Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation

Avin Maroof; Shwan Kader Media

doi:10.5455/rmj.20260829083857

2026, Vol: 51, Issue: 4

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Original Research
Online Published: 29 Oct 2026

RMJ. 2026; 51(4): 945-948

doi: 10.5455/rmj.20260829083857

Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation

Avin Maroof, Shwan Kader Media.

Abstract
Objective: To investigate the clinical and mechanistic factors underlying discordance, focusing on fibromyalgia and MRI-defined inflammation.
Methodology: In this cross-sectional study, 118 axSpA patients were classified into four phenotypes using BASDAI and ASDAS thresholds. Fibromyalgia was defined by ACR criteria, and MRI inflammation by ASAS criteria. Clinical characteristics were compared across phenotypes, and multivariable logistic regression was used to identify predictors of inflammation-dominant discordance.
Results: Fibromyalgia (25.4%) and MRI inflammation (85.6%) showed differential distribution across phenotypes. Fibromyalgia increased with symptom burden (13.6% vs 40.0%, p=0.018), while MRI inflammation was most prevalent in ASDAS-driven phenotypes (92.1% and 97.1%, p=0.009). MRI inflammation (OR 3.80, p=0.002) and fibromyalgia (OR 2.30, p=0.010) independently predicted inflammation-dominant discordance. Discordant/high activity phenotypes had worse functional status and quality of life.
Conclusion: BASDAI-ASDAS discordance reflects overlapping inflammatory and non-inflammatory mechanisms, not measurement error. MRI inflammation and fibromyalgia contribute to distinct yet coexisting processes, underscoring axSpA's multidimensional nature and supporting integrated disease assessment.

Key words: Axial spondyloarthritis, discordance, inflammatory, real-world evidence.

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How to Cite this Article

Pubmed Style

Maroof A, Media SK. Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. RMJ. 2026; 51(4): 945-948.

doi:10.5455/rmj.20260829083857

Web Style

Maroof A, Media SK. Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. https://www.rmj.org.pk/?mno=332988 [Access: November 11, 2026].

doi:10.5455/rmj.20260829083857

AMA (American Medical Association) Style

Maroof A, Media SK. Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. RMJ. 2026; 51(4): 945-948.

doi:10.5455/rmj.20260829083857

Vancouver/ICMJE Style

Maroof A, Media SK. Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. RMJ. (2026), [cited November 11, 2026]; 51(4): 945-948.

doi:10.5455/rmj.20260829083857

Harvard Style

Maroof, A. & Media, . S. K. (2026) Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. RMJ, 51 (4), 945-948.

doi:10.5455/rmj.20260829083857

Turabian Style

Maroof, Avin, and Shwan Kader Media. 2026. Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation. Rawal Medical Journal, 51 (4), 945-948.

doi:10.5455/rmj.20260829083857

Chicago Style

Maroof, Avin, and Shwan Kader Media. "Discordance between symptom burden and inflammatory activity in axial spondyloarthritis: Contributions of fibromyalgia and MRI-defined inflammation." Rawal Medical Journal 51 (2026), 945-948.

doi:10.5455/rmj.20260829083857

MLA (The Modern Language Association) Style

doi:10.5455/rmj.20260829083857

APA (American Psychological Association) Style

doi:10.5455/rmj.20260829083857

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