Criteria For Classification Of Fibromyalgia Research Articles

Peripheral joint and enthesis involvement in patients with newly diagnosed inflammatory bowel disease: symptoms, clinical and ultrasound findings - a population-based cohort study.

Musculoskeletal manifestations in patients with inflammatory bowel disease (IBD) are common and associated with poorer outcomes. Hence, early detection is important to optimally tailor treatment. We aimed to determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients. Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Data on musculoskeletal symptoms were collected by questionnaires and by structured rheumatological interview. Peripheral joints and entheses were assessed clinically and by ultrasound (US), using standardized definitions. Of 110 included patients (mean age: 42 years, 40% male, 70 with ulcerative colitis (UC), 40 with Crohn's disease (CD)), history of ≥1 musculoskeletal symptoms was reported by 49%. Clinical examination revealed peripheral musculoskeletal manifestations in 56 (52.3%) patients; 29 (27.1%) had ≥1 tender and/or swollen joints and 49 (45.8%) ≥1 tender entheses. Small peripheral joints were predominantly affected. US found inflammation in ≥1 joint or enthesis in 52 (49.5 %) patients; 29 (27.4 %) had US synovitis in ≥1 joint, while 36 (34%) US enthesitis. Fibromyalgia classification criteria were fulfilled in seven (7.9%) patients. There was no difference in clinical or US findings between patients with UC and CD, nor between patients with active and inactive IBD. Half of patients with newly diagnosed IBD had inflammation in their peripheral joints and/or entheses, documented by rheumatological clinical and ultrasound evaluations. This indicates a need for multidisciplinary collaboration to ensure an optimal therapeutic strategy for suppressing inflammation in all disease domains.

Clinical and Serologic Phenotyping and Damage Indices in Patients With Systemic Lupus Erythematosus With and Without Fibromyalgia.

Given fibromyalgia (FM) frequently co-occurs with autoimmune disease, this study was initiated to objectively evaluate FM in a multiracial/ethnic cohort of patients with systemic lupus erythematosus (SLE). Patients with SLE were screened for FM using the 2016 FM classification criteria during an in-person rheumatologist visit. We evaluated hybrid Safety of Estrogens in Lupus National Assessment (SELENA)-SLE Disease Activity Index (SLEDAI) scores, SLE classification criteria, and Systemic Lupus International Collaborating Clinics damage index. We compared patients with and without FM and if differences were present, compared patients with FM with patients with non-FM related chronic pain. 316 patients with SLE completed the FM questionnaire. 55 (17.4%) met criteria for FM. The racial composition of patients with FM differed from those without FM (P = 0.023), driven by fewer Asian patients having FM. There was no difference in SLE disease duration, SELENA-SLEDAI score, or active serologies. There was more active arthritis in the FM group (16.4%) versus the non-FM group (1.9%) (P < 0.001). The Widespread Pain Index and Symptom Severity Score did not correlate with degree of SLE activity (r = -0.016; 0.107) among patients with FM or non-FM chronic pain (r = 0.009; -0.024). Regarding criteria, patients with FM had less nephritis and more malar rash. Systemic Lupus International Collaborating Clinics damage index did not differ between groups. Except for arthritis, patients with SLE with FM are not otherwise clinically or serologically distinguishable from those without FM, and Widespread Pain Index and Symptom Severity Score indices do not correlate with SLEDAI. These observations support the importance of further understanding the underlying biology of FM in SLE.

Post-Acute COVID-19 Joint Pain and New Onset of Rheumatic Musculoskeletal Diseases: A Systematic Review.

