Fibromyalgic rheumatoid arthritis and disease assessment

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Abstract

Objective. We evaluated fibromyalgic RA to determine its clinical impact, identification using core clinical assessments and influence identifying active disease using disease activity scores (DAS-28). Methods. We examined the impact and identification using core clinical assessments (tender minus swollen joint counts) of fibromyalgic RA (>= 11 tender points) in initial (105 patients) and replicate (100 patients) cohorts. Receiver operator characteristic (ROC) curves optimized the cut-off points using tender minus swollen joint counts; their validity was confirmed in a routine practice cohort (321 patients). We evaluated whether fibromyalgic RA affected the identification of active disease using DAS-28 (>= 5.1) and the clinical disease activity index (CDAI). Results. A total of 18/105 and 12/100 patients in initial and replicate cohorts, respectively, had fibromyalgic RA. This was identified by >= 7 tender minus swollen joint counts with 83% sensitivity and 80% specificity in the initial cohort (72 and 98% in replicate, respectively) and ROC area under the curve 0.80 (0.94 in replicate). 'Fibromyalgic' RA (tender point scores in initial and tender minus swollen joints in clinical practice cohorts) had higher DAS-28, pain, fatigue and HAQ scores. More fibromyalgic RA patients had active disease by DAS-28 (odds ratio 14.3; 95% CI 5.5, 37.1; and CDAI 17.2; 95% CI 6.1, 48.5); conventional assessments (three or more tender joints; three or more swollen joints; ESR >= 28 mm/h) showed no difference (1.75; 95% CI 0.72, 4.3). Conclusion. Fibromyalgic RA affects 12-17% of RA outpatients and results in worse functional outcomes. DAS-28 scores over-interpret active disease in fibromyalgic RA.
Original languageEnglish
Pages (from-to)924 - 928
Number of pages5
JournalRheumatology
Volume49
Issue number5
DOIs
Publication statusPublished - May 2010

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