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Background Rheumatoid Arthritis (RA) has different clinical phenotypes. RA with co-existing fibromyalgic features has been termed as fibromyalgic- RA (FRA). Fatigue is a common symptom in rheumatological diseases. Objectives The aim of this study is to evaluate the effects of biological and conventional Disease-Modifying Anti-Rheumatic Drugs (DMARD) on fatigue in FRA patients. Methods Thirty (30) RA patients who met the 2010 ACR/EULAR classification criteria were enrolled in the study. Patients who had other possible causes of fatigue were excluded. The ones who met the ACR 1990 criteria for fibromyalgia were grouped in FRA group. The FRA and non- fibromyalgic RA (non-FRA) groups were divided into subgroups according to the medications used as biological-DMARD and conventional-DMARD subgroups. Fatigue was evaluated via Multidimensional Assessment of Fatigue scale (MAF) and disease activity was assessed by using Disease Activity Score-28 (DAS 28). Results The mean MAF total score of RA patients was 21.35±15.82. Eight (26.7%) of the RA patients had co-existing FMS (FRA group). The mean MAF total score in FRA group was statistically higher than the the non-FRA group (36.56±7.10, 15.81±14.45 respectively) (p<0.05). There was no correlation between MAF total score and DAS 28 score in FRA group (r=0.559, p=0.152). However a strong statistically significant positive correlation between MAF total score and DAS 28 was found in non-FRA group (r=0.550, p=0.008). In FRA group the mean MAF total score of the patients was 34.20±7.29 for the biological-DMARD subgroup and 40.50±5.76 for the conventional-DMARD subgroup. The difference between these subgroups did not reach statistical significance. However in non-FRA group mean MAF total score of the patients who were on biological DMARD therapy and conventional DMARD therapy was 2.75±3.78 and 26.70±10.12 respectively. The difference between these subgroups was statistically significant (p<0.05). Conclusions Fatigue is common in RA. Fatigue becomes more prominent if there is co-existing fibromyalgia. In non-FRA patients fatigue is correlated with the disease activity however such a correlation is absent for FRA patients. In non-FRA patients biological DMARD usage improved fatigue when compared with the conventional- DMARD therapy. However biological DMARD did not have additional benefit on fatigue in FRA patients when compared with the conventional DMARD group. When dealing with fatigue in RA patients possibility of co-existing fibromyalgia must be taken into account for treatment success. Disclosure of Interest None Declared