As the number of reports of post-acute COVID-19 musculoskeletal manifestations is rapidly rising, it is important to summarize the current available literature in order to shed light on this new and not fully understood phenomenon. Therefore, we conducted a systematic review to provide an updated picture of post-acute COVID-19 musculoskeletal manifestations of potential rheumatological interest, with a particular focus on joint pain, new onset of rheumatic musculoskeletal diseases and presence of autoantibodies related to inflammatory arthritis such as rheumatoid factor and anti-citrullinated protein antibodies. We included 54 original papers in our systematic review. The prevalence of arthralgia was found to range from 2% to 65% within a time frame varying from 4 weeks to 12 months after acute SARS-CoV-2 infection. Inflammatory arthritis was also reported with various clinical phenotypes such as symmetrical polyarthritis with RA-like pattern similar to other prototypical viral arthritis, polymyalgia-like symptoms, or acute monoarthritis and oligoarthritis of large joints resembling reactive arthritis. Moreover, high figures of post-COVID-19 patients fulfilling the classification criteria for fibromyalgia were found, ranging from 31% to 40%. Finally, the available literature about prevalence of rheumatoid factor and anti-citrullinated protein antibodies was largely inconsistent. In conclusion, manifestations of rheumatological interest such as joint pain, new-onset inflammatory arthritis and fibromyalgia are frequently reported after COVID-19, highlighting the potential role of SARS-CoV-2 as a trigger for the development of autoimmune conditions and rheumatic musculoskeletal diseases.

P096 Exploring fibromyalgia patients by gender using routinely collected primary-care data from Wales, UK: a descriptive epidemiological study

Abstract Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings show lower estimates (59%). The psychosocial impacts are similar in men and women but men delay seeking treatment and medical advice. Revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender-point sites, which led to various prevalence rates and female-to-male ratios. This study aimed to measure new cases of fibromyalgia, determine the sex ratio following criteria revisions and explore treatments and symptoms by gender. Methods A retrospective population-based cohort study using primary-care electronic health-data from the Secured Anonymised Information Linkage Databank in Wales. Individuals aged 18 years and over with fibromyalgia READ Codes (N239’. and ‘N248.’) between 2004 and 2018 were included in the study. New cases were defined at first appearance of fibromyalgia READ codes. New cases of fibromyalgia were calculated at three 5-year periods; period 1 (2004-2008), 2 (2009-2013) and 3 (2014-2018). Descriptive analysis performed on variables for individuals by gender. Results Data on 22,568 individuals with fibromyalgia were extracted. The mean age of individuals was 48 years (SD: 13) and 20,040 (88.8%) were female. In period 1, among 5,296 new cases of fibromyalgia, 784 (14.8%) were male and 4,512 (85.2%) were female. In period 2, 642 (10.8%) of 5,958 new cases were male and 5,316 (89.2%) female, while in period 3, 1,102 (9.7%) of 11,314 new cases were male and 10,212 (90.3%) female. Women had a significantly higher BMI compared to men (difference: 1.6%, 95% CI: 1.5 - 1.7) and experienced more widespread pain (difference: 3.9%, 95% CI: 2.4 - 5.6). Women also experienced more stress and bereavement (difference: 12.1%, 95% CI: 10.3 - 13.8) and adverse life events (difference 10.4%, 95% CI: 9.1 - 11.6) compared to men. Men had significantly more comorbidities however women had more gastrointestinal disorders (difference 10%, 95% CI: 8.4-11.4) and abnormal thyroid function (difference 3.3%, 95% CI: 2.7-3.8). Significantly more women received steroid treatment (difference: 8.3%, 95% CI: 6.3-10.3), antidepressants (difference: 5.4%, 95% CI: 4.2-6.6), anxiolytics and barbiturates (difference: 7.2%, 95% CI: 5.2-9.2) and vitamin D (difference: 1.8%, 95% CI: 1.0-2.5), while significantly more men were treated with gabapentin (difference: 9%, 95% CI: 7.0-11). Conclusion Routinely collected health-data does not demonstrate an increase in fibromyalgia in men despite changes in classification criteria. Fibromyalgia may be underdiagnosed in men. However, significant gender differences in men and women living with fibromyalgia were observed. Different medications used may represent clinician or patient choice and is worthy of future study. Disclosure R. Cooksey: Grants/research support; Pfizer. E. Choy: Grants/research support; Abbvie, Amgen, AstraZeneca, Biogen, Bio-Cancer, Biocon, BMS, Boehringer Ingelheim, Celgene, Chugai Pharma, Eli Lilly, Galapagos Gilead, Janssen, Novimmune, Novartis, ObsEva, Pfizer, Regneron, Roche, R-Pharm, Sanofi, SynAct Pharma, UCB.

