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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

Brink, Annie LU ; Mogard, Elisabeth LU orcid ; Lindqvist, Elisabet LU orcid ; Sagard, Jonas LU orcid ; Roseman, Carmen LU ; Geijer, Mats LU ; Olsen, Jack Kvistgaard ; Wallman, Johan K LU and Olofsson, Tor LU (2026) In Rheumatology International 46(6). p.1-12
Abstract

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... (More)

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.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Humans, Fibromyalgia/epidemiology, Female, Cross-Sectional Studies, Male, Middle Aged, Adult, Axial Spondyloarthritis/epidemiology, Comorbidity, Prevalence, Pain Measurement/methods, Quality of Life, Biological Products/therapeutic use, Pain Threshold, Employment, Antirheumatic Agents/therapeutic use
in
Rheumatology International
volume
46
issue
6
article number
99
pages
1 - 12
publisher
Springer
external identifiers
  • pmid:42176050
  • scopus:105039903881
ISSN
1437-160X
DOI
10.1007/s00296-026-06140-1
language
English
LU publication?
yes
additional info
© 2026. The Author(s).
id
9ad111f6-ad88-443a-8d15-e2ccaaed23d8
date added to LUP
2026-06-22 10:23:21
date last changed
2026-09-02 15:52:18
@article{9ad111f6-ad88-443a-8d15-e2ccaaed23d8,
  abstract     = {{<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 (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 &lt; 0.001) and more than a doubling in frequency per 5-unit BMI increase (adjusted p &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 p = 0.009), and were more often on opioids (62%/16%;adjusted p &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>}},
  author       = {{Brink, Annie and Mogard, Elisabeth and Lindqvist, Elisabet and Sagard, Jonas and Roseman, Carmen and Geijer, Mats and Olsen, Jack Kvistgaard and Wallman, Johan K and Olofsson, Tor}},
  issn         = {{1437-160X}},
  keywords     = {{Humans; Fibromyalgia/epidemiology; Female; Cross-Sectional Studies; Male; Middle Aged; Adult; Axial Spondyloarthritis/epidemiology; Comorbidity; Prevalence; Pain Measurement/methods; Quality of Life; Biological Products/therapeutic use; Pain Threshold; Employment; Antirheumatic Agents/therapeutic use}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{6}},
  pages        = {{1--12}},
  publisher    = {{Springer}},
  series       = {{Rheumatology International}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1007/s00296-026-06140-1}},
  doi          = {{10.1007/s00296-026-06140-1}},
  volume       = {{46}},
  year         = {{2026}},
}