Monday, January 14, 2019

Fibromyalgia in patients with rheumatoid arthritis and PROs (patient related outcomes)

I’ve just written on the 12th TNF-alpha-Forum in Munich. Prof. Schulze-Koops talked about patient related outcomes. The gist is: PROs are indispensable tools to capture the functional experience of the patient. PROs capture parameters that are not directly related to inflammation. The scores recorded in disease activity scores with visual analogue scales are not suitable for sensitively and adequately providing information about functionality limitations. PROs are not sufficient to escalate immune-suppressive therapy.

SA Provan and colleagues just published: “Fibromyalgia in patients with rheumatoid arthritis. A 10-year follow-up study, results from the Oslo Rheumatoid Arthritis Register.” The authors concluded: “RA-FM was associated with significantly higher levels of cross-sectional and longitudinal RA disease activity. FM should be considered in patients with RA not reaching remission.”

On the same TNF-alpha-Forum the CAPEA study has been quoted, which shows a constant DAS28 above 3.2 in a little less than 40% of RA patients. After six months nothing changes for the next 18 months.

It means that we have to find tools besides the current disease activity scores to monitor activity, which means to separate pain, inflammation, immunologic parameters, disability and more to come to safer conclusions concerning the escalation or de-escalation of immune-suppressive therapies. The fibromyalgia group could easily receive a more intensive immune-suppression, which would result in a higher risk for infections for instance. By the way, obese women share also this risk as they have elevated inflammation markers.



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