Skip to main content

Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases


Fibromyalgia is one of the numerous comorbidities that may accompany inflammatory rheumatic diseases. Concomitant fibromyalgia in inflammatory rheumatic conditions can interfere with symptomatology, disease activity and overall management plan. The aim of the present narrative review article was to discuss the current evidence on (i) the prevalence/frequency of comorbid fibromyalgia in inflammatory rheumatic conditions, (ii) the role of fibromyalgia on disease activity, (iii) the impact of concomitant fibromyalgia on biological disease-modifying antirheumatic treatment outcomes and (iv) potential effectiveness of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms among patients with inflammatory rheumatic diseases. A literature search was conducted through PubMed/MEDLINE Cochrane and Web of Science databases by using relevant keywords and their combinations. Studies representing different geographical areas of the world revealed that frequency rates of fibromyalgia are higher in inflammatory rheumatic diseases than those in the general population. Comorbid fibromyalgia interferes not only with the disease activity scores but also with the treatment outcomes and management plan. Further evidence is warranted in order to determine the potential benefits of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.

This is a preview of subscription content, access via your institution.


  1. 1.

    Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Eriksson JG, Puolakka K (2019) Increasing incidence and shifting profile of idiopathic inflammatory rheumatic diseases in adults during this millennium. Clin Rheumatol 38:555–562.

    Article  PubMed  Google Scholar 

  2. 2.

    Coskun Benlidayi I, Gokcen N, Sariyildiz A, Sarpel T (2019) They have got the blues: patient's mood- and disease activity-related psychological burden of rheumatoid arthritis on caregivers. Int J Psychiatry Clin Pract 23:84–89.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Cook MJ, Bellou E, Bowes J, Sergeant JC, O’Neill TW, Barton A, Verstappen SMM (2018) The prevalence of co-morbidities and their impact on physical activity in people with inflammatory rheumatic diseases compared with the general population: results from the UK Biobank. Rheumatology (Oxford) 57:2172–2182.

    Article  Google Scholar 

  4. 4.

    Coskun Benlidayi I (2018) Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatol Int 38:2183–2192.

    Article  PubMed  Google Scholar 

  5. 5.

    Ursum J, Nielen MM, Twisk JW, Peters MJ, Schellevis FG, Nurmohamed MT, Korevaar JC (2013) Increased risk for chronic comorbid disorders in patients with inflammatory arthritis: a population based study. BMC Family Pract 14:199

    Article  Google Scholar 

  6. 6.

    Tsilioni I, Russell IJ, Stewart JM, Gleason RM, Theoharides TC (2016) Neuropeptides CRH, SP, HK-1, and inflammatory cytokines IL-6 and TNF are increased in serum of patients with fibromyalgia syndrome, implicating mast cells. J Pharmacol Exp Ther 356:664–672.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Bäckryd E, Tanum L, Lind AL, Larsson A, Gordh T (2017) Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. J Pain Res 10:515–525.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Moltó A, Etcheto A, Gossec L, Boudersa N, Claudepierre P, Roux N, Lemeunier L, Martin A, Sparsa L, Coquerelle P, Soubrier M, Perrot S, Dougados M (2018) Evaluation of the impact of concomitant fibromyalgia on TNF alpha blockers' effectiveness in axial spondyloarthritis: results of a prospective, multicentre study. Ann Rheum Dis 77:533–540.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bello N, Etcheto A, Béal C, Dougados M, Moltó A (2016) Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis Res Ther 18:42.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Chakr RMDS, Brenol C, Ranzolin A, Bernardes A, Dalosto AP, Ferrari G, Scalco S, Olszewski V, Kohem C, Monticielo O, Brenol JCT, Xavier RM (2017) Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia. Rev Bras Reumatol Engl Ed 57:403–411.

    Article  PubMed  Google Scholar 

  11. 11.

    Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31:1409–1417.

    Article  PubMed  Google Scholar 

  12. 12.

    Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, Saraiva F, Nacci F, Thomas E, Caubère JP, Le Lay K, Taieb C, Matucci-Cerinic M (2010) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39:448–453.

    Article  PubMed  Google Scholar 

  13. 13.

    Jones GT, Atzeni F, Beasley M, Flüß E, Sarzi-Puttini P, Macfarlane GJ (2015) The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 67:568–575.

    Article  PubMed  Google Scholar 

  14. 14.

    Fan A, Pereira B, Tournadre A, Tatar Z, Malochet-Guinamand S, Mathieu S, Couderc M, Soubrier M, Dubost JJ (2017) Frequency of concomitant fibromyalgia in rheumatic diseases: monocentric study of 691 patients. Semin Arthritis Rheum 47:129–132.

    Article  PubMed  Google Scholar 

  15. 15.

    Macfarlane GJ, Pathan E, Siebert S, Packham J, Gaffney K, Choy E, Sengupta R, Atzeni F, Martin KR, Jones GT, Dean LE (2019) AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS). BMC Rheumatol 3:19.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Macfarlane GJ, MacDonald RIR, Pathan E, Siebert S, Gaffney K, Choy E, Packham J, Martin KR, Haywood K, Sengupta R, Atzeni F, Jones GT (2018) Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register. Rheumatology (Oxford) 57:1982–1990.

    Article  Google Scholar 

  17. 17.

    Macfarlane GJ, Barnish MS, Pathan E, Martin KR, Haywood KL, Siebert S, Packham J, Atzeni F, Jones GT (2017) Co-occurrence and characteristics of patients with axial spondyloarthritis who meet criteria for fibromyalgia: results from a UK National Register. Arthritis Rheumatol 69:2144–2150.

    Article  PubMed  Google Scholar 

  18. 18.

    Lage-Hansen PR, Chrysidis S, Lage-Hansen M, Hougaard A, Ejstrup L, Amris K (2016) Concomitant fibromyalgia in rheumatoid arthritis is associated with the more frequent use of biological therapy: a cross-sectional study. Scand J Rheumatol 45:45–48.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Gheita TA, Sayed S, Gheita HA, Kenawy SA (2016) Vitamin D status in rheumatoid arthritis patients: relation to clinical manifestations, disease activity, quality of life and fibromyalgia syndrome. Int J Rheum Dis 19:294–299.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Moon SJ, Kang KY, Kwok SK, Ju JH, Hong YS, Park SH, Jeon CH, Choi ST, Song JS, Min JK (2018) Differences in quality of life determinants according to the presence of fibromyalgia in middle-aged female patients with systemic lupus erythematosus: a multicenter, cross-sectional, single-ethnicity cohort. Int J Rheum Dis 21:1173–1184.

    Article  PubMed  Google Scholar 

  21. 21.

    Choi BY, Oh HJ, Lee YJ, Song YW (2016) Prevalence and clinical impact of fibromyalgia in patients with primary Sjögren's syndrome. Clin Exp Rheumatol 34(2 Suppl 96):S9–13

    PubMed  Google Scholar 

  22. 22.

    Perrot S, Peixoto M, Dieudé P, Hachulla E, Avouac J, Ottaviani S, Allanore Y (2017) Patient phenotypes in fibromyalgia comorbid with systemic sclerosis or rheumatoid arthritis: influence of diagnostic and screening tests. Screening with the FiRST questionnaire, diagnosis with the ACR 1990 and revised ACR 2010 criteria. Clin Exp Rheumatol 35(Suppl 105):35–42

    PubMed  Google Scholar 

  23. 23.

