Sara Lourenço

Gender and psychosocial context as determinants of fibromyalgia symptoms (fibromyalgia research criteria) in young adults from the general population

OBJECTIVE To quantify the prevalence of FM (FM research criteria), to describe its components-symptom severity score (SSS) and widespread pain index (WPI)-and to identify biopsychosocial predictors of the severity of SSS as well as WPI using a population-based sample of young adults. METHODS Participants were part of the 21-year-old follow-up of the EPITeen cohort, which was set up during the 2003-04 school year and comprised subjects born in 1990 attending schools in Porto, Portugal (n = 1719, 51.4% women). Data on biopsychosocial characteristics were collected, and FM-related information was gathered using the Fibromyalgia Survey Questionnaire. Sex-specific multivariate log-binomial regression coefficients (β) and 95% CI were used to quantify the associations between adverse biopsychosocial characteristics and high scores in SSS and WPI. RESULTS The overall point-prevalence of FM was 1.0%. Women scored significantly higher in SSS and WPI when compared with men. Global psychological distress was strongly and significantly associated with high scores in SSS in women and men (respectively, low sleep quality, β = 1.44, 95% CI 1.05, 1.84 and β = 1.19, 95% CI 0.78, 1.61; depressive symptoms, β = 1.64, 95% CI 1.23, 2.06 and β = 1.14, 95% CI 0.60, 1.70; eating disorders, β = 1.17, 95% CI 0.71, 1.63 and β = 1.15, 95% CI 0.52, 1.78). In women, adverse socioeconomic factors were predictors of high scores in SSS, whereas in men these contexts were significantly associated with high scores in WPI. CONCLUSION In young adulthood, psychological distress was particularly consistent in predicting SSS and may become useful as a red flag for the establishment of clinical disease.

Model-based patterns in prostate cancer mortality worldwide.

Background:Prostate cancer mortality has been decreasing in several high income countries and previous studies analysed the trends mostly according to geographical criteria. We aimed to identify patterns in the time trends of prostate cancer mortality across countries using a model-based approach.Methods:Model-based clustering was used to identify patterns of variation in prostate cancer mortality (1980–2010) across 37 European, five non-European high-income countries and four leading emerging economies. We characterised the patterns observed regarding the geographical distribution and gross national income of the countries, as well as the trends observed in mortality/incidence ratios.Results:We identified three clusters of countries with similar variation in prostate cancer mortality: pattern 1 (‘no mortality decline’), characterised by a continued increase throughout the whole period; patterns 2 (‘later mortality decline’) and 3 (‘earlier mortality decline’) depict mortality declines, starting in the late and early 1990s, respectively. These clusters are also homogeneous regarding the variation in the prostate cancer mortality/incidence ratios, while are heterogeneous with reference to the geographical region of the countries and distribution of the gross national income.Conclusion:We provide a general model for the description and interpretation of the trends in prostate cancer mortality worldwide, based on three main patterns.

Osteoarthritis medical labelling and health-related quality of life in the general population

BackgroundOsteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life.MethodsSubjects (n = 1132, 58.7% women) were approached as participants of an urban population-based cohort (EPIPorto). Self-reported information on previous diagnosis of knee, hip or hand osteoarthritis was obtained and rheumatologists established knee, hip or hand osteoarthritis clinical diagnosis in symptomatic individuals. Physical and mental dimensions of health-related quality of life were evaluated using the self-administered Medical Outcomes Study: 36-Item Short Form Survey. Crude and adjusted linear regression coefficients (beta) and the corresponding 95% confidence intervals (95% CI) were computed to estimate the associations between being labelled as an osteoarthritis case and health-related quality of life.ResultsRegardless of disease medical labelling, individuals with osteoarthritis scored significantly lower physical health-related quality of life when compared to those without joint disease (kneeunexposed: beta = −5.3, 95% CI: −7.6, −3.1; kneeexposed: beta = −6.0, 95% CI: −8.4, −3.7; hipunexposed: beta = −6.0, 95% CI: −9.8, −2.3; hipexposed: beta = −11.0, 95% CI: −15.6, −6.4; handunexposed: beta = −4.3, 95% CI: −6.5, −2.0; handexposed: beta = −4.3, 95% CI: −6.6, −2.1). The same was not observed regarding mental health-related quality of life. Among subjects with clinically confirmed osteoarthritis, the medical labelling of this joint disease was not significantly associated to health-related quality of life.ConclusionsThe labelling of knee, hip and hand osteoarthritis diagnosis may not add specific benefit to osteoarthritis patients in terms of its capability to improve health-related quality of life.

