The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia

Musa Polat1, Abdulvahap Kahveci2, Duygu Tecer3, Zafer Günendi4, Feride Göğüş4

1Department of Physical Medicine and Rehabilitation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
2Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
3Department of Rheumatology, Health Sciences University, Gülhane Faculty of Medicine, Ankara, Türkiye
4Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye

Keywords: Fibromyalgia, musculoskeletal ultrasonography, rheumatoid arthritis, subclinical inflammation.

Abstract

Objectives: This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria.

Patients and methods: This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria.

Results: In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively).

Conclusion: Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.

Citation: Polat M, Kahveci A, Tecer D, Günendi Z, Göğüş F. The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia. Arch Rheumatol 2023;38(2):174-182. doi: 10.46497/ArchRheumatol.2023.9585.

Ethics Committee Approval

The study protocol was approved by the Ni¤de Ömer Halisdemir University Non-Invasive Clinical Research Ethics Committee (no: 9586085-050.01.04-E26799/08). Reporting of this trial was conducted according to the STROBE (Strengthening the reporting of observational studies in epidemiology) checklist. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Data collection and processing: M.P., D.T., F.G.; Data analysis and interpretation: M.P., A.K., Z.G., F.G.; Drafting the manuscript: M.P.; Revising the draft critically for important intellectual content and final approval of the version to be published.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Acknowledgments

The authors wish to thank the patients with rheumatoid arthritis who participated in this study.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.