    Torrente-Segarra V, Corominas H, Sánchez-Piedra C, Fernández-Castro M, Andreu JL, Martínez-Taboada VM, Olivé A, Rosas J, Sánchez-Alonso F, SJOGRENSER Study Group of the Spanish Society of Rheumatology (2017) Fibromyalgia prevalence and associated factors in primary Sjögren's syndrome patients in a large cohort from the Spanish Society of Rheumatology registry (SJOGRENSER). Clin Exp Rheumatol 35(Suppl 105):28–34

    PubMed  Google Scholar 

  24. 24.

    Torrente-Segarra V, Salman-Monte TC, Rúa-Figueroa Í, Pérez-Vicente S, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, Ibañez-Ruán J, Horcada L, Sánchez-Atrio A, Montilla C, Rodríguez-Gómez M, Díez-Álvarez E, Martinez-Taboada V, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JA, Gantes M, Hernández-Cruz B, Pecondón-Español Á, Marras C, Bonilla G, Pego-Reigosa JM, RELESSER Study Group of the Spanish Society of Rheumatology (SER); Study Group of Systemic Autoimmune Diseases of the SER (EAS-SER) (2016) Fibromyalgia prevalence and related factors in a large registry of patients with systemic lupus erythematosus. Clin Exp Rheumatol 34(2 Suppl 96):S40–S47

    PubMed  Google Scholar 

  25. 25.

    Haliloglu S, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A (2014) Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity. Rheumatol Int 34:1275–1280.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Toprak M, Erden M, Alpaycı M, Ediz L, Yazmalar L, Hız Ö, Tekeoğlu İ (2017) The frequency and effect of fibromyalgia in patients with Behçet's disease. Turk J Phys Med Rehabil 63:160–164.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    El-Rabbat MS, Mahmoud NK, Gheita TA (2018) Clinical significance of fibromyalgia syndrome in different rheumatic diseases: Relation to disease activity and quality of life. Reumatol Clin 14:285–289.

    Article  Google Scholar 

  28. 28.

    Graceffa D, Maiani E, Sperduti I, Ceralli F, Bonifati C (2015) Clinical remission of psoriatic arthritis in patients receiving continuous biological therapies for 1 year: the experience of an outpatient dermatological clinic for psoriasis. Clin Exp Dermatol 40:136–141.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Wach J, Letroublon MC, Coury F, Tebib JG (2016) Fibromyalgia in spondyloarthritis: effect on disease activity assessment in clinical practice. J Rheumatol 43:2056–2063

    CAS  Article  Google Scholar 

  30. 30.

    Santos-Faria D, Dougados M, Gossec L, Perrot S, Moltó A (2019) Evaluation of the performance of extreme patient-reported outcomes as surrogate markers for fibromyalgia in axial spondyloarthritis. Rheumatol Int 39:141–146.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Shah K, Paris M, Mellars L, Changolkar A, Mease PJ (2017) Real-world burden of comorbidities in US patients with psoriatic arthritis. RMD Open 28(3):e000588.

    Article  Google Scholar 

  32. 32.

    Brikman S, Furer V, Wollman J, Borok S, Matz H, Polachek A, Elalouf O, Sharabi A, Kaufman I, Paran D, Elkayam O (2016) The effect of the presence of fibromyalgia on common clinical disease activity indices in patients with psoriatic arthritis: a cross-sectional study. J Rheumatol 43:1749–1754.

    Article  PubMed  Google Scholar 

  33. 33.

    Joharatnam N, McWilliams DF, Wilson D, Wheeler M, Pande I, Walsh DA (2015) A cross-sectional study of pain sensitivity, disease-activity assessment, mental health, and fibromyalgia status in rheumatoid arthritis. Arthritis Res Ther 17:11.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W (2018) Fibromyalgia diagnosis and biased assessment: sex, prevalence and bias. PLoS ONE 13:e0203755.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Salaffi F, Di Carlo M, Carotti M, Sarzi-Puttini P (2018) The subjective components of the Disease Activity Score 28-joints (DAS28) in rheumatoid arthritis patients and coexisting fibromyalgia. Rheumatol Int 38:1911–1918.

