title: The effect on treatment response of fibromyalgic symptoms in early rheumatoid arthritis patients: results from the ESPOIR cohort.
abstract: OBJECTIVE
  To evaluate whether patients with RA who belong to the spectrum of fibromyalgic RA (FRA) have an impaired response to treatment measured by traditional activity scores.
  
  
  METHODS
  Patients from the ESPOIR cohort were analysed. This prospective cohort included 813 patients with early arthritis not initially receiving DMARDs. Among the 697 patients who met RA classification criteria, we studied two groups, one with and the other without FRA. The following endpoints were compared at 6, 12 and 18 months using a mixed linear regression model: 28-joint DAS (DAS28), Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and HAQ. In addition, attainment of low disease activity (LDA; DAS28 <3.2) and remission (DAS28 <2.6, SDAI <3.3, CDAI <2.8) at these time points was analysed.
  
  
  RESULTS
  Patients with FRA (n = 120) had higher DAS28, SDAI, CDAI and HAQ scores than patients with RA and no fibromyalgic characteristics (n = 548). DAS28 and other DASs started out higher in subjects with FRA, and while they improved to a similar extent to in the isolated RA group, they remained consistently higher among FRA patients. Achievement of LDA and remission was significantly less likely in subjects with FRA.
  
  
  CONCLUSIONS
  Patients with FRA and RA will have a similar response to treatment according to the decrease in indexes of disease activity, but may miss the target of remission or LDA.
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA, Rheumatology Department, Pontificia Universidad Católica de Chile School of Medicine, Santiago, Chile, joseduransc@yahoo.com.
authors.forename: Josefina
authors.initials: J
authors.lastname: Durán
authors.affiliation: Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.affiliation: Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rincheval
authors.affiliation: Rheumatology Department, Nîmes University Hospital, Montpellier University, Nîmes, France and.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gaujoux-Viala
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA, Arthritis Research UK Epidemiology Unit, University of Manchester and Manchester NIHR Biomedical Research Unit, Manchester, UK.
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents
keywords: DMARDs; disease activity scores; early rheumatoid arthritis; fibromyalgia; fibromyalgic RA; outcome measures; rheumatoid arthritis; therapy; treat to target