Rome—A substantial proportion of patients with inflammatory back pain also have fibromyalgia, according to a poster presentation at the 2010 annual meeting of the European League Against Rheumatology. From 30% to 50% of patients who fulfilled criteria for inflammatory back pain also met some criteria for fibromyalgia, whereas only 25% of patients with inflammatory back pain had no tender points associated with fibromyalgia. “Our study found a significant degree of overlap between fibromyalgia points and enthesitis [i.e., inflammation of the point of insertion of ligament, tendon or joint capsule to bone] sites,” said lead author Euthalia Roussou, MD, King George Hospital, London. Study co-author Coziana Ciurtin, MD, consultant in rheumatology at Lister Hospital in Stevenage, United Kingdom explained that these findings have diagnostic implications for both conditions. “There is no laboratory test specific for fibromyalgia or for enthesitis; thus, the accuracy of the clinical diagnosis is key for correctly assessing patients,” she said. The situation is more complicated for overlapping syndromes because of the limitations in diagnostic tools for these entities, she continued. “Imaging techniques are available for diagnosing inflammatory enthesitic pain, but not for fibromyalgia,” she said. The treatments for enthesitic pain and fibromyalgia are different, said Dr. Ciurtin, making accurate diagnosis even more crucial. “When both conditions coexist, the treatment must address them both,” she said. The study used a mannequin depicting the tender point sites for fibromyalgia and another with enthesitis sites to record assessments of 61 consecutive outpatients presenting with inflammatory back pain. One clinician performed all assessments. Patients were asked to complete a questionnaire that included established criteria for inflammatory back pain, as well as questions related to symptoms of fibromyalgia (i.e., eating disorders, pain accentuated by pressure, headache, diffuse abdominal pain, poor concentration and alteration of bowel habits related to pain). Forty-seven (78.3%) patients returned the questionnaire. Sixty patients (97.7%) fulfilled established criteria for inflammatory back pain (JAMA1977;237:2613-2614; Ann Rheum Dis 2004;63:535-543); 80.9% fulfilled both sets of criteria and 17% fulfilled either of the two sets. Of the 60 patients with inflammatory back pain, 17 were male and 43 were female. A subgroup of 18 patients had spondyloarthritis. Eighteen patients (30%) had at least 11 of 18 tender points characteristic of fibromyalgia; three patients had 10 of 18, 22 patients had nine or fewer points, and 17 patients had no tender points. Fifty-one patients (85%) had at least one positive enthesitis site. New Findings? “These findings are not totally new, but the way the study was done differs from previous studies that simply looked at the proportion of patients with ankylosing spondylitis who met criteria for fibromyalgia,” said Daniel L. Clauw, MD, professor and director of the Chronic Pain and Research Center at the University of Michigan, Ann Arbor. “The findings are not surprising, either, since we are learning that about 20% of patients with other painful rheumatic conditions, such as osteoarthritis, rheumatoid arthritis or systemic lupus erythematosus, also have fibromyalgia, and many more patients have some features of fibromyalgia.” According to Dr. Clauw, the study findings imply that patients with ankylosing spondylitis with more widespread pain and tenderness might need to be treated with regimens such as those for fibromyalgia (i.e., tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors), in addition to the anti-inflammatory drugs typically used for ankylosing spondylitis. Source: http://www.painmedicinenews.com/index.asp?section_id=82&show=dept&article_id=16170 | 
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