Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement

Schrepf, A., Moser, S., Harte, S. E., Basu, N. , Kaplan, C., Kolarik, E., Tsodikov, A., Brummett, C. M. and Clauw, D. J. (2020) Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement. Rheumatology, 59(3), pp. 594-602. (doi: 10.1093/rheumatology/kez303) (PMID:31411333)

Abstract

Objectives: Many patients with osteoarthritis have comorbid symptoms of FM, but it is unknown how these symptoms respond to surgical procedures that address nociceptive input in the periphery, such as total joint replacement. Here we explore differences in clinical characteristics between patients whose FM symptoms do and do not improve following total hip or knee replacement. Methods: Participants were 150 patients undergoing knee or hip replacement who had a minimum FM survey score of 4 or greater prior to surgery. The top tertile of patients experiencing the most improvement in FM symptoms at month 6 were categorized as ‘Improve’ (n = 48) while the bottom two tertiles were categorized as ‘Worsen/Same’ (n = 102). Baseline symptom characteristics were compared between groups, as well as improvement in overall pain severity, surgical pain severity and physical function at 6 months. Results: The Worsen/Same group had higher levels of fatigue, depression and surgical site pain at baseline (all P < 0.05). Additionally, they improved less on overall pain severity and physical functioning 6 months after surgery (both P < 0.05). Conclusion: Most patients derive significant benefit in improvement of comorbid FM symptoms following total joint replacement, but a substantial proportion do not. Understanding the neurobiological basis for these different trajectories may help inform clinical judgment and improve patient care.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Basu, Professor Neil
• Authors: Schrepf, A., Moser, S., Harte, S. E., Basu, N., Kaplan, C., Kolarik, E., Tsodikov, A., Brummett, C. M., and Clauw, D. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Rheumatology
• Publisher: Oxford University Press
• ISSN: 1462-0324
• ISSN (Online): 1462-0332
• Published Online: 14 August 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Rheumatology 59:594–602
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher