Rheumatology International

, Volume 39, Issue 10, pp 1703–1710 | Cite as

Performance of 2016 revised fibromyalgia diagnostic criteria in patients with rheumatoid arthritis

  • Nada Mahmoud Shresher
  • Aly Elsayed Mohamed
  • Mohsen Hassan ElshahalyEmail author


Fibromyalgia (FM) is a common comorbidity in rheumatoid arthritis (RA). Recently, there were several updates for the American College of Rheumatology (ACR) FM criteria. To assess the performance of the 2016 revised ACR FM criteria in patients with RA in comparison to 1990 criteria and to study the relation to composite disease measures. This study included 130 adult RA patients fulfilling the 2010 ACR/EULAR classification criteria for RA. Patients were evaluated according to 2016 and 1990 ACR criteria for FM. Kappa agreement between the two criteria was determined. Spearman’s correlation between the polysymptomatic distress scale (PSD) and selected variables including disease activity score-28 with erythrocyte sedimentation rate (DAS-28 ESR), clinical disease activity index (CDAI), patient global assessment (PGA), and visual analogue scale (VAS) for pain was evaluated. Of the 130 RA patients, 52 patients (40%) satisfied the 2016 criteria and 40 (31.5%) the 1990 criteria. The Kappa agreement between the two criteria was 0.733. RA patients with FM had higher DAS28-ESR, CDAI, PGA, and VAS compared with those without FM. A significant positive correlation was found between the polysymptomatic Distress scale (PSD) and DAS28-ESR, CDAI, and PGA (rs 0.481, 0.516, 0.511, respectively, P < 0.001). FM coexists in a substantial number of RA patients according to the 2016 revised criteria and associated with high composite disease activity measures. Therefore, assessment of FM should be considered in RA patients with persistently high disease activity.


Fibromyalgia Rheumatoid arthritis Prevalence Polysymptomatic distress 


Author contributions

All authors are fully responsible for the integrity of all parts of the manuscript and no part of the manuscript has been copied or previously published in whole or in part elsewhere. Study conception and design: AM and ME. Subjects recruitment and data collection: NS, AM, and ME. Data analysis: AM and ME. Writing, editing, appraising, and approving the final manuscript: All authors.

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest.

Ethical approval

The study protocol was approved by the Research Ethics Committee of the Faculty of Medicine, Suez Canal University (18/7/2018-3526). All patients provided written informed consent in accordance with the ethical standards of the 2013 version of the Declaration of Helsinki.

Supplementary material

296_2019_4403_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Physical Medicine, Rheumatology and RehabilitationDamietta Specialized HospitalDamiettaEgypt
  2. 2.Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt

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