الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Fibromyalgia syndrome (FMS) is defined by the World Health Organization
(WHO) as a condition of chronic widespread pain accompanied by fatigue with sleep disturbance and a cognitive disorder, associated with varied additional syndromes such as irritable bowel syndrome, dry mouth, dry eyes, orthostatic intolerance, temporomandibular joint dysfunction, and many others.(Clauw 2014)
The prevalence of FM in the general population ranges from 2to 4%The prevalence of FM increases with age(Puche Larrubia, Castro Villegas et al. 2021) and is more common in females, with female-to-male ratios ranging from 2:1 to 30:1 depending on the criteria used.(Jones, Atzeni et al. 2015)
The prevalence of comorbid FM among populations with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are considerably higher than among the general population, with pooled prevalence estimates of 18-24% in RA, 14 -16% in axSpA and 18% in PsA.(Gist, Guymer et al. 2018)
Comorbid FMS in these patients making diagnosis and patient response
to treatment difficult. An increase in the frequency of FMS may be a result
of peripheral inflammation which increases the peripheral input in inflammatory rheumatic diseases. Central sensitization is also common in patients with inflammatory rheumatic diseases. Increased plasma/serum and/or cerebrospinal fluid levels of inflammatory cytokines support neuroinflammation and chronic systemic inflammation in the pathogenesis of FMS.(Coskun Benlidayi 2020)
Rheumatoid arthritis (RA) is a chronic, auto-immune, systemic inflammatory disease with a prevalence of approximately 1%.Synovial joints are the primary sites of disease and, if inadequately controlled, many patients go on to develop
irreversible joint destruction and consequent disability.(Bullock, Rizvi et al. 2018)
Psoriatic arthritis (PsA) is a common inflammatory arthritis that is associated with psoriasis. PsA affects( 0.3-1% )of the general population, but its prevalence can be up to 30% among those with psoriasis(Gladman, Antoni et al. 2005)
The key concept in FM pathophysiology is pain centralization: the central nervous system augments and amplifies pain, such that an individual feels more pain than would be expected given the degree of nociceptive stimuli. This activation of pain-processing areas in the brain can be observed using functional magnetic resonance imaging .(Puche Larrubia, Castro Villegas et al. 2021)
There are two main groups of FM primary’ FM initially develop regional pain conditions that become widespread over time and secondary’ FM which occurs as consequence of, a disease that has identifiable ongoing nociceptive input, such as from inflammatory arthritides.(Basu, Kaplan et al. 2018)
Many previous studies aimed to assess the prevalence of FMS in different rheumatic diseases and explain the causes of increased prevalence of FMS in these patients .
Hence, the aim of the study design to evaluate the percentage of fibromyalgia cases with Rheumatoid arthritis and Psoriatic arthritis and asess the possible causes that share in development of FMS in these patient.
Evaluate the association of FM score with the disease activity ,serum Vitamin D level in these patients and type of therapy and its role for development of FMS in these patient.
FMS also appears to be a determinant of disease activity in patients with inflammatory rheumatic diseases as RA and PSA patients . causing an increase of disease activity and poor control of this activity also we can consider that disease activity is a determent factor for FMS in inflammatory rheumatic diseases.(Gist, Guymer et al. 2018, Zhao, Duffield et al. 2019)
Concomitant FMS also has the potential to change patients’ response to DMARD therapy, including biological agents concomitant FMS can cause an unnecessary increase in or discontinuation of anti-rheumatic therapy (Moltó, Etcheto et al. 2018). Therefore, it is important to diagnose and treat FMS accompanying rheumatic diseases.(Chakr, Brenol et al. 2017)
Vitamin D is a pleiotropic hormone with a critical role in modulating several inflammatory and pain pathways in addition to calcium homeostasis. Observational studies suggest an association between vitamin D deficiency and chronic pain, most promisingly in fibromyalgia. The exact role of Vitamin D in pathogenesis is still not exactly clear but many studies highlights the association between Vitamin D defiencey and FMS in chronic inflammatory arthritis patients including RA and PSA patients. (Helde-Frankling and Björkhem-Bergman 2017)
In our study , 60RA patient ,30PSA patients and 40 controls ,all three group aree compatibe as regard age ans sex. Female sex is strog association with FMS in all three groups .
We found that prevelence of FMS in RA and PSA patient is significanty higher in comparision to control group .
In measuarig and study the association between FMS and the disease activty and serum vitamin D in both groups RA and PSA patients , we found significant correlation between FMscore and disease activity and serum vitaminD ,so patients with higher disease activity and low serum Vitamin D are more liable to express FMS ,so that we can consider both high disease activity and Vitamin D defiency both are indicators for FMS in these patients .
In measuaring and study the association between FMS and type of therapy in these patient , we found that patients receive cs DMARDS are at higher risk to develop FMS than those receiving b DMARDS but this risk not reachs significant correlation . this may be explain by that bDMARDS are more effective in controlling disease activity than cs DMARDS ,and therefore those with cs DMARDS more susptable to develop FMS.
Also PSA patients reciveing Anti –TNF is at high risk to develop FMS than those receiving IL17 inhibitors . but also this not reach significant relation .
So that we cant consider type of therapy either cs DMARDS or bDMARDS as indicator but we consider thia as predictor for FMS in these patients.
So furthur studies to evaluate exact association btween FMS and type of therapy in various inflamatory rheumatic diseases are recommended.