    Article  PubMed  Google Scholar 

  36. 36.

    Salaffi F, Gerardi MC, Atzeni F, Batticciotto A, Talotta R, Draghessi A, Di Carlo M, Sarzi-Puttini P (2017) The influence of fibromyalgia on achieving remission in patients with long-standing rheumatoid arthritis. Rheumatol Int 37:2035–2042.

    Article  PubMed  Google Scholar 

  37. 37.

    Gist AC, Guymer EK, Eades LE, Leech M, Littlejohn GO (2018) Fibromyalgia remains a significant burden in rheumatoid arthritis patients in Australia. Int J Rheum Dis 21:639–646.

    Article  PubMed  Google Scholar 

  38. 38.

    Ahmad J, Blumen H, Tagoe CE (2015) Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis. Rheumatol Int 35:1415–1421.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Kilicarslan A, Yurdakul FG, Bodur H (2018) Diagnosing fibromyalgia in rheumatoid arthritis: the importance of assessing disease activity. Turk J Phys Med Rehabil 64:133–139.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Kim H, Cui J, Frits M, Iannaccone C, Coblyn J, Shadick NA, Weinblatt ME, Lee YC (2017) Fibromyalgia and the prediction of two-year changes in functional status in rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 69:1871–1877.

    CAS  Article  Google Scholar 

  41. 41.

    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172

    CAS  Article  Google Scholar 

  42. 42.

    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610

    Article  Google Scholar 

  43. 43.

    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB (2011) Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 38:1113–1122

    Article  Google Scholar 

  44. 44.

    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B (2016) 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 46:319–329.

    Article  PubMed  Google Scholar 

  45. 45.

    Larrosa Pardo F, Bondesson E, Schelin MEC, Jöud A (2019) A diagnosis of rheumatoid arthritis, endometriosis or IBD is associated with later onset of fibromyalgia and chronic widespread pain. Eur J Pain 23:1563–1573.

    Article  PubMed  Google Scholar 

  46. 46.

    Macchioni P, Salvarani C, Possemato N, Gutierrez M, Grassi W, Gasparini S, Perricone C, Perrotta FM, Grembiale RD, Bruno C, Tripolino C, Govoni M, Ciancio G, Farina I, Ramonda R, Frallonardo P, Desiati F, Scarpa R, Costa L, Zabotti A, De Vita S, D'Attino RM, Gualberti G, Merolla R, di Luzio PU, Aldigeri R, Marchesoni A (2019) Ultrasonographic and clinical assessment of peripheral enthesitis in patients with psoriatic arthritis, psoriasis, and fibromyalgia syndrome: the ULISSE study. J Rheumatol 46:904–911.

    Article  PubMed  Google Scholar 

  47. 47.

    Curtis JR, Herrem C, Ndlovu MN, O'Brien C, Yazici Y (2017) A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: post-hoc results from the certolizumab pegol phase 4 PREDICT trial. Arthritis Res Ther 19:215.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    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 41:1755–1760.

    Article  PubMed  Google Scholar 

  49. 49.

    Provan SA, Austad C, Halsaa V, Hammer HB, Kvien TK, Uhlig T (2019) Fibromyalgia in patients with rheumatoid arthritis. A 10-year follow-up study, results from the Oslo Rheumatoid Arthritis Register. Clin Exp Rheumatol 37(Suppl 116):58–62

    PubMed  Google Scholar 

  50. 50.

    Coskun Benlidayi I (2018) Fibromyalgia as a challenge for patients and physicians. Rheumatol Int 38:2345.

    Article  PubMed  Google Scholar 

  51. 51.

    Basu N, Kaplan CM, Ichesco E, Larkin T, Harris RE, Murray A, Waiter G, Clauw DJ (2018) Neurobiologic features of fibromyalgia are also present among rheumatoid arthritis patients. Arthritis Rheumatol 70:1000–1007

    Article  Google Scholar 

  52. 52.

