Background/Purpose: The Patient-Reported Outcomes Measurement Information System short form 29 (PROMIS-29)¹ uses computer assisted technology (CAT) to derive patient assessments.  High PROMIS-29 scores are seen in patients with rheumatoid arthritis (RA) with high disease activity, but may also reflect co-morbid FM. This problem is seen also in traditional indices used to assess patients with rheumatoid arthritis (RA), including DAS28, CDAI, and RAPID3 (routine assessment of patient index data 3). For example, a patient with no tender or swollen joints, a physician global assessment of 0, ESR of 20 mm/hr, but a patient global assessment of 80/100, would have a DAS28 of 3.2, suggesting moderate disease activity. Therefore, high scores may indicate high disease activity or co-morbid FM (or both) in RA patients.

Methods: All RA patients attending the Rheumatology clinic at Liverpool Hospital complete a MDHAQ at each visit, and were asked to complete a PROMIS-29 questionnaire,¹ and the 2011 modification of the criteria for Fibromyalgia (2011 FM criteria)³ on paper.  Two indices derived from MDHAQ scores RAPID3=0-30: (physical function=0-10 + pain=0-10 + patient global assessment=0-10) assesses clinical status, and FAST3-P (Fibromyalgia Assessment Screening Tool 3 (2/3=FM): pain≥6/10=1 + number of painful joints≥16/48=1 + number of symptoms≥16/60=1) provides a clue to the presence of FM. PROMIS-29 t-scores were obtained from the Assessment Center scoring service (https://www.assessmentcenter.net/ac_scoringservice). Cross sectional analysis of 159 patients with complete data was performed. Descriptive statistics and t-tests were derived using Stata/IC 16.1 (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.)

Results: Patients had a mean (SD) age of 55.7 (15.2) years, were 67.3% female and had a mean education of 11.6 (4.0) years. 23.3% were found to have co-morbid FM by 2011 FM criteria and 28.9% by FAST3-P criteria. All PROMIS-29 t-scores indicated significantly poorer status in patients with co-morbid FM either by 2011 FM criteria or by FAST3-P criteria (Table). All scores for pain interference, depression/sadness, fatigue, anxiety/fear and sleep disturbance and poorer physical function and ability to participate were more than 0.5 SD from the population mean in the FM positive group, and within 0.5 SD of the population mean in those who did not have positive screening for FM (Table). All MDHAQ variables, including the components of RAPID3 indicated significantly poorer status in patients with co-morbid FM by either criterion (data not shown).

Conclusion: RA patients with comorbid FM by either the 2011 FM criteria or by FAST3-P had significantly higher PROMIS-29 t-scores, than RA patients who did not have FM. Interpretation of these scores in RA patients should consider whether there is coexisting FM in addition to any active inflammatory disease.

1. Cella D.et al (2019) Value in Health, 22(5):537-544.
2. Pincus T et al (2007) Best Pract Res Clin Rheumatol; 21(4):789– 804.
3. Wolfe F et al. (2011) J Rheumatol; 38:1113-22.

PROMIS29 and RAPID3 in all patients and patients with and without FM by 2011 and FAST3P criteria. Higher scores indicate more of the concept being measured in PROMIS-29. In MDHAQ higher scores indicate more severe patient impact of the concept being measured.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/promis-29-scores-are-significantly-higher-in-patients-with-rheumatoid-arthritis-who-meet-criteria-for-co-morbid-fibromyalgia-fm-than-in-those-with-rheumatoid-arthritis-and-no-fm/