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292 Fibromyalgianess and Glucocorticoid Persistence Among Patients with Rheumatoid Arthritis

Published online by Cambridge University Press:  19 April 2022

Beth Wallace
Affiliation:
University of Michigan; VA Ann Arbor Healthcare System
Meriah N. Moore
Affiliation:
University of Michigan
Andrew C. Heisler
Affiliation:
Northwestern University Feinberg School of Medicine
Lutfiyya N. Muhammad
Affiliation:
Northwestern University Feinberg School of Medicine
Jing Song
Affiliation:
Northwestern University Feinberg School of Medicine
Daniel J. Clauw
Affiliation:
University of Michigan
Clifton O. Bingham III
Affiliation:
Johns Hopkins School of Medicine
Marcy B. Bolster
Affiliation:
Massachusetts General Hospital
Wendy Marder
Affiliation:
University of Michigan
Tuhina Neogi
Affiliation:
Boston University School of Medicine
Alyssa Wohlfahrt
Affiliation:
(Tufts University School of Medicine
Dorothy D. Dunlop
Affiliation:
Northwestern University Feinberg School of Medicine
Yvonne C. Lee
Affiliation:
Northwestern University Feinberg School of Medicine
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Abstract

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OBJECTIVES/GOALS: Over 30% of patients with rheumatoid arthritis (RA) exhibit fibromyalgianess, a symptom cluster associated with increased pain sensitivity. Up to half of RA patients use oral glucocorticoids (GCs) long-term despite their known, dose-dependent toxicity. We examined the association between fibromyalgianess and oral GC persistence in RA patients. METHODS/STUDY POPULATION: We used data from the Central Pain in Rheumatoid Arthritis (CPIRA) cohort to follow participants with active RA on oral prednisone who initiated a new disease-modifying anti-rheumatic drug. We measured fibromyalgianess using the Fibromyalgia Survey Questionnaire (FSQ), previously shown to correlate with key fibromyalgia features often superimposed upon RA. We stratified fibromyalgianess severity as follows: FSQ<8 low, 8-10 moderate, >10 high/very high. We defined GC persistence as GC use at 3 month followup visit. We assessed the association between baseline fibromyalgianess (exposure) and GC persistence at followup (outcome) using multiple logistic regression, adjusted for demographics, RA duration, serostatus, and inflammatory activity measured by swollen joint count and C reactive protein. RESULTS/ANTICIPATED RESULTS: Of 97 participants on prednisone at baseline, 65% were taking prednisone at follow-up. Fifty-seven percent of participants with low baseline fibromyalgianess had persistent GC use, compared to 84% with high or very high fibromyalgianess. After adjustment as outlined above, participants with high/very high baseline fibromyalgianess remained more likely to be on prednisone at follow-up, relative to those with low fibromyalgianess (OR 4.99 [95% CI 1.20 – 20.73]). DISCUSSION/SIGNIFICANCE: In this cohort of patients with active RA, high fibromyalgianess is associated with persistent GC use, independent of inflammatory activity. This finding suggests non-inflammatory pain related to fibromyalgianess may be misclassified as inflammatory pain related to RA disease activity.

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Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2022. The Association for Clinical and Translational Science