Fibromyalgia syndrome in medical students

Aim of the workTo investigate the frequency of fibromyalgia syndrome (FMS) among medical students and its stratifications. Patients and methodsThe work included 513 medical students from Kafrelsheikh University. The 2010 and 2016 American College of Rheumatology (ACR) fibromyalgia classification criteria were used to determine the presence of FMS. The chronic pain grade questionnaire was used to assess pain severity and impact on daily activities, recreational, social and family activities, and ability to work. ResultsThe students were 296 females (57.7 %) and 217 males (42.3 %). 64 (12.5 %) fulfilled the 2010 criteria (F:M 2.8:1) (p = 0.015). The frequency of female affection was 15.9 % (47/296) compared to 7.83 % (17/217) in male. 37 (7.2 %) fulfilled 2016 criteria and only six cases (9.3 %) were known to have FMS. The frequency of FMS in students of the first 3 years (basic science) and the following 3 years (clinical) was 14.1 % and 9.5 %, respectively. Considering the chronic pain grade, there was a significant difference (p < 0.0001) in all pain items, daily recreational, social, family activities, and ability to work between those with and without FMS. 213 (41.5 %) had knowledge about FMS and the source of their information was from social media (39.4 %), their academic study (26.8 %), web pages (25.4 %) and friends (8.5 %). ConclusionFibromyalgia is highly frequent among medical students, especially females of basic years with a high impact on recreational, social, family activities, and ability to work. Medical students should be considered a “high-risk” group for FMS and should be educated about it and managed accordingly.

The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia.

This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria. This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria. In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively). Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.

Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study

<h2>Abstract</h2><h3>Background</h3> Fibromyalgia mainly affects women (80–90% of cases), but some contradictory studies have shown lower estimates (59% of cases affecting women). Psychosocial impacts of fibromyalgia are similar in men and women, but men delay seeking medical help. Subsequent revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender point sites, which led to various prevalence estimates and women to men ratios in the general population. We aimed to measure new cases of fibromyalgia to determine whether the sex ratio has changed after criteria revisions and to explore the symptoms and treatment. <h3>Methods</h3> This retrospective, population-based, cohort study was done in the UK (Wales) using primary-care electronic health data from the Secure Anonymised Information Linkage. Individuals aged 18 years or older with a first mention of fibromyalgia using READ codes (N239 and N248) were included and stratified by gender, which was coded as men or women. Cases of fibromyalgia were calculated at three 5-year periods (period 1 defined as 2004–08, period 2 defined as 2009–13, and period 3 defined as 2014–18). Descriptive analyses were performed on variables according to gender. <h3>Findings</h3> Between Jan 1, 2004, and Dec 31, 2018, data on 22 568 individuals with fibromyalgia were extracted. The mean age of participants was 48 years (SD 13) and 20 040 (88·8%) were women. In period 1, among 5296 new cases of fibromyalgia, 784 (14·8%) were men and 4512 (85·2%) were women. In period 2, 642 (10·8%) of 5958 new cases were men and 5316 (89·2%) were women, and in period 3, 1102 (9·7%) of 11 314 new cases were men and 10 212 (90·3%) were women. Women had a significantly higher BMI than men (difference 1·6%, 95% CI 1·5–1·7; p<0·01) and more widespread pain based on READ code (2·9%, 95% CI 1·8–4·0; p<0·05). Men had significantly more comorbidities; however, women had more gastrointestinal disorders (difference of 10·0%, 95% CI 8·4–11·4; p<0·01). A significantly higher number of women received steroids (difference of 8·3%, 6·3–10·3; p<0·01), antidepressants (5·4%, 4·2–6·6; p<0·01), and anxiolytics and barbiturates (7·2%, 5·2–9·2; p<0·01), whereas more men received gabapentin (9%, 7·0–11·0; p<0·01). <h3>Interpretation</h3> Routine health data does not show an increase of fibromyalgia in men compared with women, despite revisions to classification criteria. Men had significantly more comorbidities, except for gastrointestinal disorders. The sex differences in fibromyalgia treatment might represent clinician or patient choice and are worth exploring in future studies. <h3>Funding</h3> None

