Of 216 consecutive new referrals to a general rheumatology clinic 22 (10.2%) had generalized fibromyalgia syndrome (FS). In 12 cases (5.6% of all referrals, 54.5% of patients with FS) the initial presentation was with pain in the region of the hand or wrist joints, but many other joints were painful or tender. Although there may be initial confusion with rheumatoid or osteoarthritis, the positive features of FS confirm the correct diagnosis.