pain characteristics in patients with RA using the pain DETECT questionnaire. Fibromyalgia prevalence ranges from 12% to 20% among RA patients, with an estimated incidence of 5 per 100 patient-years [27,28,29,30]. Ranzolin and colleagues [31] have shown that patients with RA and concomitant fibromyalgia have higher pain scores than RA patients without fibromyalgia, yet they have relatively low provider global assessments. Their study did not report patient global assessments. Khan et al. [2] reported in the Quantitative Standard Monitoring of Patients With Rheumatoid Arthritis study that 4.6% of the positive discordance group had investigator-reported fibromyalgia compared with 2.5% in the concordant group, which was statistically significant. The present finding of a 17% prevalence of fibromyalgia diagnosis by the treating physician in the discordant group is considerably higher than in the study by Khan et al. but certainly is consistent with the overall prevalence of fibromyalgia in RA, highlighting the clinical significance of previous data on fibromyalgia to patient-provider discordance. Previous studies have demonstrated that, among RA patients, fibromyalgia is associated with higher DAS28 and adverse scores for functional ability and health-related quality of life (HRQOL) [3, 30, 32, 33]. Data also show that patients with positive discordance may be overtreated with biologic therapies to which they are unlikely to respond [32]. Considering current concepts of centralized pain in patients with fibromyalgia, the data suggest that abnormal central pain processing may be the key driver of chronic widespread pain among patients with RA in the setting of positive patient-provider discordance and may also explain some inadequate responses to DMARD therapy [26, 34, 35]. Depression is also prevalent in RA patients and has been studied extensively in this population [36]. Barton et al. [3] showed that depression is strongly associated with patient-provider discordance. In their study, the frequency of depression as defined by a PHQ-9 score ≥ 10 among the population with positive discordance was 43%, which is similar to the frequency of clinical depression of 39% in the present study. Results of the multivariable analysis suggest that pain, fibromyalgia, and depression make complementary contributions to patient-provider discordance. Osteoarthritis and elevated body mass index appear also to make a small contribution to positive discordance, mainly in LDA states. Indeed, comparison of patient-reported outcomes between the discordant and concordant groups separately in remission or with LDA versus MHDA suggests that depression and fibromyalgia have distinct roles in mediating patient-provider discordance. In LDA states, pain intensity and pain-related interference in activities and role functions, fibromyalgia, and depression are complementary mediators of positive discordance. In MHDA states, fibromyalgia as defined by the WPI and polysymptomatic distress are key determinants of discordance whereas depression has no effect. Interpretation of these findings must consider the differences in the definitions of fibromyalgia between the analyses shown in Table 3 (fibromyalgia WPI) and Table 4 (previous diagnosis of fibromyalgia). The findings suggest that the activity or severity of fibromyalgia is important, meaning that milder or partially treated fibromyalgia may be mediating discordance in LDA states and more active or severe