How Do Different Rheumatic Diseases Affect Patients?

A study published in the journal Pain Medicine compared how different rheumatic diseases—fibromyalgia, rheumatoid arthritis (RA), spondyloarthritis, and Sjögren’s syndrome—affect patients in different domains including quality of life, psychological adjustment, and use of coping strategies.

Although the four diseases have different clinical characteristics, they share symptoms including pain and fatigue. However, fibromyalgia cannot be diagnosed through the same channels and is instead diagnosed through exclusion.

“All these diseases have a major impact on patients’ daily life, requiring considerable effort to cope with the illness. Most existing studies comparing fibromyalgia with other rheumatic diseases only consider fibromyalgia when it is associated with another rheumatic disease, which does not allow a clear distinction to be made between how patients adjust psychologically to each disease,” the study authors explained.

This multicenter study included 165 women with fibromyalgia (n = 48), RA (n = 47), spondyloarthritis (n = 47), and Sjögren’s syndrome (n = 23). All patients completed the General Health Questionnaire–28 (emotional distress), Fatigue Severity Scale (fatigue), Fibromyalgia Impact Questionnaire (impact of the disease), Coping Strategies Questionnaire (coping), and Mini International Neuropsychiatric Interview (comorbidity with DSM IV axis-I disorders). Comorbid anxiety and depressive disorders and the impact of the disease on patients’ mental well-being and daily life adjustment were compared using Kruskal-Wallis test, Mann-Whitney U test, and chi2 test.

The mean age of the whole cohort was 47.24 years; mean age by disease was: fibromyalgia, 47.98 years; RA, 50.89 years; spondyloarthritis, 42.30 years; and Sjögren’s syndrome, 48.30 years. Overall, the average disease duration was 4.13 years.

Patients with fibromyalgia, compared to the other rheumatic diseases, were more likely to have recurrent (past) major depressive episodes. Compared to patients with spondyloarthritis or Sjögren’s syndrome, fibromyalgia patients had higher rates of anxiety disorders (agoraphobia and generalized anxiety disorders), and fibromyalgia patients had a higher rate of post-traumatic stress disorder than RA patients.

Menopausal fibromyalgia patients had a greater impact of disease, pain, and fatigue compared to the RA group; greater fatigue and less distancing from pain than spondyloarthritis patients; and greater distraction and ignoring pan sensations than Sjögren’s syndrome patients. Among premenopausal women, the fibromyalgia patients had more somatic symptoms and fatigue compared to RA patients, and more fatigue than spondyloarthritis patients.

The authors concluded that fibromyalgia patients had higher levels of pain; greater incidence of anxiety, somatic symptoms, and depressive disorders; and poorer quality of life compared to patients with the rheumatic diseases studied in this trial. Fibromyalgia patients also had a harder time adjusting to the disease.

“Helping patients develop appropriate coping strategies should be part of the management of rheumatic diseases, particularly fibromyalgia and Sjögren’s syndrome,” recommended the study authors. “It would be desirable for rheumatology departments to have a psychologist on their staff to systematically check for any history of mood disorders (due to their association with levels of pain, fatigue, and maladaptive coping strategies) and, more generally, to assess how patients adapt to their disease.”