Background/Purpose: Pain is the strongest driver of patient-physician discordance in global assessment in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Having secondary fibromyalgia (FM), a disorder with vague and nonspecific symptoms (e.g., widespread body pain or fatigue) may increase the likelihood of discordance. We aim to analyze if patients with RA and OA presenting with secondary FM have higher likelihood of discordance.

Methods: All patients complete a multidimensional health assessment questionnaire (MDHAQ) as part of their routine care which includes scores for physical function, pain, PATGL, fatigue, and demographic data. Rheumatologists complete a RheuMetric including 4 visual analogue scales: a physician global assessment (DOCGL) and three subscales for inflammation, damage, and distress/FM. A mean difference PATGL-DOCGL ≥2cm was considered a relevant discordance. Patients with a clinical diagnoses of OA or RA were classified into 3 categories: PATGL ≥ DOCGL by 2/10 units, PATGL = DOCGL, and DOCGL ≥ PATGL by 2 units. Secondary FM was evaluated using two criteria: 1) clinical diagnosis by the treating rheumatologist. 2) A score ≥6 in the VAS for distress/FM. The percentage of patients in each group was compared using chi-square.

Results: 243 OA and 216 RA patients were included. Patients with OA were older and showed higher scores for PATGL, pain, and fatigue (data not showed) and higher level of discordance (PATGL>DOCGL) in comparison with RA (34% vs 18%, p<0.001). A higher percentage of patients with OA showed secondary FM (15% versus 3%, p<0.001) and a VAS for distress ≥6 (12% versus 5%, p=0.01) in comparison with patients with RA. Patients with OA and secondary FM have higher level of concordance (PATGL=DOCGL) in comparison with patients with OA without secondary FM (Table). There were no significant differences in the RA patients group when comparing patients with and without secondary FM (Table).

Conclusion: Patient-physician discordance is more prevalent in patients with OA versus RA. FM is also more prevalent in OA versus RA but the presence of FM does not account for the higher discordance rate. In fact, those with OA and FM appear to have more concordant scores with their physicians. The dual diagnoses of FM may make the physicians more sensitive to the pain of their patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/secondary-fibromyalgia-is-not-associated-with-higher-likelihood-of-patient-physician-discordance-in-global-assessment-in-patients-with-osteoarthritis-and-rheumatoid-arthritis/