Fibromyalgia/Pain

CDAI remission does not describe every symptom. In a 787-patient RA study, those in remission still had meaningful pain interference (19%), fatigue (20%) and impaired function (23%). PROMIS scores show symptoms that composite score missed. #2874 @Rheumnow #ACR26

In 8,090 RApts 18.3% had unacceptable pain and 14.6% had patient-physician discordance ≥3 cm. #ACR26 Abstract 0617: discordance was the strongest correlate of unacceptable pain, followed by joint distribution and disability. Ask why pain and inflammation disagree. @RheumNow https://t.co/8zVt1fo30J

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Jamshaid & Gomaa (Tirzepatide vs semaglutide cohort): tirzepatide was associated with lower 1-year and 3-year risks of treatment-defined flare proxies compared with semaglutide. @rheumnow #ACR2026 Abstract#2641

Is an acidic joint environment accelerating OA? New translational research links joint acidosis to chondrocyte senescence, while GPR68 activation appears to attenuate senescence responses.A potential therapeutic target beyond pain relief! Yung et al. | #LB03 @RheumNow #ACR26

Pain in myositis is heterogeneous.#ACR26 abs#2597: latent class analysis 426 pts used pain distribution, persistence, flare-related change and disease duration to id distinct pain phenotypes. One label may not fit all; consider inflammatory + nociplastic mechanisms. @RheumNow

New option for fibromyalgia. #ACR26 Abstract 2546: across 4 RCTs, bedtime sublingual cyclobenzaprine 5.6 mg reduced pain by ~1.8–1.9 points at 14 wks and was more consistent than 2.8 mg. Oral numbness occurred in 17–24%. Benefit is modest; discuss oral AEs. @RheumNow

Myositis is not always “painless weakness.” #ACR26 Abstract 2825: survey of 552 pts with IIM + pain. Mean pain was 4.6/10, rising to 7.4 during flares; 77% reported persistent pain. Low back 78%, neck 72% and upper legs 72% were most affected. Ask about pain. @RheumNow https://t.co/2J7y4WA0F7

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Inflammation may improve while pain persists in SLE. #ACR26 Abstract 2824: in 372 pts, 37% had mixed inflammatory + nociplastic symptoms. Over follow-up, inflammation declined but polysymptomatic distress stayed flat; ~37% remained above the nociplastic threshold. @RheumNow

Access matters. Among 16381 Canadian adults with RMDs and diabetes starting metformin, semaglutide initiation was lower in the poorest vs high-income neighbourhoods (aHR 0.86), despite a higher obesity burden. #2705 @Rheumnow #ACR26 https://t.co/uAzwdowufE

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Pain is not always inflammation in RA. Among 283 pts starting/changing DMARDs, 4 phenotypes emerged. One had the highest pain, fatigue, poor sleep and distress despite only moderate inflammation and remained most symptomatic at 12 weeks. #ACR26 @RheumNow https://t.co/stcP70a4iZ

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Can brief tools diagnose fibromyalgia? Meta-analysis: 29 studies, 10,728 evaluations. FiRST sensitivity 79%, specificity 82%. At 10% prevalence, PPV only 33% but NPV 97%. Useful to rule out, not confirm FM. Positive screens need clinical assessment. #ACR26 @RheumNow

Sublingual Cyclobenzaprine for Fibromyalgia: A Win, But a Modest One At ACR26, Abstract #2546 looked across four randomized, placebo-controlled trials of bedtime sublingual cyclobenzaprine. BESTFIT and AFFIRM studied 2.8 mg, with 103 and 262 actively treated patients, while https://t.co/RcJB9Vx8Zr

OA treatment guidelines! #ACR26 Walking is added to the recs..exercise was always there MTX now okay to use for hand OA Supplementation- chondrotin and glucosamine as well as PRP injections NOT recommended GLP1 for weight loss for obese +knee OA. Nsaids emphasized @RheumNow https://t.co/9PJQwrrm7z

