Clinical and psychological assessment of patients with rheumatoid arthritis and fibromyalgia: a real-world study

Objectives To assess the clinical features and functional and psychological status of patients with rheumatoid arthritis (RA) and those with fibromyalgia (FM) in a real-world setting. Method Between December 2018 and April 2019, 202 inpatients with RA were enrolled from the Rheumatology and Immunology Department at Peking University People’s Hospital and assessed for the presence of FM using the 1990 American College of Rheumatology’s classification criteria for FM. Disease activity and functional and psychological status were assessed using the Disease Activity Score in 28 joints (DAS-28), Short-Form 36 (SF-36), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale, and Visual Analog Scale. Results Among the patients with RA, 42 (20.8%) had concurrent FM. Compared with patients without FM, patients with FM had higher DAS-28 (6.0 vs. 4.4, P = 0.011) and notably higher tender joint counts (16.5 vs. 4.5, P < 0.001). Patients with RA and FM had worse HAQ scores (1.24 vs. 0.66, P < 0.001) and lower SF-36 scores (28.6 vs. 58.2, P < 0.001). Patients with RA and FM experienced more fatigue (88.1% vs. 50.6%, P < 0.001) and had higher anxiety (10 vs. 4, P < 0.001) and depression scores (12 vs. 6, P < 0.001). No significant differences in erythrocyte sedimentation rate, C-reactive protein concentration, morning stiffness period, or swollen joint counts were found between the groups. Conclusions Patients with RA and FM had higher disease activity, a worse functional and psychological status, and poorer quality of life. The DAS-28 may have been overestimated in these patients. When patients with RA do not reach remission, FM should be considered. Key Points • Patients with rheumatoid arthritis and fibromyalgia had a worse functional and psychological status compared with those with rheumatoid arthritis alone. • When patients with rheumatoid arthritis do not reach remission, fibromyalgia should be considered. • Physicians should avoid overtreatment and enable these patients to receive the treatment, such as non-drug interventions, that they need.