    Ragab O, Khairy N, Taha R, Iskander M (2017) Serum seratonin in rheumatoid arthritis patients: relation to rheumatoid factor positivity, clinical manifestations and fibromyalgia. Egypt Rheumatol 40:149–153.

    Article  Google Scholar 

  53. 53.

    Berthelot JM, Bart G, Darrieutort-Lafitte C, Le Goff B, Guillot P, Glémarec J, Maugars Y (2019) Pain catastrophising worsens RAPID3 in all rheumatologic conditions. Clin Exp Rheumatol 37:600–607

    PubMed  Google Scholar 

  54. 54.

    Bal A, Sayiner Çaglar N, Çaglar Okur S, Akin T, Aytekin E, Cetin E, Pekin Dogan Y, Erdem IH, Aysar O (2015) The effect of fibromyalgia on disease activity in patients with rheumatoid arthritis. İstanbul Med J 16:18–22.

    Article  Google Scholar 

  55. 55.

    Garip Y, Güler T, Cifci N, Dortbas F, Karci AA (2016) Impact of fibromyalgia syndrome on quality of life in patients with Behçet’s disease. Turk J Phys Med Rehab 1:45–50.

    Article  Google Scholar 

  56. 56.

    Piga M, Congia M, Gabba A, Figus F, Floris A, Mathieu A, Cauli A (2018) Musculoskeletal manifestations as determinants of quality of life impairment in patients with systemic lupus erythematosus. Lupus 27:190–198.

    CAS  Article  PubMed  Google Scholar 

  57. 57.

    Etchegaray-Morales I, Méndez-Martínez S, Jiménez-Hernández C, Mendoza-Pinto C, Alonso-García NE, Montiel-Jarquín A, López-Colombo A, García-Villaseñor A, Cardiel MH, García-Carrasco M (2017) Factors associated with health-related quality of life in mexican lupus patients using the lupusQol. PLoS ONE 12:e0170209.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    de Araújo AL, Paliares IC, de Araújo MI, Novo NF, Cadaval RA, Martinez JE (2015) The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases? Rev Bras Reumatol 55:37–42.

    Article  PubMed  Google Scholar 

  59. 59.

    Levy O, Segal R, Maslakov I, Markov A, Tishler M, Amit-Vazina M (2016) The impact of concomitant fibromyalgia on visual analogue scales of pain, fatigue and function in patients with various rheumatic disorders. Clin Exp Rheumatol 34(2 Suppl 96):120–124

    Google Scholar 

  60. 60.

    Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M (1999) Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Rheumatology (Oxford) 38:878–882

    CAS  Article  Google Scholar 

  61. 61.

    Alunno A, Carubbi F, Stones S, Gerli R, Giacomelli R, Baraliakos X (2018) The impact of fibromyalgia in spondyloarthritis: from classification criteria to outcome measures. Front Med (Lausanne) 5:290.

    Article  Google Scholar 

  62. 62.

    Dougados M, Logeart I, Szumski A, Coindreau J, Jones H (2017) Evaluation of whether extremely high enthesitis or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores suggest fibromyalgia and confound the anti-TNF response in early non-radiographic axial spondyloarthritis. Clin Exp Rheumatol 35(Suppl 105):50–53

    PubMed  Google Scholar 

  63. 63.

    Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, Saag KG, O'Dell JR, Kazi S (2012) Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken) 64:640–647

    Article  Google Scholar 

  64. 64.

    Mian AN, Chaabo K, Wajed J, Subesinghe S, Gullick NJ, Kirkham B, Garrood T (2016) Rheumatoid arthritis patients with fibromyalgic clinical features have significantly less synovitis as defined by power Doppler ultrasound. BMC Musculoskelet Disord 17:404.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Segurado OG, Sasso EH (2014) Vectra DA for the objective measurement of disease activity in patients with rheumatoid arthritis. Clin Exp Rheumatol 32(5 Suppl 85):S29–S34

    Google Scholar 

  66. 66.

