Fibromyalgia or a fibromyalgia like illness is the leading comorbidity in patients with RA with persistent pain, disabilty, fatigue, brain fog, etc. It also inflates disease activity scores in RA. In my experience, this is the most common phenotype of long COVID pertaining to rheumatology. And yet, all clinical trials of RA choose to ignore this or fail to account for it. How long can we continue to ignore this situation and continue to escalate immunosuppression for RA calling it "refractory" RA? Even in RA, central and peripheral sensitization is well known as causing persistent pain. What is the best way to change this?