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

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. 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. 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. 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.

Role of ultrasound for assessment of psoriatic arthritis patients with fibromyalgia

ObjectiveTo investigate whether ultrasonography (US), as an objective imaging modality, can optimise the evaluation of disease activity in psoriatic arthritis (PsA) patients with concomitant fibromyalgia syndrome (FMS).MethodsThe study population included...

THU0456 THE “JOINT CRITERIA” FOR FIBROMYALGIA DIAGNOSIS IN RHEUMATOID ARTHRITIS PATIENTS: RELIABILITY COMPARED TO THE 2010 ACR CLASSIFICATION CRITERIA FOR FIBROMYALGIA

Background:A significant proportion of rheumatoid arthritis (RA) patients have concomitant fibromyalgia (FM) (1). Associated FM diagnosis in RA patients can determine worse treatment outcomes compared to patients without FM (1). A difference between tender joint count (TJC) and swollen joint count (SJC) ≥7, also named the ”joint criteria” was proposed as being diagnostic for FM in patients with RA. The ”joint criteria” were validated against the 1990 ACR Classification Criteria for FM and are easy to apply to patients with RA (2). Since then, the 2010 ACR Classification criteria for FM, which include somatic symptoms besides pain sensitivity, were developed and validated.Objectives:We aimed to determine the reliability of the joint criteria for fibromyalgia in RA compared to the ACR 2010 Classification Criteria for FM and to compare RA patients diagnosed with FM (FRA) to those without FM in terms of clinical variables.Methods:We performed a cross-sectional study on RA patients who presented in our department during a 3 months period. Tender joint count (TJC), swollen joint count (SJC), patient global assessment of disease activity (PGA) were determined. DAS28 scores were calculated using CRP. We applied the 2010 ACR Classification Criteria and the joint criteria for FM diagnosis. Kappa agreement coefficient was used to determine the reliability of the joint criteria against the 2010 ACR Classification Criteria for FM in patients with RA. Differences between groups were assessed using Mann-Whitney U test for numerical data or Chi square test for ordinal data.Results:We included 100 consecutive RA patients, 84% female, with a mean age of 57.3(12) years and mean disease duration of 14(9) years. Twenty-four patients (24%) had associated FM according to the ACR 2010 Classification Criteria and 22 (22%) patients satisfied the joint criteria for associated FM. The level of agreement between the joint criteria and the ACR 2010 classification criteria for FM was kappa=0.66, p&lt; 0.001, with a sensitivity of 70% and a specificity of 93%. FRA patients had similar demographic and disease characteristics compared to RA patients. Patients with FRA according to the joint criteria had significantly higher PGA, DAS28, and HAQ scores, but similar CRP values and SJC compared to RA patients (Table 1).Table 1.Demographic and clinical data of FRA and RA patientsVariableFRAn=22RAn=78p-valueAge (years)60 (10.7)59 (12.2)0.093Disease Duration (years)13.3 (13)12.2 (7.5)0.589ACPA seropositivity(%)69550.1SJC2(4)2(4)0.7CRP (g/dl)12.8(14.2)8.1(13.7)0.06DAS28CRP4 (1.7)3.5 (1.2)0.009HAQ1.75 (0.5)1 (0.7)&lt;0.001PGA (mm)70(11)44(23)&lt;0.001Data are expressed as mean (SD) or median (IQR)FRA- Fibromyalgic Rheumatoid Arthritis; RA- Rheumatoid Arthritis;ACPA- Anti- citrullinated Protein Antibodies; CRP- C-reactive Protein; SJC- Swollen Joint Count;DAS28CRP- Disease Activity Score; HAQ- Health Assessment Questionnaire; PGA- Patient Global AssessmentConclusion:The joint criteria are diagnostic for FM in RA patients with moderate reliability compared to the ACR 2010 Classification criteria. When diagnosed with the joint criteria, FRA patients have higher disease activity scores despite having similar clinical and laboratory inflammatory markers compared to RA patients.

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)

BackgroundEpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990).ObjectiveTo analyze the therapeutic measures prescribed by Brazilian physicians.Materials and methodsCross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics.ResultsWe analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%).ConclusionIn this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.

Utilization of Overnight Pulse Oximetry in Fibromyalgia Patients.

ObjectiveTo assess whether the Berlin Sleep Questionnaire and the Snoring, Tired, Observed, Pressure, Body mass, Age, Neck, and Gender questionnaire (STOP-BANG) might be suitable replacements for an overnight sleep pulse oximetry as screening tools for sleep disordered breathing in patients with fibromyalgia.Participants: From June 8, 2018 through July 25, 2018, adult patients with a confirmed diagnosis of fibromyalgia (via the 1990 and/or 2010 American College of Rheumatology Fibromyalgia Classification Criteria) who attended Mayo Clinic’s Fibromyalgia Treatment Program were invited to participate in the study.Methods: The design was a prospective comparative study with a retrospective chart review component. Participants completed 2 validated surveys: the Berlin Sleep Questionnaire and the STOP-BANG. Medical records were reviewed for demographic information and overnight pulse oximetry test results.Results: Results from both questionnaires indicate that there is an association between sleep apnea risk category (defined by questionnaire) and oximetry results. Fisher’s exact test for STOP-BANG and Berlin Sleep Questionnaire are statistically significant (P < .001), indicating that participants at high risk for sleep apnea (based on the questionnaires) had a greater prevalence of abnormal oximetry results than those at low risk for sleep apnea. Participants who were classified as high risk (85.7%) or intermediate risk (61.5%) on the STOP-BANG questionnaire for sleep apnea had abnormal oximetry results. Participants who scored as high risk (85.7%) for sleep apnea on the Berlin Sleep Questionnaire had abnormal oximetry results.Conclusions: In patients with fibromyalgia, the Berlin Sleep Questionnaire and the STOP-BANG questionnaires could be beneficial in determining the probability of obstructive sleep apnea and the subsequent need for pulse oximetry testing, in higher risk patients.

Chronic Widespread Pain in a tertiary pain clinic: classification overlap and use of a patient generated quality of life instrument.

Background and aims This study has two main aims: (1) To explore the overlap between classification criteria in patients with Chronic Widespread Pain (CWP) and (2) To explore the use of the Patient Generated Index (PGI) as a quality of life (QoL) measure in this patient group. Methods Patients with Widespread Pain (ICD-11: pain in four or more out of five bodily regions, i.e. the four quadrants and axially) in a tertiary pain outpatient clinic were assessed according to classification criteria for Fibromyalgia [FM, American College of Rheumatology (ACR) criteria of 1990, 2010, 2011 and 2016], Chronic Fatigue Syndrome [CFS, Fukuda, Canada and International Consensus Criteria (ICC)] and Bodily Distress Syndrome (BDS). Furthermore, patients completed the PGI to assess QoL, and electronic questionnaires including demographic variables and standardised patient-reported outcome measures (PROMs). Results All patients (n=33) fulfilled the criteria for musculoskeletal type single-organ BDS, 81.8% met the 2016 modified criteria for FM, 30.3% met the Canada criteria for CFS and 24.2% met the criteria for multi-organ type BDS. There was substantial agreement between the 2016 and the 2011 and 2010 criteria sets for FM compared to the 1990 criteria (κ=0.766 and 0.673 compared to 0.279). Patients generally scored low on the PGI, indicating poor QoL (mean PGI 28.9, SD 19.8, range 0-100). Conclusions Our findings support the use of the term musculoskeletal type single-organ BDS to describe patients with CWP and the 2016 revision of the FM criteria. The PGI provides useful clinical information which is not captured by standardised PROMs. Implications The terminology of CWP has become less ambiguous as the new ICD-11 is closely related to the generalised pain criterion of the modified 2016 FM definition. Studies based on the 1990 classification criteria for FM should not be directly compared to studies based on later criteria set. The PGI may be a supplement to other measurements to portray patients' individual concerns in patients with complex symptom disorders.

