Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Fibromyalgia in women with ankylosing spondylitis.

Hi, I found this article today. Possibly good news for the gals??

Abstract Fibromyalgia (FM), pre-dominantly found in women, may accompany other pre-existing rheumatic diseases. The association between FM and ankylosing spondylitis (AS) is uncertain. We evaluated FM in women with AS. Eighteen women with AS were compared with 18 men with AS (controls) for age, duration of symptoms, time to diagnosis, degree of sacroiliac involvement, history of peripheral arthritis, patient global assessment, Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, level of diffuse pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Physical examination included the number of tender points and enthesitis sites, Schober test, distance between occiput and wall, chest expansion, lateral spinal flexion, and intermalleolar distance. Inflammatory activity was measured by the erythrocyte sedimentation rate (ESR). Of all tested parameters, the ones with significant differences between the groups were time between symptom onset and AS diagnosis (longer for women), FM incidence and the number of tender points and enthesitis sites (higher for women), BASDAI (higher in women and correlated with FM and the number of tender points but not with ESR), and BASFI and BASDAI scores (increased in FM patients). FM was present in 50% of women with AS and associated with higher disease activity indices (BASDAI and BASFI) and not related to severity of physical findings or ESR. The reliability of well-accepted assessment tools of AS, such as BASDAI and BASFI, in evaluating AS activity in women may be called into question due to a confounding effect of FM.


http://www.springerlink.com/content/x811110068jwl01m/


Take care,
James.

Interesting. I can tell you as someone who participated in Dr. Bennett's study back in the 80's of Fibrositis as it was called, now Fibromyalgia, that it had only 14 tender points. It also was known and papers written, that it in fact accompanied Lupus.

Criteria then was the tender points, sleeplessness or poor REM sleep, muscle spams, burning pain for many, and it was almost a symptom of other rheumatoid type diseases instead of it's own disease process.

It never had any abnormal blood test or serology.

I have watched it grow and other Physicians get interested in study of it over the years until it now has an unlimited list of symptoms it seems.

It was at that time called a finger of faith disease until it became the thing to study.

I still am inclined to think of it as something you get when there is something else going on with you.

Guess I'm sticking to the no postive bloodwork to prove it theory as for so many years people who were the guinea pigs and diagnosed with this, never had abnormal bloods.
They had a hard time because of that, proving that they were indeed suffering.

I was diagnosed and have been since many times when complaining of problems and had normal bloodwork. Years later I had whopping high ANA titers. I knew there was more going on but couldn't get past the Fibro. thing.

I'm glad to see them connecting the dots of Fibro. to disease like AS.

Yes indeed, interesting.
~Kewanee

Interesting article, James. Thanks for posting it! I was diagnosed with FM as a secondary disease to my AS. Basically, I was in pain for so long untreated that my brain became accustomed to sending/receiving pain signals all the time and kept it up by habit (sort of).

At one point my rheumy was convinced that FM was an issue for me, but the second time he did the tender points I didn't respond as, erm, loudly as I did the first time. So he figured I didn't have FM after all. When I mentioned this to my GP, she practically blew a raspberry and reminded me that FM flares just like any other rheumatic disease. If you aren't actually flaring in a given area, you aren't going to respond as badly to the tender point being pressed.

All I know is that now that I'm on Remicade, I can tell the difference between my AS pain and my FM pain, since the volume has been lowered on the AS stuff.

My one concern with this study is that it will potentially make it that much harder to diagnose women with AS, since this study concludes that the 'white noise pain' (my description) of FM affects the BASDAI and BASFI results in women who have both. I believe that in the absence of damage visible via xray, these two tests may be key to having AS diagnosed in women. Until they come up with something else, I'd rather not have the issue obscured. If you know what I mean. It's already too hard for women to get diagnosed because we present so differently.

Many hugs,

Interesting article, James.
At the time I was diagnosed with fibromyalgia (that was when it was called 'soft tissue rheumatism' and then 'fibrositis'), I was told that I would be tested regularly for lupus, because they said that frequently an autoimmune disease followed.
My blood tests are still all normal...including my inflammation tests, even though I have visible swelling.
I do know several other women who have both fibro and auto-immune diseases.
On one of the other AS boards, there are several people who have mentioned a connection between the conditions, also.
I think it's important for doctors to understand that a dx of fibromyalgia does not mean everything that happens afterward is fibro-related. They need to be aware that autoimmune disorders can come later.

I seem to be reading this exactly opposite of everyone else so far.
I have spondylitis. I keep having morons trying to call it "Fibro."
Now this study says that maybe Fibro patients could have other rheumatic diseases as well simultaneously. Well, duh.
It's still a bunch of ****.

Quote:

---

The reliability of well accepted assessment tools for AS,such as BASDAI and BASFI, in evaluating AS activity in women may be called into question due to a confounding effect of FM.

---

The confounding effect is in the doctor's brains because they are mis- diagnosing.

No, not good news, the medical establishment needs to quit automatically shunting every female patient they see into the "fibro" category. This study seems to me to be saying it's okay to let some of the fibro patients also be diagnosed with AS because the Bath assessments aren't good enough.

Hi Kat,
Yeah, that last line had me wondering if it was going to be a good idea to post this article or not, but I think the rest of the article might show women and hopefully their doctors that Fibro may indicate another pre-existing disease (detectable or not). I hope doctors read articles like these and press on and continue evaluations with their patients, instead of brushing them off with only a FM DX.

As for the indices, they already make an AS diagnosis difficult to get, and I would hate to see it get any worse. Not only are doctors using the indices to base their diagnoses, the insurance companies are also using the indices against us for treatment. That's a double blow for the people who are out there still suffering in the early or the not clearly evident stages of the disease.

Take Care
James.

I too had a diagnosis of fibromyalgia before the AS.
I knew that there was something else wrong besides the fibromyalgia,
Every now and again a tested would be slightly elevated but not enough for them to make a diagnosis. although my ANA would always come back positive. They put me in the category of people that test false postive, the thing is though i always seem to be in that small percentage of people who either test fasle positive or don't repsond to the conventional drugs.
I am in so much pain, i know it is the As and not the fibromyalgia. I think they just lumped me with that diagnosis becasue at the time they didnot know what it was. Although i do believe that fibromyalgia is a condition casued by an auto immune disease or illness.

One thing which makes me angry is that doctors tend to treat AS in women differently, maybe becasue women tend to suffer from the arthritis more than a male does maybe why they lump fibromyalgia in with AS??
Just thoughts
mellie

My initial diagnosis was AS, plus fibromyalgia,
but frankly, I ignored the fibro, it seemed so
inconsequential to the back and hip pain.

I do believe it can exist concurrently with AS,
I get "tender point" pain, but still, 15 years
later, I find it nothing compared to the AS and
Chron's.

Then again, if i had on fibro, i am sure I would
find that pain dreadful. I think the brain can
only process so much pain at a time

fishy

Boy I love this subject. I do think Fibro. is something the Doctors use to put off patients and that is should be filed in the wastebasket most of the time.

You know anybody with arthritis in their system probably will be tender at those points anyways!!

Well I would like to see this kept up on the front page for awhile longer. Interesting responses.

Pretty much ditto with everything Mellie said. Only difference, my ANA keeps coming back negative, but they still keep testing me for it every so often. Don't know if they expect it come back positive at some point???.....