Agreed! The textbooks say that up to 50% of Sjogrens pts have FM - in my experience its closer to 90%! To not make a diagnosis of FM is one way to avoid seeing FM (you dont know what you dont know AND you cant treat what you dont see). However, most rheums know better. The issue is whether you choose to manage them chronically. My office has a "Catch & Release" approach - we diagnose them, see them once and return to their primary MD, sleep medicine MD or pain clinic if they have primary fibromyalgia.