This paper also reconsiders a number of important issues involving rheumatologists and FM. First, rheumatologists have become more aware of the frequency and effect of FM in every rheumatic disease. Whether using the FAST indices, the 2011 FM criteria, or the gold standard (Dr. Gibson’s clinical diagnosis), FM was present in about 20–30% of patients with rheumatic disease. This is consistent with reports of FM in 13–40% of cases of rheumatoid arthritis (RA)3,4, 10–20% of osteoarthritis (OA)5, 10–30% with psoriatic arthritis or a spondyloarthropathy [SpA; such as axial SpA (axSpA)]5,6, and 20–40% with systemic lupus erythematosus (SLE)7.

Patients with rheumatic diseases in this study who met the 2011 FM criteria had more pain, greater joint counts, and worse scores for function and global well-being than those not meeting FM criteria. This is also consistent with recent studies. For example, RA patients with comorbid FM compared to those without FM have higher scores on all disease activity measures despite lower disease activity measures, such as the erythrocyte sedimentation rate or ultrasound3,4. In more than 1500 subjects with axSpA, the 21% who met criteria for FM had worse disease activity scores, global severity scores, and quality of life, and more mood disturbances and fatigue. They also experienced a greater likelihood of receiving biologic therapy and much greater damage to their work situation6. In patients with OA, chronic widespread pain and evidence for central sensitization correlated with pain sensitivity and poor outcome after knee or hip replacements8.

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