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Predicting Future Fibromyalgia in Patients with Rheumatoid Arthritis

Posted on: 11/30/1999
People with rheumatoid arthritis (RA) don't have enough to worry about, there is the risk of developing more painful symptoms from fibromyalgia. In fact, one of the main characteristics of fibromyalgia is widespread pain throughout the body. Widespread body pain added to joint pain, heat, inflammation, and swelling from RA can be very disabling.

For that reason, scientists hope to be able to predict who among the patients with rheumatoid arthritis might be at risk for fibromyalgia. If predictive risk factors can be discovered, there may be a way to eliminate (or alter) the factors. The goal would be to prevent fibromyalgia in this already compromised patient group.

One way to do this is to collect as much information as possible on patients with rheumatoid arthritis (RA) who don't already have fibromyalgia. Then the group is followed over time to see who develops fibromyalgia. An analysis of the two groups (group one with RA but no fibromyalgia and group two with RA and fibromyalgia) can help shed some light on why the group did develop fibromyalgia.

In a recent study, extensive data collected on 9739 patients with rheumatoid arthritis included their age, sex (male versus female), education level and occupation, income, and marital status. Number of years they had the arthritis was factored in along with their body mass index (BMI), smoking (tobacco use) history, and any psychologic problems such as depression, anxiety, or other mood disorders.

Symptoms (how many, what type, how intense, and how often) were tallied up. Any other illnesses (e.g., diabetes, heart disease, cancer), medications, activity level, previous surgeries, and patient reported (but not tested) fitness level were also recorded. Information on sleep and sleep disturbances and the number of visits to their doctors was also collected.

The authors of the study acknowledge up front that it is still unknown whether the many and varied symptoms associated with fibromyalgia cause the problem or are a result of the condition. We don't know if risk factors are the same for healthy people as they are for patients already affected by rheumatoid arthritis. The results of this study might shed some light on these areas.

Here's what they found. Men and women with rheumatoid arthritis (RA) developed fibromyalgia in equal numbers, so sex (male versus female) didn't seem to be a factor. Other demographic factors (education, income, marital status and so on) by themselves did not predict fibromyalgia in RA patients. But if demographics were combined with severity of RA or risk factors for fibromyalgia (mood, BMI, fatigue, stress), then the odds increased for developing fibromyalgia for patients with RA.

Depression (mood), BMI associated with obesity, and poor fitness with limited exercise are predictive factors for fibromyalgia in patients with rheumatoid arthritis. These are all modifiable risk factors, which means there is something we can do to change the risk.

Two characteristics of patients with fibromyalgia bear further study in relation to people with rheumatoid arthritis. The first is the "chicken vs. the egg": which came first, the depression and poor fitness level or the fibromyalgia, which then led to the depression and lack of physical activity?

The second is what is referred to as over reporting. People with fibromyalgia tend to seek medical care and report their symptoms more often than patients with other pain-related problems. Folks with fibromyalgia have more symptoms than anyone else, a variable called symptom count. How these pieces might fit into the rheumatology patient's life in terms of developing fibromyalgia remains to be studied.

In summary, this study attempts to develop a fibromyalgia prediction model for patients with rheumatoid arthritis. Understanding how fibromyalgia develops in this patient group and what factors might be changed to prevent it will remain a key focus of future studies. Once the prediction model is complete, then testing will be done to see how accurate the model is before introducing it to the world at large.

References:
Frederick Wolfe, et al. The development of Fibromyalgia - I: Examination of Rates and Predictors in Patients with Rheumatoid Arthritis (RA). In PAIN. February 2011. Vol. 152. No. 2. Pp. 291-299.

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