title: Fibromyalgia remains a significant burden in rheumatoid arthritis patients in Australia.
abstract: OBJECTIVE
  High rates of fibromyalgia (FM) are reported in rheumatoid arthritis (RA) patients. Advances in RA management have occurred, but information regarding current significance of FM in RA is limited. This investigation estimated the prevalence and health effects of concomitant FM in Australian RA patients.
  
  
  METHODS
  Participants were recruited from Australian rheumatology clinics. Subjects were assessed using the 1990 and 2011 American College of Rheumatology (ACR) FM criteria and the polysymptomatic distress score (PDS) was calculated. A medical history and a clinical examination were recorded. RA Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS-28 ESR), and the Short Form-36 survey (SF-36) were completed.
  
  
  RESULTS
  Of 117 RA patients, 33.3% (n = 39) met 1990 ACR FM criteria and 41.9% (n = 49) met 2011 ACR FM criteria. RA patients with comorbid FM had worse outcomes across all domains of health as defined by the SF-36 (P < 0.05). There was correlation between both physical and mental health outcomes and the PDS (P < 0.001). RA patients with FM on average took 1.18 extra ongoing prescribed medications (P < 0.05), despite comparable RA disease activity (DAS-28: 3.09 vs. 3.27, P = NS). Comorbid central sensitivity conditions were more common in patients with FM (P < 0.001).
  
  
  CONCLUSIONS
  FM continues to demonstrate a high prevalence in a population of RA patients. RA patients with FM have more symptoms of other chronic sensitivity syndromes in addition to FM. They have a lower quality of life outcome and higher medication use. This has important clinical implications in terms of diagnosis, response to therapy, prescribing choices and clinical outcomes.
authors.affiliation: Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Anthea C
authors.initials: AC
authors.lastname: Gist
authors.affiliation: Department of Rheumatology, Health and Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Emma K
authors.identifier: http://orcid.org/0000-0001-6712-1331
authors.initials: EK
authors.lastname: Guymer
authors.affiliation: Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Eades
authors.affiliation: Department of Rheumatology, Health and Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Leech
authors.affiliation: Department of Rheumatology, Health and Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Geoffrey O
authors.initials: GO
authors.lastname: Littlejohn
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D001799:Blood Sedimentation; D015897:Comorbidity; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: clinical aspects rheumatoid arthritis; clinical aspects soft tissue rheumatism; regional pain syndromes