Does Fibromyalgia Syndrome Affect The Treatment And Disease Activity In Rheumatoid Arthritis?

In patients with rheumatoid arthritis (RA), concomitant fibromyalgia syndrome (FMS) has been reported in 14-17% of cases. Several methods are used to evaluate the outcomes in RA. Among them, disease activity score (DAS 28) is the most frequently used. The previous studies demonstrated that the presence of FMS is associated with a significant increase in the DAS 28 scores in patients with RA. Therefore if, the presence of FMS is ignored if more aggressive treatment approach can be applied to these patients. The aim of this study was to assess the frequency of FMS and evaluate the effect of FMS to disease severity and treatment approach in RA patients. A total of 74 female RA patients were enrolled to the study and they were separated in two groups with regards to presence of concomitant FMS (Group 1 only RA, and group 2 RA with FMS). The number of tender (TJ) and swollen joints (SJ), erythrocyte sedimentation rate (ESR) and for pain visual analog scale (VAS) levels were noted and DAS 28 scores were calculated for RA disease severity. Additionally, the patients were examined for the presence of pain in 18 FMS tender points. Group 1 included 44 patients, while there were 30 patients in group 2. The mean DAS 28 score (3.41 & 4.77, p:0,000), the median number of TJ (4 & 11) (p:0,000) and mean VAS (21,81 & 45,00) (p:0,000) were significantly higher in group 2. However, the difference in SJ (0 & 0) and ESR (24.93 ± 18 & 30.33 ± 25 mm/h) values were not significant. The type of medication used for treatment (DMARD or Anti-TNF drug) did not differ according to FMS existence in RA patients or not whether having FMS or not in RA patients. This study revealed that, the number of TJ, mean VAS and mean DAS 28 score are higher in in RA patients having concomitant FMS in RA patients. RA severity evaluated with DAS28 score may be overestimated due to concomitant FMS which may lead to inappropriate treatment approaches. There was no difference in terms of medical treatments because the presence of FMS considered in our clinic.