title: Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia.
abstract: OBJECTIVE
  To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.
  
  
  METHODS
  A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
  
  
  RESULTS
  256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2,986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001).
  
  
  CONCLUSIONS
  RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil. Electronic address: rafaelchakr@gmail.com.
authors.forename: Rafael Mendonça da Silva
authors.initials: RM
authors.lastname: Chakr
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Claiton
authors.initials: C
authors.lastname: Brenol
authors.affiliation: Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Aline
authors.initials: A
authors.lastname: Ranzolin
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bernardes
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Dalosto
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Giovani
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Scalco
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Olszewski
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Charles
authors.initials: C
authors.lastname: Kohem
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Odirlei
authors.initials: O
authors.lastname: Monticielo
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: João Carlos T
authors.initials: JC
authors.lastname: Brenol
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Xavier
keywords: Artrite reumatoide; Drug Therapy; Fibromialgia; Fibromyalgia; Rheumatoid Arthritis; Tratamento farmacológico