the overall response to treatment.

David Borenstein, MD

Executive Editor TheSpineCommunity.com

  1. Clauw DJ. Fibromyalagia: a cinical review. JAMA 2014;311:1547-1555
  2. Borenstein DG: Prevalence and treatment outcome of primary and secondary fibromyalgia in spinal pain patients. Spine 20:796-800, 1995
  3. Mease PJ. Fibromyalgia, a missee comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment. Curr Opin Rheumatol 2017;29:304-310
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