Do patients with ankylosing spondylitis have an excess prevalence of chronic widespread pain? Results from the Scotland and Ireland Registry for Ankylosing Spondylitis (SIRAS) and the MUSICIAN study

Fabiola Atzeni, Marcus Beasley, Linda Elspeth Dean, Gareth Jones, Jane Gibson, Piercarlo Sarzi-Puttini, Gary Macfarlane

Research output: Contribution to journalAbstractpeer-review


To determine whether there is an excess prevalence
of chronic widespread body pain (CWP) in patients with Ankylosing spondylitis
Patients were participants in the Scotland and Ireland Registry for
Ankyolsing Spondylitis (SIRAS), an ongoing study of patients attending second-
ary care in Scotland who had received a clinical diagnosis of AS. The study
collected information on clinical features, including extra-spinal manifestations,
BASDAI and BASFI from medical records, and patient-reported data by
self-completion questionnaires (including fatigue measured by the Chalder Fa-
tigue Scale (CFS)). Information on CWP was collected by four-view body
manikins and required to satisfy the definition used in the ACR 1990 criteria for
FM (ACR-CWP) – i.e. chronic pain (

3 months) in 2 contralateral body
quadrants, plus axial pain. We believed the reporting of CWP among AS patients
would be strongly influenced by spinal disease and, thus, would be difficult to
interpret. Therefore, we evaluated the total number of painful body regions
reported (up to a maximum of 30) and used an alternative definition for CWP
(aCWP) requiring chronic pain in 2 contralateral body quadrants, but excluding
pain in the axial skeleton and/or the buttocks. Population data on the prevalence
of CWP (using the same definitions) was from the MUSICIAN study, a large
two-centre UK population-based study of pain in adults. Prevalence of aCWP was
calculated in AS patients and reported as a standardised prevalence ratio (SPR).
Relationships with reporting aCWP in the AS population were evaluated by
logistic regression and expressed as odds ratios (OR) with 95% Confidence
Intervals (95%CI).
The analysis involved 547 AS patients in SIRAS (71% male;
median age 52yrs) and a population sample of 14,680 persons from the
MUSICIAN study. The majority of the AS patients (89% of those tested) were
HLA B27 positive, 81% had documented sacroiliitis, 34% had peripheral joint
involvement and 29% had a history of uveitis. 24% had ever been prescribed
anti-TNF drugs. The prevalence of ACR-CWP among AS patients was 55.0%
The number of non-spine body regions in which pain was reported was
significantly higher in AS patients (median

5) than the general population

2) (Mann-Whitney p

0.001). The prevalence of aCWP was 53.4%
and the SPR in AS patients using this alternative definition was (284; 95%CI
260–307). Prevalence of aCWP was higher among women than men (OR: 1.56;
95%CI: 1.07–2.27), and amongst those of lower education (school vs university
education 1.89; 1.14–3.14); those unemployed due to ill-health (5.11; 2.57–10.17,
vs those in paid employment); and those with a BASDAI or BASFI score

(3.94; 2.38–6.49, and 3.75; 2.24–6.25, respectively). Similarly, high levels of
fatigue (CFS

4) (2.86, 2.01–4.08) and past or current use of anti-TNF agents
(1.63; 1.07–2.49) were also associated with aCWP.
The age and sex adjusted prevalence of CWP (using a modified
definition more suited to AS patients) was almost three times higher in AS
patients than in the general population, and was related to both individual and
clinical factors. The identification of such symptoms in AS patients is challenging
but important for management
Original languageEnglish
Pages (from-to)S652-S652
Number of pages1
JournalArthritis & Rheumatism
Issue numberS10
Publication statusPublished - Oct 2013
Event77th Annual Meeting of the American-College-of-Rheumatology / 48th Annual Meeting of the Association-of-Rheumatology-Health-Professionals - San Diego, Canada
Duration: 25 Oct 201330 Oct 2013


  • chronic widespread pain
  • epidemiology
  • ankylosing spondylitis


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