Swiss SCQM registry: 63.6% of 2,087 PsA patients had overweight or obesity, against 31% overweight and 12% obese in the general population. Key finding: higher BMI was associated with higher disease activity, cardiometabolic comorbidity and depression. @rheumnow #ACR26

Symptom-Inflammation Phenotypes in Active RA Data from CPIRA cohort (n=283, established active RA), used K-means clustering on PROs + inflammatory markers (SJC28, hsCRP) to find phenotypes. Identified 4 clusters: -C1 (n=117): low-moderate inflammation, low symptoms -C2 (n=77): https://t.co/s8wCEtj3iI

The Problem of Pain in SLE 372 adults with SLE in FORWARD (National Databank for Rheumatic Diseases) evaluated nociplastic (Type 2: based on PSD scale) vs inflam. (Type 1) disease activity overlap and change over time. -At baseline: 36% Minimal, 21% Type 1, 6% Type 2, 37% Mixed.

Tender-Swollen Joint Difference Thresholds in RA with Fibromyalgia: Data from CPIRA study (n=295) on RA pts either starting or switching DMARDs due to active disease. -TSJD was calculated as the number of tender joints minus swollen joints on standardized 28-joint exams. - 29% https://t.co/WIg1j1O4vz

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Mastocytosis and Pain? Single-center, retrospective, cross-sectional study assessed msk pain through standardized questionnaire in 74 pts with mastocytosis. 47 (58.7%) reported musculoskeletal pain. -Pain was chronic (53.1%), persistent (74.4%) and predominantly nociceptive

Age-related differences in cannabis consumption patterns in pts with RMDs with chronic pain. Cross-sectional, online survey of 865 adults (81% Female, 93% White, 65% with at least a bachelor’s degree) with self-reported RMDs. Chronic pain > 3 months was reported by 82%. RA

A#2826 @RheumNow #ACR26 Transcriptional profile of circulating monocytes assoc w nociplastic pain in RA Key pathways: - NFkB correlates w high pain sensitization - Macrophage activation corr PROMIS pain - Cytokine production LOWER PROMIS fatigue Further study IFN sig w pain sens https://t.co/AVvQLgUPLT

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Conaghan et al. (TRIUMPH-4): Retatrutide 9 mg: weight -26.4% and WOMAC pain -4.48 at week 68; placebo: -2.1% and -2.43, respectively. A potentially important OA strategy. @rheumnow #ACR2026 Abstract#0871

#ACR26 @RheumNow Ab#2824 FORWARD - type 2 SLE sx (nociplastic, non-inflamm) Scored Inflammatory sx score (SLAQ), Fibromyalgia survey score -59% had high FM score -Opioid use in combined inflamm/FM group -FM scores did not follow inflamm improv 1 in 6 had peristent nociplastic sx https://t.co/lNwhz4uunA

#ACR26 @RheumNow Ab#2823 CPIRA (Centralized Pain in RA) - RA observ cohort, change of DMARD at entry, 12 wk 1/4 pts = symptom-dominant phenotype w less inflamm, highest BMI, TJC, FSQ Symptoms do not align with inflamm Distinct profiles remain apparent at 12 wks despite new Rx https://t.co/92EK2P568s

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#ACR26 @RheumNow A#1822 B/L Nociplastic Pain Assoc w Worse Chronic Low Back Pain (CLBP) Fxn comeBACK - prospective, longitudinal cohort of CLBP Evaluate absent/possible/probable nociplastic pain Absent - improvement of Phys fxn over time, possilbe - stable, probable-show decline https://t.co/9m1NM6t6N3

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A#1554 #ACR26 @RheumNow Survey of Canada Rheum 2012 v 2026 In 2026: more say Fibro disables (71% v 58% in 2012) BUT LESS say it's Rheum responsibility- ONLY 7% (was 29%), Less accept referrals (24% v 60%) Who treats? Per rheum: 2012: 89% said PCP 2026: 52% said pain mgmt, 39% PCP

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