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J Rheumatol. 2019 Aug 1. pii: jrheum.190149. doi: 10.3899/jrheum.190149. [Epub ahead of print]

The Relation of Physical Comorbidity and Multimorbidity to Fibromyalgia, Widespread Pain, and Fibromyalgia-related Variables.

Author information

1
From the National Data Bank for Rheumatic Diseases; University of Kansas School of Medicine, Wichita, Kansas, USA; Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Monash University and Monash Health, Melbourne, Australia; Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands. F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; J. Ablin, MD, Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University; E.K. Guymer, MBBS, FRACP, Monash University and Monash Health; G.O. Littlejohn, MBBS (Hons), MD, MPH, Monash University and Monash Health; J.J. Rasker, Faculty of Behavioral, Management and Social Sciences, University of Twente. Address correspondence to Dr. F. Wolfe, National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Ste. 288, Wichita, Kansas 67214, USA. E-mail: fwolfe@arthritis-research.org. Accepted for publication July 16, 2019.

Abstract

OBJECTIVE:

To investigate the relation of physical (non-psychological) comorbidity and multimorbidity to quantitative measures of fibromyalgia (FM) and musculoskeletal pain.

METHODS:

We studied 12,215 patients in a research databank with quantitative measures of FM-related variables (FMV) that included binary determinations of FM and widespread pain (WSP), and constituent variables of FM diagnosis that included the WSP index (WPI), the symptom severity score (SSS), and the polysymptomatic distress scale (PSD). We assessed self-reported comorbid conditions and covariates that included age, sex, body mass index, hypertension, smoking history, and total household income. We used nearest-neighbor matching and regression adjustment treatment effects models to measure the effect of comorbidities on FMV.

RESULTS:

We found a positive association between FMV and the probability of having each comorbid condition. Patients with ≥ 1 comorbidities had PSD, WPI, and SSS increases of 3.0 (95% CI 2.7-3.3), 1.8 (95% CI 1.6-2.0), and 1.2 (95% CI 1.1-1.3) units, respectively, and an increase in FM prevalence from 20.4% to 32.6%. As the number of comorbid conditions present increased from 1 to 4 or more, PSD, WPI, SSS, and FM percent increased stepwise. For patients with ≥ 4 conditions, the predicted prevalence of FM was 55.2%.

CONCLUSION:

FM and FMV are associated with an increase in the number of comorbidities, and the association can be measured quantitatively. However, the association of WSP and FM may be an effect of definitions of WSP and FM, because comorbidity increases are also present with subsyndromal levels of both conditions.

PMID:
31371651
DOI:
10.3899/jrheum.190149

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