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The subjective components of the Disease Activity Score 28-joints (DAS28) in rheumatoid arthritis patients and coexisting fibromyalgia

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Abstract

To determine the contribution of fibromyalgia (FM) to the subjective components of the Disease Activity Score 28-joints (DAS28) in patients with rheumatoid arthritis (RA), and to analyse the discriminatory performance of the derived DAS28 patient-reported components (DAS28-P) to identify patients with fibromyalgic RA. Consecutive RA patients underwent clinical and clinimetric assessment. The DAS28-P index was derived from the components of the DAS28 scores by rearranging the DAS28-ESR formula. Patients were distinguished by the presence of FM. Student parametric t tests or Mann–Whitney non-parametric U tests were used to determine any between-group differences. Receiver operating characteristic (ROC) curve analysis was used to test the ability of the DAS28-P index to distinguish patients with RA and those with fibromyalgic RA. The study involved 292 RA patients (80.5% females, mean age 63 years) with a mean disease duration of 11.6 ± 8.5 years. Forty-three patients (14.7%) had concomitant FM, and significantly higher tender joint count (p < 0.001), pain numerical rating scale, global health status (p = 0.007), and DAS28 scores (p = 0.006) than those without FM. The DAS28-P values were also significantly higher in the patients with FM (0.68 ± 0.09 vs 0.58 ± 0.06; p < 0.001). The discriminatory power of the DAS28-P was very good (area under the ROC of 0.858, optimal cut-off value of 0.631). The presence of FM strongly influences the DAS28 results. The assessment of patient-reported components to the DAS28 through the DAS28-P can be a useful way to identify patients with fibromyalgic RA.

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Authors and Affiliations

  1. Rheumatological Clinic, Ospedale “Carlo Urbani”, Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi, Ancona, Italy

    Fausto Salaffi & Marco Di Carlo

  2. Clinic of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy

    Marina Carotti

  3. Department of Rheumatology, ASST-FBF-Sacco, Milan, Italy

    Piercarlo Sarzi-Puttini

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  1. Fausto Salaffi
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  2. Marco Di Carlo
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  4. Piercarlo Sarzi-Puttini
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Contributions

FS and MDC contributed to the study design, data collection, data analysis, the interpretation of the results, and the preparation of the manuscript. MC contributed to the revision of the manuscript. PSP contributed to the revision of the manuscript and the design of the study. All of the authors read and approved the final manuscript.

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Correspondence to Marco Di Carlo.

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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.

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Salaffi, F., Di Carlo, M., Carotti, M. et al. The subjective components of the Disease Activity Score 28-joints (DAS28) in rheumatoid arthritis patients and coexisting fibromyalgia. Rheumatol Int 38, 1911–1918 (2018). https://doi.org/10.1007/s00296-018-4096-z

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  • DOI: https://doi.org/10.1007/s00296-018-4096-z

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