What is the study about?
We know that around 1 in 6 people with axial spondyloarthritis (axSpA) will also have symptoms of fibromyalgia. However, while they will receive management for their axSpA it is rare for any specific management to be offered for their fibromyalgia symptoms. We have shown in other studies that telephone delivered cognitive behaviour therapy (tCBT) is effective for fibromyalgia. To investigate further, we undertook a study to see whether it was feasible to offer tCBT alongside axSpA management. We wanted to find out:
- what patients thought of this, and
- to see whether there was any evidence that it was beneficial
We included patients with axSpA and fibromyalgia symptoms as well as patients who only had axSpA.
What did we do?
Patients who were taking part in the British Society for Rheumatology Biologics Registry for Ankylosing Spondylitis (BSRBR-AS) were offered a course of tCBT (which we described as “coaching”). We measured their health at the beginning of the study and again when they completed the course, using interviews to find out what patients thought of the intervention.
What did we find?
We had 42 patients who attended for an initial assessment. Those who completed at least one tCBT session were younger and more likely to have fibromyalgia symptoms as well as having worse disease. Patients reported improvements across a range of disease activity and wider health measures, with 6 out of 10 patients rating their health as improved 3 months after receiving the course.
Those interviewed told us that they liked the tCBT and it offered them a personalised approach to their condition. At the beginning of the course they did not know what to expect, but afterwards they described improved sleep and mental health and they told us they had gained new skills to support self-management. We also interviewed some people who did not take up the offer of the course – the main reasons were they didn’t think they needed it or they didn’t think that would be useful for their condition. Importantly participants told us that this sort of course would be of greatest benefit soon after a person was diagnosed.
What does this mean?
The high uptake of this course suggests that axSpA patients who also have fibromyalgia symptoms do have needs which are not currently being met. The findings are helpful in identifying patients most likely to engage with and benefit from tCBT and indicating at what point it is best to offer it to patients.