Pilot study to assess the frequency of fibromyalgia, depression, and sleep disorders in patients with granulomatosis with polyangiitis (Wegener's)

Abstract

Objective: To assess the frequency of fibromyalgia syndrome (FMS), depression, and sleep disorders in patients with granulomatosis with polyangiitis (Wegener's) (GPA).

Methods: The London Fibromyalgia Epidemiologic Study Screening Questionnaire (LFESSQ), Symptom Intensity Scale, Epworth Sleepiness Scale (ESS), and the Brief Patient Health Questionnaire-9 (BPHQ-9) were administered prospectively to patients who met the American College of Rheumatology criteria for GPA. Fatigue was captured quantitatively by the fatigue visual analog scale (VAS) and qualitatively by the LFESSQ fatigue questionnaire. Disease activity and damage were captured by using the Birmingham Vasculitis Activity Score for GPA (BVAS/GPA) and the Vasculitis Damage Index (VDI). Frequency of FMS and depression in GPA was compared with the general population.

Results: Patients with GPA have significantly greater frequency of FMS (LFESSQ 23.6 versus 13; P = 0.02) and depression (22% versus 7.6%; P < 0.001) than the general population. Twenty-nine percent of GPA patients had sleep abnormalities according to ESS scores of ≥10; 76.4% reported fatigue and 49.1% indicated that fatigue significantly limited their activities. There was no correlation between BPHQ-9, ESS, LFESSQ, fatigue VAS, and VDI, BVAS/GPA, or disease duration. There was a strong correlation between fatigue VAS and BPHQ-9 (r = 0.73; 95% confidence interval [95% CI] 0.54, 0.92). The correlation between fatigue VAS and ESS was significant but not as strong as with the BPHQ-9 (r = 0.36; 95% CI 0.10, 0.62).

Conclusion: FMS and depression occur more often in GPA compared with the general population. The association is not related to disease activity, damage, or disease duration. Fatigue is very common and significantly limits normal daily activities. Depression and sleep disorders contribute to fatigue in GPA patients.