    Lee YC, Hackett J, Frits M, Iannaccone CK, Shadick NA, Weinblatt ME, Segurado OG, Sasso EH (2016) Multibiomarker disease activity score and C-reactive protein in a cross-sectional observational study of patients with rheumatoid arthritis with and without concomitant fibromyalgia. Rheumatology (Oxford) 55:640–648.

    CAS  Article  Google Scholar 

  67. 67.

    Curtis JR, Greenberg JD, Harrold LR, Kremer JM, Palmer JL (2018) Influence of obesity, age, and comorbidities on the multi-biomarker disease activity test in rheumatoid arthritis. Semin Arthritis Rheum 47:472–477.

    Article  PubMed  Google Scholar 

  68. 68.

    da Silva Chakr RM, Brenol JC, Behar M, Mendonça JA, Kohem CL, Monticielo OA, Brenol CV, Xavier RM (2015) Is ultrasound a better target than clinical disease activity scores in rheumatoid arthritis with fibromyalgia? A case–control study. PLoS ONE 10:e0118620.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Ghib LJ, Tămaş MM, Damian LO, Felea I, Muntean LM, Rednic N, Rednic S (2015) The role of ultrasonography in assessing disease activity in patients with rheumatoid arthritis and associated fibromyalgia. Med Ultrason 17:339–344.

    Article  PubMed  Google Scholar 

  70. 70.

    Coskun Benlidayi I (2019) Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int 39:781–791.

    CAS  Article  PubMed  Google Scholar 

  71. 71.

    Imamura M, Targino RA, Hsing WT, Imamura S, Azevedo RS, Boas LS, Tozetto-Mendoza TR, Alfieri FM, Filippo TR, Battistella LR (2014) Concentration of cytokines in patients with osteoarthritis of the knee and fibromyalgia. Clin Interv Aging 9:939–944.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Mendieta D, De la Cruz-Aguilera DL, Barrera-Villalpando MI, Becerril-Villanueva E, Arreola R, Hernández-Ferreira E, Pérez-Tapia SM, Pérez-Sánchez G, Garcés-Alvarez ME, Aguirre-Cruz L, Velasco-Velázquez MA, Pavón L (2016) IL-8 and IL-6 primarily mediate the inflammatory response in fibromyalgia patients. J Neuroimmunol 290:22–25.

    CAS  Article  PubMed  Google Scholar 

  73. 73.

    Kadetoff D, Lampa J, Westman M, Andersson M, Kosek E (2012) Evidence of central inflammation in fibromyalgia-increased cerebrospinal fluid interleukin-8 levels. J Neuroimmunol 242:33–38.

    CAS  Article  PubMed  Google Scholar 

  74. 74.

    Pernambuco AP, Schetino LP, Alvim CC, Murad CM, Viana RS, Carvalho LS, Reis D (2013) Increased levels of IL-17A in patients with fibromyalgia. Clin Exp Rheumatol 31(6 Suppl 79):S60–63

    PubMed  Google Scholar 

  75. 75.

    Rifbjerg-Madsen S, Christensen AW, Christensen R, Hetland ML, Bliddal H, Kristensen LE, Danneskiold-Samsøe B, Amris K (2017) Pain and pain mechanisms in patients with inflammatory arthritis: a Danish nationwide cross-sectional DANBIO registry survey. PLoS ONE 12:e0180014.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references



Author information



Corresponding author

Correspondence to Ilke Coskun Benlidayi.

Ethics declarations

Conflict of interest

The author declares that she has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Coskun Benlidayi, I. Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases. Rheumatol Int 40, 849–858 (2020).

Download citation


  • Biological drugs
  • Disease-modifying antirheumatic drugs
  • Fibromyalgia
  • Rheumatic diseases
  • Rheumatoid arthritis
  • Spondyloarthritis