PO:24:059 | Sjögren's disease-associated Fibromyalgia: pitfalls in disease assessment using ESSDAI and ESSPRI

Lucia Cristiana Colaprico¹, Stefano Stano¹, Daniele Domanico¹, Maria Iacovantuono², Eduardo Urgesi³, Fabio Cacciapaglia^1|4, Maria Giannotta¹, Paola Conigliaro², Vincenzo Venerito¹, Maria Sole Chimenti², Giuseppe Lopalco¹, Florenzo Iannone¹ | ¹Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area DiPReMeJ, University of Bari, Bari, Italy; ²University of Rome Tor Vergata, Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Roma, Italy; ³University Cardiologic Unit - Interdisciplinary Department of Medicine - Policlinico University Hospital, University Bari, Italy; ⁴Rheumatology Service, Internal Medicine Unit F. Miulli General Hospital, Department of Medicine and Surgery, LUM Casamassima, Italy

Objectives. The prevalence of Fibromyalgia (FM) is higher in Sjögren's disease (SjD) patients than healthy individuals, with evidence of a bidirectional association between these conditions [1,2]. However, the clinical features of patients with concomitant FM and SjD are not well defined. This study aimed to assess the updated prevalence and characteristics of SjD-FM patients in an Italian multicentric cohort.

Methods. Patients with diagnosis of SjD, meeting the 2016 ACR-EULAR classification criteria [3], with or without diagnosis of FM according to the 2016 FM diagnostic criteria [4], were included. Clinical data were retrospectively collected from medical records, including the EULAR Sjögren's syndrome disease activity index (ESSDAI) and EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI) [5]. Statistical analysis was performed using StataMP 18 software. Odds ratios (OR) with 95% confidence intervals (CI) for FM were estimated via logistic regression analysis and adjusted for ongoing therapies, including pilocarpine, myorelaxants, antidepressants, corticosteroids and disease-modifying anti-rheumatic drugs (DMARD).

Results. This study included 267 SjD patients (253 female - 95.1%), with a median (interquartile range (IQR)) age of 60 (51-70) years. The prevalence of FM in our SjD multicentric cohort was 30%. Disease duration was longer in SjD-FM patients compared to SjD patients without FM (p<0.05). Comorbidities, including diabetes and osteoporosis, were similarly distributed between groups, while mixed anxious-depressive disorder (MADD) was more frequent in SjD patients with FM (p<0.01). Arthralgia, but not arthritis, was more frequent in SjD-FM patients (p<0.05). Dryness, exocrine glands swelling, neuropathy and lymphoma had similar frequency in SjD patients with and without FM. The disease activity assessment with ESSDAI showed similar results in SjD patients with and without FM, with a median (IQR) score of 1 (0-2). On the contrary, the reported severity of symptoms, expressed as median (IQR) ESSPRI, was 6.7 (4.7-8) in our cohort, and significantly higher in SjD-FM patients compared to those without FM (p<0.001). Moreover, fatigue VAS (p<0.001), pain VAS (p<0.001), and dryness VAS (p=0.005) were all significantly higher in SjD-FM patients compared to SjD patients without FM. Treatment with DMARD and pilocarpine was similar between groups, while treatment with antidepressants (p<0.001) and myorelaxants (p<0.001) was prescribed more frequently in SjD-FM patients. At unadjusted logistic regression analysis, the presence of MADD or arthralgia, therapy with antidepressants and higher ESSPRI were significant FM predictors in SjD patients (Table). After adjustment for ongoing drug therapies, a higher ESSPRI level was confirmed a significant predictor of FM.

Conclusions. The ESSDAI is not influenced by concomitant FM. In contrast, the ESSPRI score may be higher in SjD patients with associated FM, regardless of ongoing pharmacological therapy. Therefore, caution should be exercised when using and interpreting the ESSPRI in this subset of patients.