Our analysis showed that fibromyalgia was significantly associated with D2T axSpA, which is consistent with literature data and in particular the findings of Phillipoteaux et al.17,18 In addition, Bello et al. reported that the switching rate was significantly higher in SpA patients treated with TNF-inhibitors with associated fibromyalgia when compared to patients without fibromyalgia (15.2% vs 4%, respectively), furthermore, retention rate of anti-TNF-alpha after 2 years was also shorter in this patient category.19 Here, TNF is linked to fibromyalgia.