title: Fibromyalgia is common and adversely affects pain and fatigue perception in North Indian patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Fibromyalgia (FM) has been shown to be common in patients with rheumatoid arthritis (RA), but studies on Asian patients are lacking. It remains unclear whether FM has an adverse influence on pain, fatigue, quality of life, and mood in these patients, and what its relationship is with disease activity. We studied prevalence and effects of FM in North Indian patients with RA and associations of RA with disease activity.
  
  
  METHODS
  This cross-sectional study included 200 RA patients and an equal number of controls. Presence of FM was defined using the American College of Rheumatology 1990 criteria. Pain and fatigue scores were assessed using a 10 cm visual analog scale. Quality of life and presence of depression/anxiety were determined using validated questionnaires. Disease activity and functional disability in RA patients was assessed using the Disease Activity Score 28-3 and Health Assessment Questionnaire, respectively.
  
  
  RESULTS
  FM was present in 15% of patients with RA compared to 2.5% of controls in the North Indian population. RA patients with FM did not differ from those without FM in terms of age, gender, current disease-modifying agents, or steroid use. RA patients with FM had higher disease activity and worse functional disability. The number of tender and swollen joints was higher in patients with FM, but correlated poorly with each other. RA patients with FM had higher pain and fatigue scores but were not different in the quality of life or mood.
  
  
  CONCLUSIONS
  FM is more common in North Indian patients with RA compared to controls. It adversely affects the pain and fatigue felt by RA patients. Disease activity and FM influence each other.
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Dhir
authors.forename: Able
authors.initials: A
authors.lastname: Lawrence
authors.forename: Amita
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Ramnath
authors.initials: R
authors.lastname: Misra
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D044466:Asian People; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D010147:Pain Measurement; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires