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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(09): 803-808
DOI: 10.1055/s-0043-1772673
Original Article

Prevalence of fibromyalgia in a Brazilian series of patients with multiple sclerosis

Prevalência de fibromialgia em uma série brasileira de pacientes com esclerose múltipla
Cinthia Thomas 
1   Hospital São Vicente de Paulo, Passo Fundo RS, Brazil.
,
Bianca Thais Schneider 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Caroline Schiochet Verza 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Gabriel Fassina 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Laís Restel Weber 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Marlinton Moreira 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Paula Tormen Fusinato 
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
,
Cassiano Mateus Forcelini 
1   Hospital São Vicente de Paulo, Passo Fundo RS, Brazil.
2   Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil.
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Abstract

Background The prevalence of pain in patients with multiple sclerosis is remarkable. Fibromyalgia has been considered as one of the forms of chronic pain encompassed in multiple sclerosis, but data are restricted to studies from Europe and North America.

Objective To assess the prevalence of fibromyalgia in a series of Brazilian patients with multiple sclerosis and the characteristics of this comorbidity.

Methods The present cross-sectional study included 60 consecutive adult patients with multiple sclerosis. Upon consent, participants underwent a thorough evaluation for disability, fatigue, quality of life, presence of fibromyalgia, depression, and anxiety.

Results The prevalence of fibromyalgia was 11.7%, a figure similar to that observed in previous studies. Patients with the comorbidity exhibited worse scores on fatigue (median and interquartile range [IQR]: 68 [48–70] versus 39 [16.5–49]; p < 0.001), quality of life (mean ± standard deviation [SD]: 96.5 ± 35.9 versus 124.8 ± 28.8; p = 0.021), anxiety (mean ± SD: 22.7 ± 15.1 versus 13.8 ± 8.4; p = 0.021), and depression (median and IQR: 23 [6–28] versus 6 [3–12.5]; p = 0.034) indices than patients without fibromyalgia. There was a strong positive correlation between depression and anxiety scores with fatigue (r = 0.773 and r = 0.773, respectively; p < 0.001). Conversely, a moderate negative correlation appeared between the Expanded Disability Status Scale (EDSS), fatigue, and depression scores with quality of life (r= −0.587, r= −0.551, r= −0.502, respectively; p < 0.001).

Conclusion Fibromyalgia is a comorbidity of multiple sclerosis that can enhance fatigue and decrease quality of life, although depression, anxiety, and disability are factors that can potentiate the impact of the comorbidity.

Resumo

Antecedentes A prevalência de dor em pacientes com esclerose múltipla é significativa. A fibromialgia é considerada uma forma de dor crônica encontrada na esclerose múltipla, mas os dados são restritos a estudos europeus e da América do Norte.

Objetivo Avaliar a prevalência de fibromialgia em uma série de pacientes com esclerose múltipla e as características desta comorbidade.

Métodos O presente estudo transversal incluiu consecutivamente 60 pacientes adultos com esclerose múltipla. Após o consentimento, os participantes foram submetidos à avaliação para determinação de incapacidade, fadiga, qualidade de vida, presença de fibromialgia, depressão e ansiedade.

Resultados A prevalência de fibromialgia foi de 11,7%, similar ao observado em estudos prévios. Pacientes com a comorbidade apresentaram piores escores de fadiga (mediana e intervalo interquartil [IIQ]: 68 [48–70] versus 39 [16,5–49]; p < 0,001], qualidade de vida (média ± desvio padrão [DP]: 96,5 ± 35,9 versus 124,8 ± 28,8; p = 0,021), ansiedade (média ± DP: 22,7 ± 15,1 versus 13,8 ± 8,4; p = 0,021) e depressão (mediana e IIQ: 23 (6–28) versus 6 (3–12,5); p = 0,034] do que pacientes sem fibromialgia. Houve correlação positiva forte dos escores de depressão e de ansiedade com a fadiga (r = 0,773 e r = 0,773, respectivamente; p < 0,001). Concomitantemente, houve correlação negativa moderada entre os escores de escala de estado de incapacidade expandida, fadiga e depressão com a qualidade de vida (r = - 0,587, r = - 0,551, r = - 0,502, respectivamente; p < 0,001).

Conclusão A fibromialgia é uma comorbidade de esclerose múltipla que pode aumentar a fadiga e diminuir a qualidade de vida, embora depressão, ansiedade e incapacidade sejam fatores potencializadores dessa morbidade associada.

Keywords

Multiple Sclerosis - Pain - Fibromyalgia - Comorbidity - Depression - Anxiety

Palavras-chave

Esclerose Múltipla - Dor - Fibromialgia; - Comorbidade - Depressão - Ansiedade

Authors' Contributions

CT: conceptualization, data curation, investigation, methodology, resources, validation, visualization, writing – original draft; BTS, CSV, GF, LRW, MM, PTF: data curation, investigation, methodology, resources, validation, writing – original draft; CMF: conceptualization, data curation, formal analysis, methodology, project administration, validation, visualization, supervision, writing – original draft, writing – review and editing.