Psychosocial Work Environment and Musculoskeletal Symptoms among 21-Year-Old Workers: A Population-Based Investigation (2011-2013)

Background The current labour market is becoming more flexible and informal, with job insecurity selectively affecting young workers. However, the role of these increasing adverse psychosocial working conditions on health outcomes remains little known among newly employed workers. Objective To estimate the associations between psychosocial work environment and musculoskeletal outcomes (widespread pain syndrome features and regional pain) in a population-based sample of young workers. Methods Cross-sectional data from workers aged 21 years were collected during the third wave of the EPITeen cohort study (2011-2013; n=650). The Job Content Questionnaire was used to characterize the psychosocial work environment according to the demand-control-support model. Data on pain and non-pain dimensions of the widespread pain syndrome (Fibromyalgia Survey Questionnaire) as well as on regional musculoskeletal pain (Nordic Musculoskeletal Questionnaire) were also collected. Crude and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were computed using logistic regression and all estimates were adjusted for sex, education and occupational biomechanical demands. Results Job insecurity was significantly associated to the non-pain dimension of the widespread pain syndrome (adjusted OR [95% CI]=1.51 [1.08, 2.12]). Young workers with strain jobs were significantly more likely to report high levels of non-pain symptoms when compared with those with no-strain jobs and this effect was even stronger when social support was added to the main exposure: workers with strain jobs and low social support had twice the odds of reporting high levels of non-pain features than those with high strain but high social support jobs (adjusted OR=1.86, 95% CI: 1.04, 3.31). These significant associations were not observed when widespread pain or multisite regional pain were the outcomes. Conclusion In the beginning of professional life, high strain jobs were associated to non-pain complaints, especially when the work environment provided also low social support.

THU0322 Fibromyalgia Ascertainment in Young Adults from the General Population: What Changes with the 2010 ACR Criteria?

Background Since 2010, fibromyalgia is modelled as a syndrome of progressive severity where non-specific symptoms other than pain precede the establishment of clinical disease. Detecting those symptoms is expected to improve sensitivity by widening the spectrum of clinical features, namely in early stages of the disease. However, little is known about the frequency and predictors of the non-pain component of the fibromyalgia syndrome in early adulthood. Objectives To quantify the prevalence of fibromyalgia (2010 ACR), to describe its components – symptom severity score and widespread pain index – and to identify psychosocial predictors of the severity of symptom severity score and widespread pain using a population-based sample of male and female young adults. Methods Participants were part of the 21-year-old follow-up of the EPITeen cohort study, which was set up during the 2003/2004 school year and gathered subjects born in 1990 attending schools in Porto, Portugal (n=1561, 51.3% women). Data on socioeconomics (work situation, parental and individual education and household income), lifestyle factors (smoking, alcohol drinking and sports practice) and psychological characteristics (health-related quality of life, sleep quality, depressive symptoms, eating disorders and maladaptive personality traits) were collected using structured face-to-face and self-administered questionnaires. Data on fibromyalgia and the severity of its two main components were collected using the Fibromyalgia Survey Questionnaire. Medians of symptom severity score and widespread pain index severity were compared according to each psychosocial factor using the Mann-Whitney test or the Kruskal-Wallis one-way analyses of variance. Results The overall point-prevalence of fibromyalgia was 1.1%, higher in women than in men (1.5% vs. 0.7%, p=0.110). Women scored significantly higher both in symptom severity score (median (P25; P75)=3.0 (2.0; 5.0) vs. 2.0 (1.0; 4.0), p<0.001) and widespread pain index (median (P25; P75)=1.0 (0.0; 1.0) vs. 0.0 (0.0; 1.0), p<0.001). Both in female and male young adults, socioeconomics, lifestyle factors and psychological features were not significantly associated with higher scores in widespread pain index. Socioeconomic indicators, such as work situation (employed vs never worked: median (P25; P75)=4.0 (2.0; 5.0) vs 3.0 (2.0; 5.0), p<0.01), and lifestyle factors, such as smoking (smokers vs non-smokers: median (P25; P75)=4.0 (2.0; 5.0) vs 3.0 (2.0; 5.0), p<0.05), were significantly associated to higher scores in symptom severity score in female sex. Additionally, most adverse psychological characteristics (poor quality of life, decreased sleep quality, relevant depressive symptoms, eating disorders and maladaptive personality traits such as interpersonal distrust, interoceptive awareness and ineffectiveness) were significantly associated with higher scores in symptom severity score in both sexes. Conclusions In young adults, prevalence of fibromyalgia was similar to other high burden chronic diseases. Using the symptom severity score may be useful in widening case ascertainment to young adults whose main clinical manifestations are related to psychological distress. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5684