Evidence map›Paper›PMID 42236570›Full record

ArticleRheumatology international2026

Fibromyalgia in systemic autoimmune rheumatic diseases: a mixed-methods study of patient and clinician perspectives.

Dorsa Manavi, Alice Tunks, Wendy Diment, Alessandra Bortoluzzi, James A Bourgeois, Lucy Calderwood, Xiaofeng Yan, Melanie Sloan

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Rheumatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Dorsa ManaviUniversity of Cambridge School of Clinical Medicine, Hills Rd, Cambridge, CB2 0SP, UK. dm929@cam.ac.uk.ORCID http://orcid.org/0009-0009-4154-6687
Alice TunksDepartment of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK.ORCID http://orcid.org/0000-0002-7960-7870
Wendy DimentPatient and Public Co-Investigators, Cambridge, UK.
Alessandra BortoluzziDepartment of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy.ORCID http://orcid.org/0000-0003-2416-8134
James A BourgeoisDepartment of Psychiatry and Behavioral Sciences, Davis Medical Center, University of California, Sacramento, CA, USA.ORCID http://orcid.org/0000-0002-1426-474X
Lucy CalderwoodPatient and Public Co-Investigators, Cambridge, UK.ORCID http://orcid.org/0009-0007-7098-688X
Xiaofeng YanNorCal Neurostimulation, Folsom, CA, USA.
Melanie SloanDepartment of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK.ORCID http://orcid.org/0000-0001-8153-9064

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Fibromyalgia is frequently diagnosed alongside systemic autoimmune rheumatic diseases (SARDs), yet impacts remain poorly understood. This study aimed to examine patients' and clinicians' perspectives of the psychosocial, clinical, and relational impact of fibromyalgia as a co-diagnosis in SARDs. We employed explanatory mixed-methods study integrating survey data from 1269 adults with SARDs, and interviews with patients (n = 19) and clinicians (n = 21). Outcomes included wellbeing (WEMWBS, 14-70), trust, confidence in receiving medical help, adaptation, satisfaction with care (all 1-5), and self-rated health (0-100). Independent t-tests compared outcomes by fibromyalgia status and by patients' diagnostic acceptance. Qualitative open-text responses and interviews were analysed thematically. Among participants (95.1% female n = 1207; lupus 31.0% n = 393 and rheumatoid arthritis 31.3% n = 397), fibromyalgia was reported by 25.9% (n = 329) of whom 52.8% (n = 174) questioned diagnostic accuracy. Compared with those without fibromyalgia, affected participants reported significantly lower wellbeing (mean difference(SD) = -4.206(0.608)), trust in GPs (mean difference(SD) = -0.239(0.092)) and rheumatologists (mean difference(SD) = -0.515(0.097)), confidence in receiving help (mean difference(SD) = -0.459(0.073)), and satisfaction with care (mean difference(SD) = -0.563(0.073)), alongside poorer adaptation (mean difference(SD) = -0.223(0.066)) and life satisfaction (mean difference(SD) = -0.519(0.071)), but higher self-rated health (mean difference(SD) = 11.107(1.411); all p < 0.05). Diagnostic acceptance showed minimal quantitative differences across outcomes. Thematic analysis highlighted that diagnostic uncertainty was driven by overlapping symptoms and limited biomarkers. Variations in clinician practices affected patients' trust and acceptance. Furthermore, misdiagnosis and dismissal led to stigma, delayed recognition of conditions, and considerable patient distress. In SARDs, fibromyalgia diagnosis is associated with poorer wellbeing and reduced trust in healthcare providers, irrespective of diagnostic acceptance, and often reflects diagnostic uncertainty. Mechanism-based explanations may help improve communication and provide greater clinical utility than categorical diagnostic labelling.

Indexed as

Arthritis, RheumatoidAttitude of Health PersonnelAutoimmune DiseasesFibromyalgiaLupus Erythematosus, SystemicRheumatic DiseasesAdaptation, PsychologicalAdultAgedFemaleHumansMaleMiddle AgedPatient SatisfactionPhysician-Patient RelationsPsychological Well-BeingAutoimmune diseasesDiagnostic uncertaintyFibromyalgiaMixed methods researchPhysician–patientRelationsRheumatic diseasesSurveys and questionnaires

Identifiers

PMID42236570
PMCPMC13234023

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.