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Does Fibromyalgia Mask Spondyloarthritis?

Does Fibromyalgia Mask Spondyloarthritis?

In patients with a diagnosis of fibromyalgia syndrome, radiographic evidence of axial spondyloarthritis is common. Because the conditions may have considerable clinical overlap, the fibromyalgia syndrome may mask the underlying spondyloarthritis.

Centralized pain or “fibromyalgianess” (polysymptomatic distress) may be responsible for observed differences in spondyloarthritis pain and inflammatory damage between men and women.

Jacob Ablin and colleagues in Israel pointed out that fibromyalgia syndrome is classically considered a noninflammatory widespread pain disorder with pathogenic characteristics very different from those of spondyloarthritis. Although the conditions differ in etiology, they appear to coexist with some frequency, which the authors noted in a recent Arthritis Care & Research article.

Current guidelines suggest that once a diagnosis of fibromyalgia syndrome is made, aggressive investigations should be avoided to minimize further discomfort or complication. This suggestion confounds the discovery of underlying or concurrent inflammatory disease and may lead to underdiagnosis.

This study’s findings suggest that physicians remain vigilant and actively search for underlying inflammatory disorders in patients with fibromyalgia syndrome.

An increased prevalence of secondary fibromyalgia syndrome has been described in female patients with spondyloarthritis. No investigation into the converse has been made.

Attention has been paid to gender differences in patients with axial spondyloarthritis, but little effort has been made to uncover the mechanisms beneath differing clinical manifestations in men and women.

The study

Ultimately, 99 patients who met American College of Rheumatology 1990 criteria for fibromyalgia syndrome were included. Patients were examined by MRI and classified as having features of spondyloarthritis or not, based on the Assessment of Spondyloarthritis International Society criteria.

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