Prevalence and impact of fibromyalgia in patients with systemic lupus erythematosus at the Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: Fibromyalgia is an increasingly recognized medical disorder that presents with chronic widespread musculoskeletal pain, fatigue, and poor sleep. The aetiology remains unknown, but it has been described in association
with other rheumatological diseases. The overlapping symptoms of lupus and fibromyalgia can lead to misinterpretation of lupus activity and risk of overtreatment.
No studies of this association have been held in the black African population, bearing in mind the nature of the influence
of chronic disorders on quality of life and disease activity. Understanding the nature of this association in our population may contribute to this discussion.
Objectives: To determine the prevalence and impact of fibromyalgia in patients with Systemic Lupus Erythematosus
(SLE) attending the rheumatology clinic at the Kenyatta National Hospital (KNH).
Methodology: This was a cross-sectional descriptive study of SLE patients attending a rheumatology clinic at the KNH. All the SLE patients with chronic musculoskeletal pain were screened for fibromyalgia using the revised 2010 ACR criteria. The study tools included the study proforma, the FIQR, SF-36, and SLEDAI-2K; which were used to assess the severity and the impact of fibromyalgia on the quality of life, and disease activity of lupus respectively.
Results: Sixty patients with SLE were recruited into the study, all female with a mean age of 34 years. The prevalence of fibromyalgia among SLE patients was 39 (65%). All domains of HRQoL were impaired. The mean score of the 8 domains were; Physical function 30.6±19.2, physical health 3.2±8.5, emotional
problems 15.4±36.6, fatigue 32.1±12.5, social function 39.5±16.3, emotional well-being 39.4±18.0, pain 39.7±12.7 and general health 30.6±19.2. The median SLEDAI score was 7.0 (IQR 4.0-10.0), with half of the patients having moderate–
severe disease activity (51.3%). Patients with fibromyalgia were more likely to be on steroids than non-fibromyalgia (p-value
< 0.05). Other factors like marital status, nature of employment, and age were not found to be statistically significant.
Conclusion: Fibromyalgia is prevalent in SLE patients presenting with chronic musculoskeletal pain, in their middle
age. The majority of the patients have moderate disease activity. The presence of fibromyalgia adversely impairs the quality of life of patients with lupus.