Researchers Debate Conventional Treatment Guidelines for Rheumatoid Arthritis Patients with Fibromyalgia

Researchers Debate Conventional Treatment Guidelines for Rheumatoid Arthritis Patients with Fibromyalgia

In a recent study entitled “The role of ultrasonography in assessing disease activity in patients with rheumatoid arthritis and associated fibromyalgia” and published in the Medical Ultrasonography journal, a team of researchers discusses how ultrasonography helps in selecting the appropriate therapy for rheumatoid arthritis patients with associated fibromyalgia.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by irreversible joint damage, which affects mostly women in middle and elderly ages. Approximately 20% of RA patients develop fibromyalgia, a syndrome affecting muscles and soft tissues, whose symptoms include diffuse pain, fatigue, sleep disturbance and painful tender or trigger points. RA and fibromyalgia are associated with a higher patient disability, lower quality of life and higher medical costs.

RA treatment is symptomatic, aiming at controlling and preventing joint damage. In 2010, an international team of rheumatologists suggested that RA treatment should follow specific guidelines, according to the disease activity score. Tender joint and swollen joint counts, patient and physician global assessments and erythrocyte sedimentation rate are the parameters defining the RA disease activity score. Nonetheless, studies indicate that RA disease activity scores might be overestimated in RA patients with associated fibromyalgia. These results unveil the need for disease assessment approaches that can discriminate between RA and fibromyalgia symptoms.

In this study, researchers evaluated the use of ultrasonography, an important tool to determine joint health and RA radiological progression, when compared to a conventional method to determine RA disease score (DAS28) in patients with RA, RA and fibromyalgia and fibromyalgia. Each study group was comprised of 10 patients with the associated conditions.

The team found that the overall disease score given by DAS28 is not a reliable measure of disease activity in patients with RA and associated fibromyalgia. An objective assessment of RA activity is given by the joint evaluation parameters – synovial hypertrophy, effusions and neovascularization – determined by ultrasonography. The authors recommend that before employing treatments against RA symptoms, fibromyalgia status should be assessed. Therapeutic decisions should be taken carefully, considering the individual components of disease activity scores, which are different between RA patients and RA patients with fibromyalgia. Alternatively, ultrasonography parameters should be used to decide the appropriate RA treatment. Nonetheless, authors’ recommendations should be taken with ease, since their findings are based on a small sample size and on a single method to determine RA disease activity score.

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