Rheumatology International

, Volume 37, Issue 12, pp 2035–2042 | Cite as

The influence of fibromyalgia on achieving remission in patients with long-standing rheumatoid arthritis

  • Fausto Salaffi
  • Maria Chiara Gerardi
  • Fabiola Atzeni
  • Alberto Batticciotto
  • Rossella Talotta
  • Antonella Draghessi
  • Marco Di Carlo
  • Piercarlo Sarzi-Puttini
Observational Research


To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6 months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) (p = 0.0001), the FM presence (p = 0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score (p = 0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS (p = 0.011), on the sleep Visual Analogue Scale (VAS) (p = 0.018), on the self-counts of tender joints (p = 0.039), and on the PainDetect Questionnaire (PDQ) (p = 0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria.


Rheumatoid arthritis Fibromyalgia Remission Outcome measures 


Compliance with ethical standards

Conflict of interest

All the authors declare that they have not received any financial support or other benefits from commercial sources for the work described in this paper. They also declare that they have no other financial interests that could create a potential conflict of interest or the appearance of a conflict of interest with regard to this work.



Ethical approval

All the procedures in this work were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Salaffi F, De Angelis R, Grassi W (2005) Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. The MAPPING study. Clin Exp Rheumatol 23:819–828PubMedGoogle Scholar
  2. 2.
    Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Makinen H, Hannonen P, Sokka T (2006) Definitions of remission for rheumatoid arthritis and review of selected clinical cohorts and randomized clinical trials for the rate of remission. Clin Exp Rheumatol 24:S22–S28Google Scholar
  4. 4.
    Masri KR, Shaver TS, Shahouri SH, Wang S, Anderson JD, Busch RE et al (2012) Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice. J Rheumatol 39:1139–1145CrossRefPubMedGoogle Scholar
  5. 5.
    Wolfe F, Cathey MA, Kleinheksel SM (1984) Fibrositis (fibromyalgia) in rheumatoid arthritis. J Rheumatol 11:814–818PubMedGoogle Scholar
  6. 6.
    Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L (1995) The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 38:19–28CrossRefPubMedGoogle Scholar
  7. 7.
    Bazzichi L, Giacomelli C, Consensi A, Atzeni F, Batticciotto A, Di Franco M, Casale R, Sarzi-Puttini P (2016) One year in review 2016: fibromyalgia. Clin Exp Rheumatol 34:S145–S149PubMedGoogle Scholar
  8. 8.
    Wolfe F, Michaud K (2004) Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia. J Rheumatol 31:695–700PubMedGoogle Scholar
  9. 9.
    Wolfe F, Michaud K (2009) Outcome and predictor relationships in fibromyalgia and rheumatoid arthritis: evidence concerning the continuum versus discrete disorder hypothesis. J Rheumatol 36:831–836CrossRefPubMedGoogle Scholar
  10. 10.
    Khan NA, Spencer HJ, Abda E, Aggarwal A, Alten R, Ancuta C et al (2012) Determinants of discordance in patients’ and physicians’ rating of rheumatoid arthritis disease activity. Arthritis Care Res 64:206–214CrossRefGoogle Scholar
  11. 11.
    Studenic P, Radner H, Smolen JS, Aletaha D (2012) Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis Rheum 64:2814–2823CrossRefPubMedGoogle Scholar
  12. 12.
    Lee YC, Cui J, Lu B, Frits ML, Iannaccone CK, Shadick NA et al (2011) Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study. Arthritis Res Ther 13:R83CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Burckhardt CS (1984) The use of the McGill Pain Questionnaire in assessing arthritis pain. Pain 19:305–314CrossRefPubMedGoogle Scholar
  14. 14.
    Charter RA, Nehemkis AM, Keenan MA, Person D, Prete PE (1985) The nature of arthritis pain. Br J Rheumatol 24:53–60CrossRefPubMedGoogle Scholar
  15. 15.
    Roche PA, Klestov AC, Heim HM (2003) Description of stable pain in rheumatoid arthritis: a 6 year study. J Rheumatol 30:1733–1738PubMedGoogle Scholar
  16. 16.
    Koop SM, ten Klooster PM, Vonkeman HE, Steunebrink LM, van de Laar MA (2015) Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. Arthritis Res Ther 17:R237CrossRefGoogle Scholar
  17. 17.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581CrossRefPubMedGoogle Scholar
