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Concomitant fibromyalgia in rheumatoid arthritis: challenges in diagnosis and disease assessment
Fibromyalgia, characterized by chronic generalized pain and multiple somatic symptoms, is frequently associated with rheumatoid arthritis. This association causes worse disease outcomes and poses challenges in rheumatoid arthritis disease assessment. Recent studies found that fibromyalgia is a disease continuum. Varying degrees of symptoms can be present in patients with rheumatoid arthritis even if they do not satisfy diagnosis criteria for fibromyalgia. Classification criteria for fibromyalgia are recommended for use in research, but in clinical practice diagnosis should be based on physician judgment. Rheumatoid arthritis disease activity scores should be used with caution in patients with concomitant fibromyalgia because they are disproportionately high based on subjective variables, not inflammation. Other means of assessing disease activity such as ultrasonography or inflammation markers can be employed when trying to distinguish between inflammatory and non-inflammatory pain in patients with rheumatoid arthritis and concomitant fibromyalgia.
Keywords: pain, polysymptomatic distress, disease activity scores