Frequency and clinical impact of fibromyalgia among patients with multiple sclerosis in Saudi Arabia: A cross-sectional study

Background

Pain is a prevalent and disabling symptom in multiple sclerosis (MS). Fibromyalgia (FM), a chronic widespread pain syndrome, may coexist with MS and exacerbate fatigue, anxiety, depression, and poor quality of life (QoL). While this association has been studied in Western populations, data from Saudi-Arabia and the Middle-East are limited.

Aim of the work

To determine the frequency of FM in Saudi MS patients and assess its impact on fatigue, disability, depression, anxiety, and quality of life as well as its association with disease characteristics and treatment.

Patients and methods

This retrospective study included 73 Saudi adults with MS. FM was screened using the Arabic Fibromyalgia Rapid Screening Tool (FiRST). Fatigue was assessed using the modified fatigue impact scale (MFIS), disability via expanded disability status scale (EDSS), depression with the patient health questionnaire (PHQ-9), anxiety with the generalized anxiety disorder (GAD-7) and QoL with the MS international QoL (MusiQoL) questionnaire.

Results

The mean patient age was 37.3 ± 10.2 years; 52 females and 21 males. FM was detected in 11 (15.1 %) patients. Disease-modifying therapies were significantly less frequently received by patients with FM (p = 0.015). FIRST score significantly correlated with MFIS (r = 0.45,p < 0.0001), PHQ-9 (r = 0.3,p = 0.009) and GAD-7 (r = 0.29,p = 0.013) and inversely with MusiQoL (r = -0.3,p = 0.011). In regression analysis, fatigue remained the only significant predictor of FM.

Conclusion

FM is not uncommon in Saudi MS patients and is associated with fatigue, depression, anxiety, and reduced QoL. Fatigue emerged as a significant predictor of FM. Early identification and integrated management of FM may improve outcomes in MS.