FIRST Questionnaire Can Help Detect Fibromyalgia in RA Patients

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A study from EULAR details the ability of the FIRST self-questionnaire to identify fibromyalgia in patients with rheumatoid arthritis.

A diagnosis of fibromyalgia was associated with a negative impact on the evolution of rheumatoid arthritis (RA), leading investigators of a recent study to call for a greater emphasis on optimal screening strategies.

Results of the study, which were presented at the Annual European Congress of Rheumatology (EULAR) 2024, indicate presence of fibromyalgia was associated with greater disease activity in RA, but investigators also found a novel self-questionnaire could help improve diagnosis of concomitant fibromyalgia in this patient population.1

“This investigation estimated the prevalence and health effects of concomitant [fibromyalgia] in RA patients. High rates of [fibromyalgia] are reported in this rheumatic disease. High rates of [fibromyalgia] are reported in this rheumatic disease,” investigators wrote.1 “Fibromyalgia has a negative impact on the evolution of RA”

Distinct conditions with similar deleterious effects on quality of life, recent estimates indicate fibromyalgia is present in approximately 1 in 5 patients with RA. A disease characterized by widespread pain and fatigue, research indicates fibromyalgia can influence disease severity in multiple forms of inflammatory arthritis.1,2

Led by Ichrak Mnif and colleagues at the Hedi Chaker University Hospital, the current study was launched to assess the prevalence of fibromyalgia among patients with RA, performance of the Fibromyalgia Rapid Screening Tool (FIRST) self-questionnaire for the detection of fibromyalgia and assess demographic and clinical differences among patients with and without concomitant rheumatoid arthritis. With this in mind, investigators designed a cross-sectional study of patients diagnosed with rheumatoid arthritis diagnosed according to the American College of Rheumatology (ACR)/EULAR 2010 criteria.1

The FIRST questionnaire was a 6-item questionnaire, with each question worth a single point and is a screening questionnaire for fibromyalgia if an individual score of 5 or more was achieved. The diagnosis of fibromyalgia was confirmed using ACR 2010 criteria. Outcomes of interest related to disease activity and clinical factors included epidemiological characteristics, Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ), which investigators noted were assessed for each patient.1

A total of 60 patients were identified for inclusion in the study. This cohort was 88.3% female, had a mean age of 54 (SD, 12) years, and had a mean duration of disease of 12 (SD, 8) years. Assessment of disease activity indicated 9 patients had low disease activity, 34 patients had moderate disease activity, and 15 patients had high disease activity.1

All 60 patients completed the questionnaire and 26 had a score of 5 or greater. Among this group of 26, 18 (30%) fulfilled the ACR 2010 criteria for fibromyalgia. Further analysis found patients with concomitant fibromyalgia had a greater use of corticosteroids and biological therapy (P = .05), greater rate of high disease activity (50% vs 14.2%), and a reduced rate of remission (0% vs 4.7%).1

Investigators highlighted patients with concomitant fibromyalgia had greater DAS-28 score (5.2 vs 4.3; P = .03), worse HAQ (1.7 vs 1.1; P = .17), increased rate of positive rheumatoid factor (55.6% vs 44.2%; P >.05), and increased rate of positive anti-CCP 55.6% and 41.9%; P >.05).1

“Making a screening strategy is vitally important to avoid over or inadequate treatment,” investigators wrote.1 “The FIRST questionnaire is easy and straightforward to use.”


  1. Inf I, Feki A, Gassara Z, et al. THE PREVALENCE AND IMPACT OF COMORBID FIBROMYALGIA IN RHEUMATOID ARTHRITIS. Abstract presented at Annual European Congress of Rheumatology (EULAR) 2024. Vienna, Austria. June 12-15, 2024.
  2. Zhao SS, Duffield SJ, Goodson NJ. The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis. Best Pract Res Clin Rheumatol. 2019;33(3):101423. doi:10.1016/j.berh.2019.06.005