RESEARCH - Fibromyalgia, SLE, and evaluation of SLE activity

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J Rheumatol. 2008 Nov 1. [Epub ahead of print]

Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of

SLE Activity.

Wolfe F, Petri M, Alarcón GS, Goldman J, Chakravarty EF, Katz RS, Karlson EW.

From the National Data Bank for Rheumatic Diseases, Wichita, Kansas;

s Hopkins University School of Medicine, Baltimore, land;

University of Alabama-Birmingham, Birmingham, Alabama; Emory

University, Atlanta, Georgia; Stanford University School of Medicine,

Palo Alto, California; Rush University Medical Center, Chicago,

Illinois; and Brigham and Women's Hospital, Boston, Massachusetts,

USA.

OBJECTIVE: To determine if fibromyalgia (FM) or fibromyalgia-ness (the

tendency to respond to illness and psychosocial stress with fatigue,

widespread pain, general increase in symptoms, and similar factors) is

increased in patients with compared to those without systemic lupus

erythematosus (SLE); to determine whether FM or fibromyalgia-ness

biases the SLE Activity Questionnaire (SLAQ); and to determine if the

SLAQ is overly sensitive to FM symptoms.

METHODS: We developed a 16-item SLE Symptom Scale (SLESS) modeled on

the SLAQ and used that scale to investigate the relation between SLE

symptoms and fibromyalgia-ness in 23,321 patients with rheumatic

disease. FM was diagnosed by survey FM criteria, and fibromyalgia-ness

was measured using the Symptom Intensity (SI) Scale. As comparison

groups, we combined patients with rheumatoid arthritis and

noninflammatory rheumatic disorders into an " arthritis " group and also

utilized a physician-diagnosed group of patients with FM.

RESULTS: FM was identified in 22.1% of SLE and 17.0% of those with

arthritis. The SI scale was minimally increased in SLE. The

correlation between SLAQ and SLESS was 0.738. SLESS/SLAQ scale items

(Raynaud's phenomenon, rash, fever, easy bruising, hair loss) were

significantly more associated with SLE than FM, while the reverse was

true for headache, abdominal pain, paresthesias/stroke, fatigue,

cognitive problems, and muscle pain or weakness. There was no evidence

of disproportionate symptom-reporting associated with

fibromyalgia-ness. Self-reported SLE was associated with an increased

prevalence of FM that was unconfirmed by physicians, compared to SLE

confirmed by physicians.

CONCLUSION: The prevalence of FM in SLE is minimally increased

compared with its prevalence in patients with arthritis.

Fibromyalgia-ness does not bias the SLESS and should not bias SLE

assessments, including the SLAQ.

PMID: 19004039

http://www.ncbi.nlm.nih.gov/pubmed/19004039

Not an MD