Ischaemic heart disease in rheumatoid arthritis patients.

1. Hazemeijer I, Rasker JJ. Fibromyalgia and the therapeutic domain. A philosophic study on the origins of fibromyalgia in a specific social setting. Rheumatology 2003;42:507–15. 2. Wolfe F. For example is not evidence: fibromyalgia and the law [editorial; comment]. Pain extent and diagnosis: development and validation of the regional pain scale in 12 799 patients with rheumatic disease. van Riel PLCM, van de Putte LBA. Development of a disease activity score based on judgment in clinical practice by rheumatologists. Reply First we thank Frederick Wolfe for seriously reading and criticizing our article from the outside of Plato's cave [1]. Secondly, after reading his comment, it seems we have to make our statement more clear. Wolfe states that we said fibromyalgia does not exist and that we should give some proof for this statement (or rather: we should give proof, like he does, that fibromyalgia really does not exist). However, neither in the quote of Wolfe in our article ('Wolfe's assertion that fibromyalgia will always be with us [.. .] regardless of what name the syndrome has, is unlikely to be true'), nor elsewhere in our article, do we say that fibromyalgia does not exist. There are specific people complaining of pain, sleeping disorders and fatigue who have been 'diagnosed' as fibromyalgia patients. We are neither denying the existence of these patients nor their complaints. So, we also know that fibromyalgia exists, but not in the same way an object in Plato's world of ideas is supposed to exist outside the cave. The form of representation called fibromyalgia must not be confused with a shadow of a Platonic idea. There is no such objective thing as fibromyalgia, in contrast to measurable inflammation factors or any other organic disease. What clinicians, by using classification criteria (although often called diagnostic criteria), recognize as fibromyalgia is a way of behaviour, a phenomenon, a representation of complaints changing in time. By applying 'diagnostic' criteria to a data bank Wolfe tries to prove the existence of fibromyalgia. But isn't that similar to how we know fibromyalgia exists (and even in a way is produced)? The proof of the existence of fibromyalgia is the proof of relationships in a therapeutic domain and the processes of assigning meaning. By only looking backwards and applying criteria on already ill diagnosed and classified people in a huge data bank, it is not possible to find the proof of the existence …