Worse psychological symptoms in IBD patients with concomitant fibromyalgia

The study also revealed an 8.7% fibromyalgia prevalence in IBD patients; higher than the prevalence in the general population of 2–3%.

Overall fibromyalgia prevalence per cohort was 8.7% in IBD, 7.6% in CD and 9.9% in the UC group

Fibromyalgia is a common chronic disorder that can present as a comorbidity in, among others,  IBD. 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 presenting to 2 IBD units in the Luigi Sacco University Hospital from August to November 2021. Excluded were patients with severe disease activity (assessed in Crohn’s disease activity index [CDAI] and Mayo score for 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 ulcerative colitis (UC). The overall prevalence of fibromyalgia in the IBD cohort was 8.7%, with a prevalence of 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%). There were no significant demographic (i.e. gender, age) or clinical differences (i.e. BMI, CRP, disease activity, ongoing treatment modality) found between the groups with and without fibromyalgia as comorbidity.

Fibromyalgia in IBD can considerably impact quality of life

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 for each comparison).

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 IBD patients with CD. 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 comorbidity of fibromyalgia in IBD can considerably impact the quality of life, especially by causing depression, anxiety, stress, chronic fatigue, sleep disturbances, and discomfort.

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