RESEARCH - Association of concomitant fibromyalgia with worse disease activity score in 28 joints, HAQ, and SF-36 scores in patients with RA

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Arthritis Rheum. 2009 May 28;61(6):794-800.

Association of concomitant fibromyalgia with worse disease activity

score in 28 joints, health assessment questionnaire, and short form 36

scores in patients with rheumatoid arthritis.

Ranzolin A, Brenol JC, Bredemeier M, Guarienti J, Rizzatti M, Feldman

D, Xavier RM.

Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio

Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

OBJECTIVE: To study the association of the presence of fibromyalgia

(FM) with the Disease Activity Score in 28 joints (DAS28), the Health

Assessment Questionnaire (HAQ), and the Medical Outcomes Study Short

Form 36 (SF-36) health survey in patients with rheumatoid arthritis

(RA).

METHODS: A total of 270 outpatients with RA were enrolled in a

prospective cross-sectional study. The patients underwent clinical

evaluation and application of the HAQ and SF-36 questionnaires.

Disease activity was evaluated using the DAS28 score. FM and RA

diagnoses were made according to American College of Rheumatology

criteria.

RESULTS: The overall prevalence of FM was 13.4%. This group of

patients had a higher prevalence of female sex, older mean age, higher

functional class, and longer morning stiffness than patients with only

RA. Mean +/- SD DAS28 scores were significantly higher in patients

with RA and FM (5.36 +/- 0.99) than in patients with RA only (4.03 +/-

1.39; P < 0.001). In a multivariable linear regression analysis, FM

was an important predictor of the DAS28 score, even after adjusting

for the erythrocyte sedimentation rate, number of swollen joints,

functional class, number of disease-modifying antirheumatic drugs

currently in use, current dose of steroids, and articular erosions.

HAQ and SF-36 scores were also worse in patients with RA and

associated FM.

CONCLUSION: FM is related to worse scores on the DAS28, HAQ, and SF-36

in patients with RA. The presence of FM may have major implications in

the interpretation of the DAS28 score because it is related to higher

scores independently of objective evidence of RA activity.

PMID: 19479706

http://www.ncbi.nlm.nih.gov/pubmed/19479706

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