Patient global assessment is elevated by up to 5 of 10 units in patients with inflammatory arthritis who screen positive for fibromyalgia (by FAST4) and/or depression (by MDS2) on a single MDHAQ

•Evidence before this study: Patient global assessment (PATGL) was designed to assess disease activity, and is a component of most indices to assess patient status in inflammatory rheumatic diseases such as DAS28, CDAI, ASDAI, DAPSA, and others.  PATGL distinguishes active from control treatments in clinical trials as significantly as swollen or tender joint counts. However, clinical trial patients are selected for high inflammatory activity; more than 75% of all patients with a given diagnosis such as rheumatoid arthritis (RA) or spondyloarthritis (SpA) are excluded, primarily due to joint damage and comorbidities, notably fibromyalgia and/or depression, in addition to or in the absence of inflammatory activity. An elevated PATGL is recognized to prevent more RA patients from being in remission than other measures, but the basis for the elevations is not assessed according to quantitative data. Most long-term rheumatology databases do not include quantitative measures of joint damage or patient distress to recognize fibromyalgia and/or depression, which may be easily recognized in some patients but often are underrecognized. Elevation of PATGL by joint damage, fibromyalgia, and/or depression may affect interpretation of indices for a "treat-to-target” strategy, in which escalation of therapy is recommended for patients with moderate or high scores on an index that includes PATGL but may be inappropriate if inflammatory activity is low and index scores are raised by fibromyalgia and/or depression.•Added value of this study: A multidimensional health assessment questionnaire (MDHAQ) includes simple screening indices for fibromyalgia (FAST4) and/or depression (MDS2), which are positive in 41% of patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA). These comorbidities elevate median 0–10 PATGL from 3 to 8, which often elevates indices to levels suggesting moderate or high index scores and possible inappropriate escalation of therapy with a high risk/benefit ratio. Similar findings in 3 settings on 3 continents suggest generalizability of the results. The MDHAQ is quite feasible in busy routine care clinical settings, unlike many reported patient questionnaires, completed by patients in 5–10 min and scored in 20–30 s, instantaneously with a computer, but not requiring a computer.•Implications of the available evidence: Simple MDHAQ screens for fibromyalgia and/or depression identify common comorbidities which often are underrecognized in patients with any diagnosis. Recognition of these comorbidities may help explain poor responses to powerful anti-inflammatory agents and reassure rheumatologists not to escalate therapy despite high index scores, a common situation, which may lead to initiation of powerful agents with a high risk/benefit ratio. The findings may be useful toward modification of recommended treatment strategies such as "treat-to-target," and promotion of quantitative assessment of joint damage and patient distress in routine care and long-term databases.