Fibromiyaljinin Spondiloartrit Hastalık Ölçeklerine Etkisi

Yıl 2024, Cilt: 11 Sayı: 4, 503 - 507, 29.12.2024

Menice Güler Şen , Özgül Soysal Gündüz , Özgür Akgül , Timur Pırıldar

https://doi.org/10.34087/cbusbed.1308494

Öz

Amaç: Spondiloartrit (SpA) hastalarının değerlendirilmesi ve takibi için çeşitli ölçeklerden faydalanılmaktadır. Bu ölçeklerde hastaların subjektif yakınmaları değerlendirilmektedir. Hastalık aktivitesi ve hastanın fonksiyonel değerlendirmesi, tedavi yanıtının belirlenmesi açısından önemlidir. Fibromiyalji (FMS) yaygın ve kronik kas-iskelet sistemi ağrısı, uyku bozuklukları, sabah katılığı ve halsizlikle karakterize bir sendromdur. Spondiloartrit tanılı hastalarda fibromiyalji birlikteliği hastalık aktivitesi ve yaşam kalitesini gösteren ölçeklerde yanlış yüksek sonuçlara neden olabilir. Bu durum tedavi belirlenmesini zorlaştırabilir. Literatürde konuyla ilgili geniş hasta katılımının olduğu çalışma sayısı kısıtlıdır. Çalışmamızda SPA tanılı hastalarda, hastalık aktivitesi, fiziksel kısıtlılık, psikolojik durum ve hayat kalitesi ölçeklerine FMS varlığının etkisini yüksek populasyonlu bir hasta grubunda değerlendirmeyi amaçladık.
Materyal Metod: Ocak 2019 - Mayıs 2019 tarihleri arasında, Celal Bayar Üniversitesi Tıp Fakültesi Hastanesi Romatoloji polikliniğinde takipli SpA tanısı konulan 236 hasta bilgilendirme yapılıp onamları alınarak çalışmaya dâhil edildi. ACR 2016 FMS kriterlerine göre hastalar FMS+SpA ve SpA olarak iki gruba ayrıldı. Gruplar arasında hastalık aktivite ölçekleri karşılaştırıldı.
Sonuçlar: Çalışmaya katılan hastaların BASDAI, BASFI, BASMI, ASDAS-ESH, ASDAS-CRP, AsQoL, HAD ve VAS ortalama değerleri FMS+SpA grubunda istatiksel olarak anlamlı oranda yüksek saptandı.
Tartışma: SpA tanılı hastalarda fonksiyonel kapasite ve hastalık aktivite ölçüm skorlamaları hastaların değerlendirilmesinde ve tedavi kararında önemli bir yer tutmaktadır. Ancak bu ölçekler fibromiyalji varlığında doğru sonuçlar vermemektedir. Bu durum spondiloartrit ve fibromiyaljinin birlikte görüldüğü hastalarda hastalık aktivite, fonksiyonel kısıtlılık, yaşam kalitesinin değerlendirilmesinde karışıklığa neden olabilmektedir. Özellikle yüksek hastalık aktivitesi bulunan SpA hastalarında tedavi planında değişiklik yapılmadan önce FMS varlığı açısından taranması, yorgunluk ve depresyon durumlarının değerlendirilmesi faydalı olabilir. Ülkemizde konuyla ilgili yapılan çalışmalar içinde yüksek hasta sayısına sahip olması ile bizim çalışmamız öne çıkmaktadır. SpA tanılı hastalarda yaşam kalitesi, hastalık aktivitesi, fonksiyonel kısıtlılık değerlendirmesi yapan objektif ölçeklerin geliştirilmesine ihtiyaç vardır.

Anahtar Kelimeler

Fibromiyalji, spondiloartrit, hastalık aktivite ölçekleri

Evaluation of Disease Activity Scales in Patients with Spondyloarthritis accompanied by Fibromyalgia

Öz

Objective: Various scales are used for the evaluation and follow-up of spondyloarthritis (SpA) patients. Subjective complaints of patients are evaluated in these scales. Disease activity and functional evaluation of the patient are important in determining the treatment response. Fibromyalgia (FMS) is a syndrome characterized by widespread and chronic musculoskeletal pain, sleep disturbances, morning stiffness and fatigue. Coexistence of fibromyalgia in patients with spondyloarthritis may cause falsely high results in scales showing disease activity and quality of life. This may complicate the determination of treatment. The number of studies in the literature with large patient participation on the subject is limited. In our study, we aimed to evaluate the effect of the presence of FMS on disease activity, physical limitation, psychological status and quality of life scales in patients with a diagnosis of SPA in a high population patient group.
Material and Method: Between January 2019 and May 2019, 236 patients with SpA who were followed up in the Rheumatology outpatient clinic of Celal Bayar University Medical Faculty Hospital were included in the study after their informed consent was obtained. Patients were divided into two groups as FMS+SPA and SPA according to ACR 2016 FMS criteria. In our study, we compared the differences between the two groups in terms of disease activity scales.
Results: We found statistically significantly higher mean values of BASDAI, BASFI, BASMI, ASDAS-ESH, ASDAS-CRP, AsQoL, HAD and VAS of the patients in the FMS group.
Discussion: Functional capacity and disease activity measurement scores in patients with SpA have an important place in the evaluation and treatment decision of patients. However, these scales do not give accurate results in the presence of fibromyalgia. This situation can cause confusion in the evaluation of disease activity, functional limitation, and quality of life in patients with spondyloarthritis and fibromyalgia together. It may be useful to screen for the presence of FMS and to evaluate fatigue and depression before making changes in the treatment plan, especially in SpA patients with high disease activity. Our study stands out with the high number of patients among the studies on the subject in our country. There is a need to develop objective scales that evaluate quality of life, disease activity, and functional limitation in patients with SpA.

