INTRODUCTION: Pain remains the most important problem for people with rheumatoid 
arthritis (RA). Active inflammatory disease contributes to pain, but pain due to 
non-inflammatory mechanisms can confound the assessment of disease activity. We 
hypothesize that augmented pain processing, fibromyalgic features, poorer mental 
health, and patient-reported 28-joint disease activity score (DAS28) components 
are associated in RA.
METHODS: In total, 50 people with stable, long-standing RA recruited from a 
rheumatology outpatient clinic were assessed for pain-pressure thresholds (PPTs) 
at three separate sites (knee, tibia, and sternum), DAS28, fibromyalgia, and 
mental health status. Multivariable analysis was performed to assess the 
association between PPT and DAS28 components, DAS28-P (the proportion of DAS28 
derived from the patient-reported components of visual analogue score and tender 
joint count), or fibromyalgia status.
RESULTS: More-sensitive PPTs at sites over or distant from joints were each 
associated with greater reported pain, higher patient-reported DAS28 components, 
and poorer mental health. A high proportion of participants (48%) satisfied 
classification criteria for fibromyalgia, and fibromyalgia classification or 
characteristics were each associated with more sensitive PPTs, higher 
patient-reported DAS28 components, and poorer mental health.
CONCLUSIONS: Widespread sensitivity to pressure-induced pain, a high prevalence 
of fibromyalgic features, higher patient-reported DAS28 components, and poorer 
mental health are all linked in established RA. The increased sensitivity at 
nonjoint sites (sternum and anterior tibia), as well as over joints, indicates 
that central mechanisms may contribute to pain sensitivity in RA. The 
contribution of patient-reported components to high DAS28 should inform 
decisions on disease-modifying or pain-management approaches in the treatment of 
RA when inflammation may be well controlled.