Sudden Lower Limb Arthralgia/Trauma Triggering Fibromyalgia

Fibromyalgia (FM) is a common systemic disorder characterized by widespread musculoskeletal pain and a generalized reduction in pain threshold. The application of the American College of Rheumatology (ACR) Fibromyalgia classification criteria in 1990 has resulted in increasing recognition of the syndrome. The prevalence of FM in the United States is approximately 2%-4%, of which about 80% are women in the age range of 20 to 60 years. The cause of fibromyalgia is not clearly identified; however, it is assumed to involve a combination of genetic and environmental factors, with half the risk attributed to each.

Clinical, psychological features and quality of life of fibromyalgia patients: a cross-sectional study of Chinese sample.

This study aimed to determine the clinical, psychological features, and quality of life in Chinese fibromyalgia (FM) patients who fulfilled the American College of Rheumatology (ACR) 2010 FM classification criteria at initial diagnosis. A cross-sectional study was carried out in the Chinese People's Liberation Army (PLA) General Hospital. A hundred and seven Chinese FM patients (86 females, 21 males) were included. Eighty-six patients completed the questionnaires. Descriptive, differences, and correlation analyses were performed. The results showed that Chinese FM patients started their diseases at a median age of 37years, with a male-to-female ratio of 1:4.1. Most patients were diagnosed about 2years after symptoms onset. Nearly 60 % (59.81%) patients had less than college education, 58.88% did not have a full-time job, and 41.12% had low-back pain. Out of 86 patients, 58 (67.4%) had anxiety and 75 (87.2%) had depression. FM patients had poor quality of life in each aspect and deficient social support. The level of pain for the past 7days was strongly correlated with patient global impression of severity (PGI-S; r=0.651, p<0.001) and patient global impression of bother (PGI-B; r=0.628, p<0.001). PGI-B was correlated with seven subscales of short-form health survey (SF-36). The study demonstrated the clinical, psychological features of Chinese patients. The diagnosis was delayed for about 2years. Most of the patients had anxiety and depression, had poor quality of life, and lacked proper social support. PGI-B might be a simple measurement to evaluate patients' quality of life.

Fibromyalgia in patients with thyroid autoimmunity: prevalence and relationship with disease activity.

Fibromyalgia (FM) is a syndrome characterised by chronic musculoskeletal pain, tenderness and other somatic symptoms. The prevalence of FM is approximately 2-7% in the general global population and is 30-40% in the population of Hashimoto thyroiditis (HT) with a structural pathology. In 2010, new classification criteria for FM were proposed, as an alternative to the American College of Rheumatology (ACR) 1990 criteria. The objectives of the present study were to identify the prevalence of FM in the HT population and evaluate the associated features by using the new diagnostic criteria. The study group included 79 consecutive patients with HT with or without FM. Recorded data included age, gender, laboratory parameters, sociodemographic features and clinical findings, presence of somatic symptoms, and disease activity indices. The prevalence of FM in patients with HT was 62%. Antithyroid peroxidase antibody (TPOAb) positivity, duration of disease, and waist circumference were significantly associated with concomitant FM (p=0.000, p=0.000, and p=0.015, respectively). A strong positive correlation was noted between fibromyalgia impact questionnaire (FIQ) scores and disease duration, age, values of thyroid-stimulating hormone (TSH) and TPOAb, waist circumference and marital status. TPOAb was found to be independent of body mass index, age and TSH. Concomitant FM is a common clinical problem in HT and its recognition is important for the optimal management of the disease. The new set of diagnostic criteria for FM reinforces this situation. Consideration of the FM component in the management of HT increases the likelihood of treatment success.

EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation

IntroductionEpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). ObjectivesTo determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. MethodsThis is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. Results810 patients’ data were analyzed. Patients presented a mean age of 51.8±11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1±7.5 months (1–44). Most patients became stable. ConclusionInEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time.

CONCOMITANT FIBROMYALGIA IN RHEUMATOID ARTHRITIS: CHALLENGES IN DIAGNOSIS AND DISEASE ASSESSMENT

Fibromyalgia, characterized by chronic generalized pain and multiple somatic symptoms, is frequently associated with rheumatoid arthritis. This association causes worse disease outcomes and poses challenges in rheumatoid arthritis disease assessment. Recent studies found that fibromyalgia is a disease continuum. Varying degrees of symptoms can be present in patients with rheumatoid arthritis even if they do not satisfy diagnosis criteria for fibromyalgia. Classification criteria for fibromyalgia are recommended for use in research, but in clinical practice diagnosis should be based on physician judgment. Rheumatoid arthritis disease activity scores should be used with caution in patients with concomitant fibromyalgia because they are disproportionately high based on subjective variables, not inflammation. Other means of assessing disease activity such as ultrasonography or inflammation markers can be employed when trying to distinguish between inflammatory and non-inflammatory pain in patients with rheumatoid arthritis and concomitant fibromyalgia.

Rheumatoid arthritis patients with fibromyalgic clinical features have significantly less synovitis as defined by power Doppler ultrasound.

BackgroundIn patients with rheumatoid arthritis (RA) clinical measures of disease activity may not reliably discriminate between patients with active inflammatory disease and those with concomitant fibromyalgia (FM). Recent work has shown RA patients with a 28 tender joint count (TJC) minus swollen joint count (SJC) of 7 or more (joint count criteria) are more likely to meet classification criteria for FM. This study aimed to determine whether RA patients meeting clinical criteria for FM had lower levels of joint inflammation as determined by ultrasound (US).MethodsRA patients with DAS28 > 2.6 were recruited. Patients underwent clinical assessment including ultrasound examination of the hands and wrists with quantification of grey scale (GS) and power Doppler (PD) synovitis. Patients completed questionnaires to assess pain, fatigue, disability and psychological comorbidity.ResultsPatients meeting either of the FM criteria had higher scores for disease activity, depression, disability and fatigue. Those meeting both the joint count and classification FM criteria had significantly lower levels of GS and PD inflammation on US.ConclusionsRA patients with concomitant FM, as determined by widespread soft tissue tenderness but fewer clinically inflamed joints, have higher disease activity scores but may have lower levels of synovial inflammation on US. This has implications for the identification and management of these patients who may not respond to conventional therapy and hence be more suitable for alternative approaches to treatment.

EpiFibro (Registro Brasileiro de Fibromialgia): dados sobre a classificação do ACR e preenchimento dos critérios diagnósticos preliminares e avaliação de seguimento

IntroductionEpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). ObjectivesTo determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow‐up evaluation. MethodsThis is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow‐up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. Results810 patients’ data were analyzed. Patients presented a mean age of 51.8±11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between PDS and FIQ. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow‐up monitoring parameter were considered. (FIQ: 222; PDS: 199; both: 195). The mean follow‐up time was 9.1±7.5 months (1‐ 44). Most patients became stable. ConclusionInEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation. Most patients remained stable over time.