Anahtar Kelimeler

Fibromyalgia, Spondyloarthritis, Disease Activity Scales

Kaynakça

• 1. Dougados M, Linden SVD, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis&Rheumatism: Official Journal of the AmericanCollege of Rheumatology. 1991;34(10):1218‐27.
• 2. Dougados M, Hochberg MC. Why is the concept of spondyloarthropathies important? Best Pract Res Clin Rheumatol 2002; 16:495-505.
• 3. Rooks DS. Fibromyalgia treatment update. Current opinion in rheumatology.2007;19(2):111‐7.
• 4. Cetin N, Yalbuzdag SA, Cabioglu MT, Turhan N. Factors affecting the quality of life inpatients with fibromyalgia/Fibromiyalji sendromunda yasam kalitesi uzerine etkili faktorler. Turkish Journal of Rheumatology. 2009:77‐82.
• 5. Bello N, Etcheto A, Béal C, Dougados M, Moltó A. Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis research&therapy. 2016;18(1):42. 6. Alunno A, Carubbi F, Stones S, Gerli R, Giacomelli R, Baraliakos X. Theimpact of fibromyalgia in Spondyloarthritis: from classification criteria to outcome measures. Frontiers in medicine. 2018;5. 7. Almod var R, Carmona L, Zarco P, Collantes E, Mulero J, FernndezSueiro J, et al.Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage. Clinical and Experimental Rheumatology‐InclSupplements. 2010;28(6):S33.
• 8. Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi‐Puttini P, Atzeni F. Fibromyalgia in patients with axialspondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatology international. 2014;34(8):1103‐10.
• 9. Haliloglu S, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A. Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity. Rheumatology international. 2014;34(9):1275‐80.
• 10. J Sieper, D van der Heijde, R Landewé, J Brandt, R Burgos-Vagas, E Collantes-Estevez, B Dijkmans, M Dougados, M A Khan, M Leirisalo-Repo, S van der Linden, W P Maksymowych, H Mielants, I Olivieri, M Rudwaleit. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)
• 11. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity FrederickWolfe 1, Daniel J Clauw, Mary-AnnFitzcharles, Don L Goldenberg, Robert S Katz, Philip Mease, Anthony S Russell, I JonRussell, John B Winfield, Muhammad B Yunus, Dr M Rudwaleit, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatologie, Medizinische Klinik I, Hindenburgdamm 30, 12203 Berlin, Germany
• 12. Downie WW, Leatham PA, et al. Studies with pain rating scales. Annals Rheumatic Diseases 37: 378-381, 1978
• 13. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. Journal of Rheumatology 1994, 21 (12): 2286-91
• 14. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:18-24.
• 15. Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath ankylosing spondylitis functional index. J Rheumatol 1994;21(12):2281-5.
• 16. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garett SL, Calin A. Definingspinalmobility in ankylosingspondylitis (AS). TheBath AS Metrologyindex. J Rheumatol 1994;21(9):1694-8
• 17. L C Doward 1, A Spoorenberg, S A Cook, D Whalley, P S Helliwell, L J Kay, S P McKenna, A Tennant, D van der Heijde, M A Chamberlain. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis Ann Rheum Dis 2003 Jan;62(1):20-6. doi: 10.1136/ard.62.1.20.
• 18. A S Zigmond, R P Snaith. The hospital anxiety and depression scale, Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.
• 19. Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O, et al. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. TheJournal of Rheumatology. 2008;35(2):305‐9.
• 20. Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi‐Puttini P, Atzeni F. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatology international. 2014;34(8):1103‐10.
• 21. Altan L, SİVRİOĞLU Y, Ercan I. Can Bath Ankylosing Spondylitis Disease Activity Index be Affected by Accompanying Fibromyalgia or Depression? Archives of Rheumatology. 2015;30(1).
• 22. Azevedo VF, PaivaEdos S, Felippe L, Moreira RA. Occurrence of fibromyalgia inpatients with ankylosing spondylitis. RevBrasReumatol. 2010;50(6):646‐50.
• 23. Heikkilä S, Ronni S, Kautiainen HJ, Kauppi MJ. Functional impairment in spondyloarthropathy and fibromyalgia. TheJournal of rheumatology. 2002;29(7):1415‐9.
• 24. Au YLE, Wong WSR, Mok MY, Chung HY, Chan E, Lau CS. Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS? Clinical rheumatology. 2014;33(8):1127‐34.
• 25. Bobek D, Žagar I, KovačDurmiš K, Perić P, Ćurković B, Babić‐Naglić Đ. Scoring of disease activity using BASDAI and ASDAS method in ankylosing spondylitis. Reumatizam. 2012;59(1):5‐10.
• 26. .Macfarlane GJ, Barnish MS, Pathan E, Martin KR, Haywood KL, Siebert S, et al. Co-OccurrenceandCharacteristics of Patients With Axial Spondyloarthritis Who Meet Criteria for Fibromyalgia: ResultsFrom a UK National Register. Arthritis&Rheumatology. 2017;69(11):2144‐50.