Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of SLE Activity

Overview

Journal J Rheumatol

Specialty Rheumatology

Date 2008 Nov 13

PMID 19004039

Citations 23

Authors

Frederick Wolfe

Michelle Petri

Graciela S Alarcon

John Goldman

Eliza F Chakravarty

Robert S Katz

Elizabeth W Karlson

Affiliations

Soon will be listed here.

Abstract

Objective: To determine if fibromyalgia (FM) or fibromyalgia-ness (the tendency to respond to illness and psychosocial stress with fatigue, widespread pain, general increase in symptoms, and similar factors) is increased in patients with compared to those without systemic lupus erythematosus (SLE); to determine whether FM or fibromyalgia-ness biases the SLE Activity Questionnaire (SLAQ); and to determine if the SLAQ is overly sensitive to FM symptoms.

Methods: We developed a 16-item SLE Symptom Scale (SLESS) modeled on the SLAQ and used that scale to investigate the relation between SLE symptoms and fibromyalgia-ness in 23,321 patients with rheumatic disease. FM was diagnosed by survey FM criteria, and fibromyalgia-ness was measured using the Symptom Intensity (SI) Scale. As comparison groups, we combined patients with rheumatoid arthritis and noninflammatory rheumatic disorders into an "arthritis" group and also utilized a physician-diagnosed group of patients with FM.

Results: FM was identified in 22.1% of SLE and 17.0% of those with arthritis. The SI scale was minimally increased in SLE. The correlation between SLAQ and SLESS was 0.738. SLESS/SLAQ scale items (Raynaud's phenomenon, rash, fever, easy bruising, hair loss) were significantly more associated with SLE than FM, while the reverse was true for headache, abdominal pain, paresthesias/stroke, fatigue, cognitive problems, and muscle pain or weakness. There was no evidence of disproportionate symptom-reporting associated with fibromyalgia-ness. Self-reported SLE was associated with an increased prevalence of FM that was unconfirmed by physicians, compared to SLE confirmed by physicians.

Conclusion: The prevalence of FM in SLE is minimally increased compared with its prevalence in patients with arthritis. Fibromyalgia-ness does not bias the SLESS and should not bias SLE assessments, including the SLAQ.

Citing Articles

The frequency of fibromyalgia in patients with systemic lupus erythematosus and associated factors: a systematic review and meta-analysis.

Mistry S, Daoud A, Nighat Magrey M, Pamuk O Clin Rheumatol. 2024; 44(1):9-21.

PMID: 39424681 DOI: 10.1007/s10067-024-07188-9.

Emerging Molecular and Synaptic Targets for the Management of Chronic Pain Caused by Systemic Lupus Erythematosus.

Weng H Int J Mol Sci. 2024; 25(7).

PMID: 38612414 PMC: 11011483. DOI: 10.3390/ijms25073602.

Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients.

Denvir B, Carlucci P, Corbitt K, Buyon J, Belmont H, Gold H Front Epidemiol. 2024; 4:1334859.

PMID: 38516120 PMC: 10956350. DOI: 10.3389/fepid.2024.1334859.

Clinical and Serologic Phenotyping and Damage Indices in Patients With Systemic Lupus Erythematosus With and Without Fibromyalgia.

Corbitt K, Carlucci P, Cohen B, Masson M, Saxena A, Belmont H ACR Open Rheumatol. 2024; 6(4):172-178.

PMID: 38196183 PMC: 11016564. DOI: 10.1002/acr2.11641.

Rapid Biomarker-Based Diagnosis of Fibromyalgia Syndrome and Related Rheumatologic Disorders by Portable FT-IR Spectroscopic Techniques.

Yao S, Bao H, Nuguri S, Yu L, Mikulik Z, Osuna-Diaz M Biomedicines. 2023; 11(3).

PMID: 36979691 PMC: 10044908. DOI: 10.3390/biomedicines11030712.

References

Wolfe F . Pain extent and diagnosis: development and validation of the regional pain scale in 12,799 patients with rheumatic disease. J Rheumatol. 2003; 30(2):369-78. View

Wolfe F, Rasker J . The Symptom Intensity Scale, fibromyalgia, and the meaning of fibromyalgia-like symptoms. J Rheumatol. 2006; 33(11):2291-9. View

Bombardier C, Gladman D, Urowitz M, Caron D, Chang C . Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992; 35(6):630-40. DOI: 10.1002/art.1780350606. View

Wolfe F, Smythe H, Yunus M, Bennett R, Bombardier C, Goldenberg D . The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33(2):160-72. DOI: 10.1002/art.1780330203. View

Gladman D, Urowitz M, Gough J, Mackinnon A . Fibromyalgia is a major contributor to quality of life in lupus. J Rheumatol. 1998; 24(11):2145-8. View

Hochberg M . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40(9):1725. DOI: 10.1002/art.1780400928. View

Tan E, Cohen A, Fries J, MASI A, McShane D, Rothfield N . The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982; 25(11):1271-7. DOI: 10.1002/art.1780251101. View

Handa R, Aggarwal P, Wali J, Wig N, Dwivedi S . Fibromyalgia in Indian patients with SLE. Lupus. 1998; 7(7):475-8. DOI: 10.1191/096120398678920497. View

Wolfe F, Caplan L, Michaud K . Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum. 2006; 54(2):628-34. DOI: 10.1002/art.21568. View

10.

Wolfe F, Michaud K . Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize ra patients with fibromyalgia. J Rheumatol. 2004; 31(4):695-700. View

11.

Bae S, Koh H, Chang D, Kim M, Park J, Kim S . Reliability and validity of systemic lupus activity measure-revised (SLAM-R) for measuring clinical disease activity in systemic lupus erythematosus. Lupus. 2001; 10(6):405-9. DOI: 10.1191/096120301678646146. View

12.

Wolfe F, Michaud K . The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person-years of observation. Arthritis Rheum. 2007; 56(5):1433-9. DOI: 10.1002/art.22579. View

13.

Yazdany J, Yelin E, Panopalis P, Trupin L, Julian L, Katz P . Validation of the systemic lupus erythematosus activity questionnaire in a large observational cohort. Arthritis Rheum. 2008; 59(1):136-43. PMC: 3759159. DOI: 10.1002/art.23238. View

14.

Wolfe F . Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. J Rheumatol. 2004; 31(10):1896-902. View

15.

Altman D, Royston P . The cost of dichotomising continuous variables. BMJ. 2006; 332(7549):1080. PMC: 1458573. DOI: 10.1136/bmj.332.7549.1080. View

16.

Wolfe F . The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic. Ann Rheum Dis. 1997; 56(4):268-71. PMC: 1752352. DOI: 10.1136/ard.56.4.268. View

17.

Wessely S, Hotopf M . Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. Baillieres Best Pract Res Clin Rheumatol. 1999; 13(3):427-36. DOI: 10.1053/berh.1999.0032. View

18.

Akkasilpa S, Goldman D, Magder L, Petri M . Number of fibromyalgia tender points is associated with health status in patients with systemic lupus erythematosus. J Rheumatol. 2005; 32(1):48-50. View

19.

Valencia-Flores M, Cardiel M, Santiago V, Resendiz M, Castano V, Negrete O . Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus. Lupus. 2004; 13(1):4-10. DOI: 10.1191/0961203304lu480oa. View

20.

MIDDLETON G, McFarlin J, Lipsky P . The prevalence and clinical impact of fibromyalgia in systemic lupus erythematosus. Arthritis Rheum. 1994; 37(8):1181-8. DOI: 10.1002/art.1780370812. View