title: Patient phenotypes in fibromyalgia comorbid with systemic sclerosis or rheumatoid arthritis: influence of diagnostic and screening tests. Screening with the FiRST questionnaire, diagnosis with the ACR 1990 and revised ACR 2010 criteria.
abstract: OBJECTIVE
  Fibromyalgia (FM) may occur with rheumatoid arthritis (RA) and systemic sclerosis (SSc), and debate remains about its diagnosis. We aimed to use three FM tools (a screening tool (FiRST), diagnostic criteria (ACR 1990 and revised 2010), to compare FM prevalence between RA and SSc patients, to describe the phenotypes of patients with comorbid FM, and to analyze links between FM and secondary Sjögren's syndrome (SS).
  
  
  METHODS
  Consecutive adult patients with confirmed RA or SSc from four university hospitals were tested with the three FM tools.
  
  
  RESULTS
  FiRST detected FM in 22.6% of the 172 RA patients, with confirmation in 22.1% (ACR1990) and 19.1% (ACR2010). ACR1990FM+ RA patients had more diffuse pain, whereas ACR2010FM+ RA patients had higher BMI and pain intensity, more diffuse pain, active disease, disability, and associated SS. FiRST detected FM in 27.8% of the 122 SSc patients, with confirmation in 30.3% (ACR1990) and 23.7% (ACR2010). ACR1990FM+ SSc patients had greater disability and pain intensity, and more diffuse pain, whereas ACR2010FM+ SSc patients had higher BMI, pain intensity, more disability and diffuse pain, and associated SS. Correlations between FM diagnostic and screening tool results were modest in both conditions. Secondary SS was associated with comorbid FM.
  
  
  CONCLUSIONS
  The prevalence of FM is high in SSc and RA, whatever the FM diagnostic tool used. Secondary SS is associated with FM in both RA and SSc. The revised ACR 2010 FM criteria and FiRST screening tool reveal specific phenotypes potentially useful for improving disease management.
authors.affiliation: Pain Clinic, Cochin-Hôtel Dieu Hospital, Paris Descartes University, Paris, France. serge.perrot@aphp.fr.
authors.forename: Serge
authors.initials: S
authors.lastname: Perrot
authors.affiliation: Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Mariana
authors.initials: M
authors.lastname: Peixoto
authors.affiliation: Rheumatology Department, Bichat Hospital, René Diderot University, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dieudé
authors.affiliation: Internal Medicine Department, Claude Huriez Hospital, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMINeNT), Lille University, Lille France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.affiliation: Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Avouac
authors.affiliation: Rheumatology Department, Bichat Hospital, René Diderot University, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ottaviani
authors.affiliation: Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D012595:Scleroderma, Systemic / Q000453:epidemiology*; D011795:Surveys and Questionnaires