The concept of secondary fibromyalgia (FM) has garnered increasing interest over the last decade. This has resulted from the realization that many common rheumatic disorders have an FM comorbidity that influences, or should influence, optimal management1,2. In this edition of The Journal, Wolfe and colleagues reconsider the issue of primary and secondary FM, asking whether they are equivalent3. Currently, there is no universally agreed-upon definition. Dr. Kahler Hench, the originator of the term fibromyalgia, provided this definition: “Fibrositis is considered primary when there is no associated underlying disorder and secondary when it occurs in patients with underlying rheumatic or other organic disease”4. The 1990 American College of Rheumatology (ACR) criteria paper noted: “To avoid argument over the existence or nonexistence of ‘secondary fibromyalgia,’ which is believed by some investigators to be fibromyalgia caused [author’s italics] by another condition, we adopted the term secondary-concomitant fibromyalgia [original italics] to indicate fibromyalgia occurring in the presence of another significant rheumatic disorder which may have been caused by or was merely associated with the patient’s fibromyalgia”5. In the current paper by Wolfe, et al, the following definition is given: Secondary FM is FM occurring in the presence of another clinically important and dominant medical disorder3. We agree with this simplified definition and note that there is an ever-increasing list of disorders that have been associated with FM [Table 1; plus the same table with references (Supplementary Table 1, available with the online version of this article)]; whether a patient is designated as having primary FM becomes dependent upon a diligent search for all such associated comorbidities.
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Address correspondence to Dr. R.M. Bennett, 6119 SW California St., Portland, Oregon 97219, USA. E-mail: bennetrob1{at}comcast.net