title: Rheumatoid arthritis patients with fibromyalgic clinical features have significantly less synovitis as defined by power Doppler ultrasound.
abstract: BACKGROUND
  In patients with rheumatoid arthritis (RA) clinical measures of disease activity may not reliably discriminate between patients with active inflammatory disease and those with concomitant fibromyalgia (FM). Recent work has shown RA patients with a 28 tender joint count (TJC) minus swollen joint count (SJC) of 7 or more (joint count criteria) are more likely to meet classification criteria for FM. This study aimed to determine whether RA patients meeting clinical criteria for FM had lower levels of joint inflammation as determined by ultrasound (US).
  
  
  METHODS
  RA patients with DAS28 > 2.6 were recruited. Patients underwent clinical assessment including ultrasound examination of the hands and wrists with quantification of grey scale (GS) and power Doppler (PD) synovitis. Patients completed questionnaires to assess pain, fatigue, disability and psychological comorbidity.
  
  
  RESULTS
  Patients meeting either of the FM criteria had higher scores for disease activity, depression, disability and fatigue. Those meeting both the joint count and classification FM criteria had significantly lower levels of GS and PD inflammation on US.
  
  
  CONCLUSIONS
  RA patients with concomitant FM, as determined by widespread soft tissue tenderness but fewer clinically inflamed joints, have higher disease activity scores but may have lower levels of synovial inflammation on US. This has implications for the identification and management of these patients who may not respond to conventional therapy and hence be more suitable for alternative approaches to treatment.
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK. Aneela.mian@nhs.net.|Department of Academic Rheumatology, King's College London, 10 Cutcombe Road, London, SE5 9RT, UK. Aneela.mian@nhs.net.
authors.forename: Aneela N
authors.initials: AN
authors.lastname: Mian
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Chaabo
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Julekha
authors.initials: J
authors.lastname: Wajed
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Sujith
authors.initials: S
authors.lastname: Subesinghe
authors.affiliation: Department of Rheumatology, King's College Hospital London, Denmark Hill, SE5 9RS, UK.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Gullick
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Bruce
authors.initials: B
authors.lastname: Kirkham
authors.affiliation: Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Garrood
keywords: Fibromyalgic rheumatoid; Rheumatoid arthritis; Ultrasound