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Performance of 2016 revised fibromyalgia diagnostic criteria in patients with rheumatoid arthritis

Nada Mahmoud Shresher1, Aly Elsayed Mohamed2, Mohsen Hassan Elshahaly3

  • 1Department of Physical Medicine, Rheumatology and Rehabilitation, Damietta Specialized Hospital, Damietta, Egypt.

Rheumatology International
|August 5, 2019
PubMed

Insights

The 2016 fibromyalgia (FM) criteria identify more rheumatoid arthritis (RA) patients with FM than older criteria. This comorbidity is linked to higher RA disease activity, suggesting FM screening is important for RA management.

Area of Science:

  • Rheumatology
  • Clinical Immunology
  • Pain Medicine

Background:

  • Fibromyalgia (FM) frequently co-occurs with rheumatoid arthritis (RA).
  • Recent updates to the American College of Rheumatology (ACR) criteria for FM necessitate evaluating their performance in RA populations.
  • Understanding the relationship between FM and RA disease activity measures is crucial for patient management.

Purpose of the Study:

  • To compare the diagnostic performance of the 2016 revised ACR FM criteria against the 1990 criteria in RA patients.
  • To investigate the association between fibromyalgia and composite disease activity measures in rheumatoid arthritis.

Main Methods:

  • 130 adult RA patients meeting 2010 ACR/EULAR criteria were assessed using both 1990 and 2016 ACR FM criteria.
  • Kappa agreement was calculated to compare the two FM criteria.
  • Spearman's correlation assessed the relationship between the polysymptomatic distress scale (PSD) and disease activity scores (DAS28-ESR, CDAI, PGA, VAS pain).

Main Results:

  • The 2016 ACR FM criteria identified 40% (52/130) of RA patients with FM, compared to 31.5% (40/130) using the 1990 criteria.
  • Kappa agreement between the 1990 and 2016 criteria was substantial (0.733).
  • RA patients with FM exhibited significantly higher DAS28-ESR, CDAI, PGA, and VAS pain scores. The PSD showed a significant positive correlation with DAS28-ESR, CDAI, and PGA.

Conclusions:

  • The 2016 ACR FM criteria are effective in identifying a significant proportion of RA patients with comorbid fibromyalgia.
  • Fibromyalgia in RA patients is associated with increased disease activity and symptom burden.
  • Routine assessment for FM should be considered in RA patients with persistently high disease activity measures.
Keywords:
FibromyalgiaPolysymptomatic distressPrevalenceRheumatoid arthritis

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