  18. 18.
    Mierau M, Schoels M, Gonda G, Fuchs J, Aletaha D, Smolen JS (2007) Assessing remission in clinical practice. Rheumatology 46:975–979CrossRefPubMedGoogle Scholar
  19. 19.
    Salaffi F, Migliore A, Scarpellini M, Corsaro SM, Laganà B, Mozzani F et al (2010) Psychometric properties of an index of three patient-reported outcome (PRO) measures, termed the CLinical ARthritis Activity (PRO-CLARA) in patients with rheumatoid arthritis. The NEW INDICES study. Clin Exp Rheumatol 28:186–200PubMedGoogle Scholar
  20. 20.
    Salaffi F, Bazzichi L, Stancati A, Neri R, Cazzato M, Consensi A et al (2005) Development of a functional disability measurement tool to assess early arthritis: the Recent-Onset Arthritis Disability (Road) Questionnaire. Clin Exp Rheumatol 23:628–636PubMedGoogle Scholar
  21. 21.
    Stucki G, Liang MH, Stucki S, Brühlmann P, Michel BA (1995) A self-administered rheumatoid arthritis disease activity index (RADAI) for epidemiologic research: psychometric properties and correlation with parameters of disease activity. Arthritis Rheum 38:795–798CrossRefPubMedGoogle Scholar
  22. 22.
    Salaffi F, Stancati A, Neri R, Grassi W, Bombardieri S (2005) Measuring functional disability in early rheumatoid arthritis: the validity, reliability and responsiveness of the Recent-Onset Arthritis Disability (ROAD) index. Clin Exp Rheumatol 23:S31–S42PubMedGoogle Scholar
  23. 23.
    Salaffi F, Franchignoni F, Giordano A, Ciapetti A, Gasparini S, Ottonello M (2013) Classical test theory and Rasch analysis validation of the Recent-Onset Arthritis Disability questionnaire in rheumatoid arthritis patients. Clin Rheumatol 32:211–217CrossRefPubMedGoogle Scholar
  24. 24.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62:600–610CrossRefGoogle Scholar
  25. 25.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS et al (2011) Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 38:1113–1122CrossRefPubMedGoogle Scholar
  26. 26.
    Freynhagen R, Baron R, Gockel U, Tölle TR (2006) PainDetect: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22:1911–1920CrossRefPubMedGoogle Scholar
  27. 27.
    Spaetgens B, Wijnands JM, van Durme C, Boonen A (2015) Content and construct validity of the rheumatic diseases comorbidity index in patients with gout. Rheumatology (Oxford) 54:1659–1663CrossRefGoogle Scholar
  28. 28.
    Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheum 21:885–906CrossRefGoogle Scholar
  29. 29.
    Group EQ (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Pol 16:199–208CrossRefGoogle Scholar
  30. 30.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  31. 31.
    Ranzolin A, Brenol JC, Bredemeier M, Guarienti J, Rizzatti M, Feldman D et al (2009) 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. Arthritis Rheum 61:794–800CrossRefPubMedGoogle Scholar
  32. 32.
    Inanc N, Yilmaz-Oner S, Can M, Sokka T, Direskeneli H (2014) The role of depression, anxiety, fatigue, and fibromyalgia on the evaluation of the remission status in patients with rheumatoid arthritis. J Rheumatol 41:1755–1760CrossRefPubMedGoogle Scholar
  33. 33.
    Durán J, Combe B, Niu J, Rincheval N, Gaujoux-Viala C, Felson DT (2015) The effect on treatment response of fibromyalgic symptoms in early rheumatoid arthritis patients: results from the ESPOIR cohort. Rheumatology (Oxford) 54:2166–2170Google Scholar
  34. 34.
    Lee YC, Chibnik LB, Lu B, Wasan AD, Edwards RR, Fossel AH et al (2009) The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross- sectional study. Arthritis Res Ther 11:R160CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ablin JN, Efrati S, Buskila D (2016) Building up the pressure on chronic pain. Clin Exp Rheumatol 34:S3–S5PubMedGoogle Scholar
  36. 36.
    Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M (2013) Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC Neurol 13:21CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Fausto Salaffi
    • 1
  • Maria Chiara Gerardi
    • 2
  • Fabiola Atzeni
    • 2
  • Alberto Batticciotto
    • 2
  • Rossella Talotta
    • 2
  • Antonella Draghessi
    • 1
  • Marco Di Carlo
    • 1
  • Piercarlo Sarzi-Puttini
    • 2
  1. 1.Rheumatology DepartmentUniversità Politecnica delle Marche, c/o Ospedale “Carlo Urbani”JesiItaly
  2. 2.Rheumatology UnitASST Fatebenefratelli-L. Sacco University HospitalMilanItaly

Personalised recommendations