CHRONIC WIDESPREAD PAIN AND MORTALITY - A 25 YEAR FOLLOW UP

BackgroundChronic widespread pain (CWP) has been suggested as a risk for mortality in especially cardiovascular diseases and malignancies (1, 2). Most studies are based on the CWP definition that is part of ACR1990 criteria for fibromyalgia (3). The ACR1990 definition has been criticized for being too including, and recently a more stringent definition, the WP2019, has been suggested (4). It is yet to be investigated how the more stringent WP2019 definition compares to the ACR1990 definition regarding excessed mortality and certain causes of death.ObjectivesTo study if overall mortality and common causes of death are increased among people with CWP in a 25 year follow up of a cohort from the general population. Additionally, to study if the definition of CWP, according to ACR1990 or WP2019, influences these outcomes.MethodsA 25-year follow up of the EPIPAIN cohort study that in 1995 included 2425 person from the general population (5). They were at baseline divided into three pain groups: CWP, chronic regional pain (CRP) and no chronic pain (NCP). CWP was defined according to both the ACR1990 (CWPACR1990) and the more stringent WP2019 (CWPWP2019) criteria. Deaths and causes of death were derived from the official national Swedish register. Mortality, adjusted for age, sex, socioeconomic status, and smoking habits, was analyzed with Cox regression and presented as Hazard Ratios (HR).ResultsAn overall increased mortality was predicted by CWPWP2019 (HR 1.32, p = 0.033), but not by CWPACR1990 (HR 1.08, p = 0.484), compared to NCP. An increased mortality in diseases of the circulatory system was predicted by CWPWP2019 (HR 1.70, p= 0.016), but not by CWPACR1990 (HR 1.35, p=0.128). Neither definition of CWP, CWPWP2019 (HR 1.35, p= 0.176) or CWPACR1990 (HR 1.21, p=0.327) predicted a significantly increased mortality for neoplastic diseases overall.ConclusionThe WP2019 definition of CWP enhanced the association between CWP and increased mortality, and especially mortality in diseases of the circulatory system. This suggests that the CWPWP2019 definition captures a more vulnerable subset of the population that should be assessed for other cardiovascular risk factors in the clinic.References[1]Da Silva JAP, Geenen R, Jacobs JWG. Chronic widespread pain and increased mortality: biopsychosocial interconnections. Ann Rheum Dis. 2018;77(6):790-2.[2]Macfarlane GJ, Barnish MS, Jones GT. Persons with chronic widespread pain experience excess mortality: longitudinal results from UK Biobank and meta-analysis. Ann Rheum Dis. 2017;76(11):1815-22.[3]Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.[4]Wolfe F, Butler SH, Fitzcharles M, Häuser W, Katz RL, Mease PJ, et al. Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria. Scand J Pain. 2019;20(1):77-86.[5]Bergman S, Herrström P, Jacobsson LT, Petersson IF. Chronic widespread pain: a three year of pain distribution and risk factors. J Rheumatol. 2002;29(4):818-25.Disclosure of InterestsNone declared