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AxSpA patients from the population-based SPARTAKUS cohort evaluated for fibromyalgia (1990 ACR criteria) were included (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009243; r-axSpA\/nr-axSpA\u2009=\u2009165\/78). Factors associated with fibromyalgia were cross-sectionally analyzed by logistic\/linear regression, and discriminative potential of algometry-assessed measures estimated by ROC-curve analysis. A fibromyalgia prevalence of 9% was demonstrated, with a higher frequency in female than male patients (17%\/2%;adjusted\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and more than a doubling in frequency per 5-unit BMI increase (adjusted\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.002). Fibromyalgia was associated with several disease\/work outcomes, including higher disease activity, lower quality-of-life, and less employment although without association to swollen joints\/CRP. Additionally, patients with (versus without) fibromyalgia had higher bDMARD exposure (19%\/5% had tried\u2009\u2265\u20093 bDMARDs; adjusted\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.009), and were more often on opioids (62%\/16%;adjusted\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Algometry-assessed measures displayed a sensitivity\/specificity of 79%\/70% (pain threshold) and 71%\/83% (pain tolerance) for fibromyalgia differentiation (positive\/negative predictive values 16%\/99% and 23%\/98%, respectively). Fibromyalgia is a frequent comorbidity in axSpA, more common in female patients\/patients with higher BMI, and associated with worse levels of patient-reported disease\/work outcomes. Our findings highlight the challenge of assessing axSpA disease activity when fibromyalgia is present and suggest a role for algometry as a complementary, evaluator-independent assessment tool, potentially useful for fibromyalgia rule-out but less so for rule-in. The results further suggest that fibromyalgia may be associated with DMARD overtreatment, reflecting a need for earlier and more precise targeting.\n                  <\/jats:p>","DOI":"10.1007\/s00296-026-06140-1","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T13:01:04Z","timestamp":1779541264000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Axial spondyloarthritis patients with comorbid fibromyalgia feel worse, work less and more often try multiple biological therapies: results from a population-based, cross-sectional study investigating the discriminative capacity of pressure algometry"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8630-1407","authenticated-orcid":false,"given":"Annie","family":"Brink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5706-203X","authenticated-orcid":false,"given":"Elisabeth","family":"Mogard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9937-6352","authenticated-orcid":false,"given":"Elisabet","family":"Lindqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7227-0665","authenticated-orcid":false,"given":"Jonas","family":"Sagard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Roseman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-7723","authenticated-orcid":false,"given":"Mats","family":"Geijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8591-7501","authenticated-orcid":false,"given":"Jack Kvistgaard","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-2924","authenticated-orcid":false,"given":"Johan K.","family":"Wallman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9919-4487","authenticated-orcid":false,"given":"Tor","family":"Olofsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"issue":"9","key":"6140_CR1","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1007\/s00296-017-3725-2","volume":"37","author":"F Heidari","year":"2017","unstructured":"Heidari F, Afshari M, Moosazadeh M (2017) Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. 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MG has received a speaker honorarium from Abbvie and UCB Pharma. JKW has received grant\/research support from AbbVie, Amgen, Eli, Lilly, Novartis and Pfizer (unrelated to the present work). All other authors declared no financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was granted by the Regional Ethical Review Board in Lund (Dnr. 2015\/436, date of approval 15-08-20) and all patients gave verbal and written informed consent in compliance with the Declaration of Helsinki before enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"99"}}