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Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis
Arthritis Care and Research , 06/03/09

Ranzolin A et al. – Study demonstrates that fibromyalgia (FM) is related to worse scores on the DAS28, HAQ, and SF-36 in patients with rheumatoid arthritis (RA).

Methods

Aim was to investigate the association of the presence of FM with the DAS28, HAQ, and SF-36 health survey in RA pts
270 outpatients with RA underwent clinical evaluation and application of the HAQ and SF-36 questionnaires
Disease activity was evaluated using the DAS28 score
FM and RA diagnoses were made according to ACR criteria

Results

Overall prevalence of FM was 13.4%; this group of pts had a higher prevalence of:
- female sex, older mean age,
- higher functional class, and longer morning stiffness
  than patients with only RA
Mean DAS28 scores were higher in pts with RA and FM vs pts with RA only
Multivariable linear regression analysis: FM was an important predictor of the DAS28 score, even after adjusting for:
- erythrocyte sedimentation rate (ESR)
- number of swollen joints
- functional class
- number of disease-modifying antirheumatic drugs (DMARDs) currently in use
- current dose of steroids, and
- articular erosions
HAQ and SF-36 scores were also worse in pts with RA and associated FM

Exclusive Author Commentary
Aline Ranzolin, 06/07/09

Our study has demonstrated that the association of a painful condition (like fibromyalgia) is responsible for a misinterpretation of activity disease and clinical evaluation of rheumatoid arthritis patients. The DAS28 must be analyzed with caution when fibromyalgia is present, and attention should be given to the individual components of this score. When evaluating and monitoring patients with RA, the presence of associated FM should be considered. In these cases, a more cautious interpretation of the instruments of RA evaluation should be given and the therapeuthic approach must be to both disease. Careful clinical judgment may be more appropriate than relying exclusively on numbers when assessing the activity of the disease.

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