Publication History

Received: 29 March 2023

Accepted: 05 June 2023

Article published online:
04 October 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Walton C, King R, Rechtman L. et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 2020; 26 (14) 1816-1821
    CrossrefPubMedSearch in Google Scholar
  • 2 Dahham J, Rizk R, Kremer I, Evers SMAA, Hiligsmann M. Economic burden of multiple sclerosis in low- and middle-income countries: a systematic review. PharmacoEconomics 2021; 39 (07) 789-807
    CrossrefPubMedSearch in Google Scholar
  • 3 Marrie RA, Cohen J, Stuve O. et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21 (03) 263-281
    CrossrefPubMedSearch in Google Scholar
  • 4 Foley PL, Vesterinen HM, Laird BJ. et al. Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain 2013; 154 (05) 632-642
    CrossrefPubMedSearch in Google Scholar
  • 5 Clemenzi A, Pompa A, Casillo P. et al. Chronic pain in multiple sclerosis: is there also fibromyalgia? An observational study. Med Sci Monit 2014; 20: 758-766
    CrossrefPubMedSearch in Google Scholar
  • 6 Ulusoy EK. Effects of Comorbid Fibromyalgia Syndrome on activities of daily living in multiple sclerosis patients. Arq Neuropsiquiatr 2020; 78 (09) 556-560
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Marrie RA, Yu BN, Leung S. et al; CIHR Team in the Epidemiology and Impact of Comorbidity in Multiple Sclerosis. The incidence and prevalence of fibromyalgia are higher in multiple sclerosis than the general population: A population-based study. Mult Scler Relat Disord 2012; 1 (04) 162-167
    CrossrefPubMedSearch in Google Scholar
  • 8 da Gama Pereira AB, Sampaio Lacativa MC, da Costa Pereira FF, Papais Alvarenga RM. Prevalence of multiple sclerosis in Brazil: A systematic review. Mult Scler Relat Disord 2015; 4 (06) 572-579
    CrossrefPubMedSearch in Google Scholar
  • 9 Souza JB, Perissinotti DMN. The prevalence of fibromyalgia in Brazil – a population-based study with secondary data of the study on chronic pain prevalence in Brazil. Br J Pain 2018; 1 (04) 345-348
    Search in Google Scholar
  • 10 Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33 (11) 1444-1452
    CrossrefPubMedSearch in Google Scholar
  • 11 Pavan K, Schmidt K, Marangoni B, Mendes MF, Tilbery CP, Lianza S. [Multiple sclerosis: cross-cultural adaptation and validation of the modified fatigue impact scale]. Arq Neuropsiquiatr 2007; 65 (3A): 669-673
    Search in Google Scholar
  • 12 Mendes MF, Balsimelli S, Stangehaus G, Tilbery CP. [Validation of the functional assessment of multiple sclerosis quality of life instrument in a Portuguese language]. Arq Neuropsiquiatr 2004; 62 (01) 108-113
    Search in Google Scholar
  • 13 Wolfe F, Clauw DJ, Fitzcharles MA. et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 2011; 38 (06) 1113-1122
    CrossrefPubMedSearch in Google Scholar
  • 14 Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988; 8: 77-100
    CrossrefSearch in Google Scholar
  • 15 Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32 (01) 50-55
    CrossrefPubMedSearch in Google Scholar
  • 16 Dai D, Sharma A, Phillips AL, Lobo C. Patterns of comorbidity and multimorbidity among patients with multiple sclerosis in a large US commercially insured and medicare advantage population. J Health Econ Outcomes Res 2022; 9 (02) 125-133
    CrossrefPubMedSearch in Google Scholar
  • 17 Branco JC, Bannwarth B, Failde I. et al. Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 2010; 39 (06) 448-453
    CrossrefPubMedSearch in Google Scholar
  • 18 Topbas M, Cakirbay H, Gulec H, Akgol E, Ak I, Can G. The prevalence of fibromyalgia in women aged 20-64 in Turkey. Scand J Rheumatol 2005; 34 (02) 140-144
    PubMedSearch in Google Scholar
  • 19 Lawrence RC, Felson DT, Helmick CG. et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
    CrossrefPubMedSearch in Google Scholar
  • 20 Solomon AJ, Bourdette DN, Cross AH. et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. Neurology 2016; 87 (13) 1393-1399
    CrossrefPubMedSearch in Google Scholar
  • 21 Davis JA, Robinson RL, Le TK, Xie J. Incidence and impact of pain conditions and comorbid illnesses. J Pain Res 2011; 4: 331-345
    CrossrefPubMedSearch in Google Scholar
  • 22 Pompa A, Clemenzi A, Troisi E. et al. Chronic pain in multiple sclerosis patients: utility of sensory quantitative testing in patients with fibromyalgia comorbidity. Eur Neurol 2015; 73 (5-6): 257-263
    CrossrefPubMedSearch in Google Scholar
  • 23 Srotova I, Kocica J, Vollert J. et al. Sensory and pain modulation profiles of ongoing central neuropathic extremity pain in multiple sclerosis. Eur J Pain 2021; 25 (03) 573-594
    CrossrefPubMedSearch in Google Scholar
  • 24 Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci 2021; 22 (08) 3891
    CrossrefPubMedSearch in Google Scholar
  • 25 Marrie RA, Horwitz R, Cutter G, Tyry T. Cumulative impact of comorbidity on quality of life in MS. Acta Neurol Scand 2012; 125 (03) 180-186
    CrossrefPubMedSearch in Google Scholar
  • 26 Oliva Ramirez A, Keenan A, Kalau O, Worthington E, Cohen L, Singh S. Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review. BMC Neurol 2021; 21 (01) 468
    CrossrefPubMedSearch in Google Scholar
  • 27 Boeschoten RE, Braamse AMJ, Beekman ATF. et al. Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017; 372: 331-341
    CrossrefPubMedSearch in Google Scholar
  • 28 Marrie RA, Reingold S, Cohen J. et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21 (03) 305-317
    CrossrefPubMedSearch in Google Scholar
  • 29 Fromont A, Binquet C, Rollot F. et al. Comorbidities at multiple sclerosis diagnosis. J Neurol 2013; 260 (10) 2629-2637
    CrossrefPubMedSearch in Google Scholar
  • 30 Peres DS, Rodrigues P, Viero FT. et al. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain Behav Immun Health 2022; 24: 100484
    CrossrefPubMedSearch in Google Scholar