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J Rheumatol. 2019 Sep 1. pii: jrheum.190277. doi: 10.3899/jrheum.190277. [Epub ahead of print]

Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care.

Author information

1
From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia. Dr. Pincus holds a copyright and trademark on MDHAQ and RAPID3 (Routine Assessment of Patient Index Data 3), for which he receives royalties and license fees, all of which are used to support further development of quantitative questionnaire measurements for patients and doctors in clinical rheumatology care. K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center. Address correspondence to Dr. K.A. Gibson, Liverpool Hospital, Rheumatology, Locked Bag 7103, Liverpool BC, Liverpool, New South Wales 1871, Australia. E-mail: Kathy.gibson@health.nsw.gov.au. Accepted for publication August 6, 2019.

Abstract

OBJECTIVE:

To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied.

METHODS:

All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST).

RESULTS:

In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria.

CONCLUSION:

FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.

PMID:
31474596
DOI:
10.3899/jrheum.190277

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