High prevalence of fibromyalgia in patients with inflammatory bowel disease

An Italian study including patients with inflammatory bowel disease (IBD) revealed that those also suffering from fibromyalgia have a significantly impaired quality-of-life. IBD patients with this comorbidity present particularly psychological manifestations like depression, anxiety, and stress, but also chronic fatigue and sleep disturbances.  

Fibromyalgia, characterised by widespread pain, fatigue, sleep disturbances, and functional symptoms, has a worldwide prevalence of 2–3% [1]. However, a meta-analysis published previously showed that the prevalence of fibromyalgia in the general population is significantly lower than in populations with certain diseases and can be as high as 12.9% in patients with IBD [1]. Information on the prevalence and the impact of fibromyalgia in patients with IBD is limited. To address this knowledge gap, Dr Laura Guida (Luigi Sacco University Hospital, Italy) and her team performed a study on consecutive patients attending 2 IBD hospital units from August to November 2021 [2]. Excluded were patients with severe disease activity (assessed by Crohn’s disease activity index [CDAI] and Mayo score for ulcerative colitis [UC]) or those with other concomitant chronic diseases. Clinical and demographic data and patient-reported outcomes (PROs) were collected using the IBD Questionnaire (IBD-Q), Depression Anxiety Stress Scale-21 (DASS-21), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Pittsburgh Sleep Quality Index (PSQI). An expert rheumatologist diagnosed fibromyalgia according to the 2011 ACR classification criteria.

Among the 196 IBD patients enrolled in the study, 105 (53.6%) had Crohn’s disease (CD), and the rest had UC. The overall prevalence of fibromyalgia in the IBD cohort was 8.7%, with 7.6% in the CD group and 9.9% in the UC group. As expected, the prevalence was higher in women (11.6%) than in men (6.3%). No significant demographic (i.e. gender, age) or clinical (i.e. body mass index, C-reactive protein, disease activity, ongoing treatment modality) differences were found between the groups with and without fibromyalgia as comorbidity.

As assessed by IBD-Q, the quality-of-life in IBD patients with fibromyalgia was significantly lower than in those who did not have fibromyalgia (P<0.001). Furthermore, they experienced significantly worse symptoms (i.e. depression, anxiety, stress, chronic fatigue, and discomfort) than patients without fibromyalgia (P<0.001; see Table).

Table: High prevalence of depression, anxiety, and stress in patients with inflammatory bowel disease and fibromyalgia [1]



 

 

 

 

 

 

 

 

IBD, inflammatory bowel disease; FM, fibromyalgia; IBD-Q, inflammatory bowel disease Questionnaire; DASS-21, Depression Anxiety Stress Scale-21; FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue; IES-R, Impact of Event Scale-Revised.

Moreover, multivariate analysis showed that disease activity (CDAI; P=0.025), chronic fatigue (FACIT-F; P=0.006), and sleep disturbances (PSQI; P=0.044) have a significant influence on the quality-of-life of CD patients. In contrast, disease severity (Mayo score; P=0.012) was the only independent variable that positively correlated with quality-of-life in UC patients.

In conclusion, Dr Guida emphasised that the presence of fibromyalgia in IBD can considerably impact the quality-of-life, especially by causing depression, anxiety, stress, chronic fatigue, sleep disturbances, and discomfort.

1. GuidaL, et al. Prevalence and impact of fibromyalgia in patients with inflammatory bowel disease. POS0023, EULAR 2022 Congress, 1-4 June, Copenhagen, Denmark.
2. Heidari F, et al. Rheumatol Int. 2017;37:1527–1539.

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Posted on 21 July 20228 April 2024