ANALYSIS OF 26 CASES OF ANKYLOSING SPONDYLITIS COMPLICATED WITH FIBROMYALGIA

Yu Xie¹, Qiuchi Zhang^{2, *}

¹Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine (Affiliated Hospital of Nanjing University of Chinese Medicine), Nanjing, Jiangsu 210000, China - ²Department of Neurology, Jiangsu Province Hospital of Chinese Medicine (Affiliated Hospital of Nanjing University of Chinese Medicine), Nanjing, Jiangsu 210000, China

Introduction: To summarize the clinical characteristics of patients with ankylosing spondylitis (AS) combined with fibromyalgia (FM), in order to provide clues and a basis for early diagnosis and standard treatment.

Materials and methods: A total of 26 patients with AS complicated with FM who were treated in Jiangsu Province Hospital of Traditional Chinese Medicine from January 1, 2017 to December 31, 2021, were collected. The clinical data of the patients were retrospectively analyzed, including epidemiological characteristics, clinical manifestations, diagnostic characteristics, drug conditions and treatment effects.

Results: The onset age of AS combined with FM was concentrated between 19 and 40 years old (73%), and the ratio of male to female was close to 1:1 (54% vs 46%). When FM was diagnosed, all patients did not show typical inflammatory low back pain, and most of the patients could not relieve the pain after activity (88%), but no patient (0%) recorded waking up with pain at night. All patients (100%) had dorsoaxial pain, most patients also had shoulder girdle pain (69%) and buttock pain (54%). A small number of patients had chest pain (31%), upper limb pain (46%), and lower limb pain (35%). Most patients had sleep disorders (62%), fatigue (69%), neuropsychiatric symptoms (54%), and self-reported paresthesia (81%). Prior to diagnosis, most patients had used 1-2 NSAIDs (81%) and most had used biologics (74%). After the diagnosis of FM, the symptoms of most patients (77%) were improved after adding the indicated drugs (pregabalin and duloxetine).

Conclusion: In patients with AS who present with diffuse pain, especially diffuse pain that does not show a clear tendency to improve with rest after activity, nor does it show a tendency to wake up with pain and difficulty turning over at night (especially 3-5 am). In cases where there is no improvement with multiple NSAIDs, biologics, the possibility of comorbid FM needs to be considered with emphasis. In patients with AS combined with FM, anti-FM drugs are required to improve the patient’s symptoms.