Background/Purpose:

Fibromyalgia (FM) generally is easily diagnosed, but maybe complex, particularly in patients who meet criteria for other rheumatic diseases. FM criteria have been revised in 2011, based entirely on a patient self-report questionnaire. However, these criteria generally are rarely used in routine clinical care because it is not feasible to use multiple patient questionnaires in busy clinical settings. An MDHAQ (multi-dimensional health assessment questionnaire) documents change in status in all rheumatic diseases in which it has been studied, and includes scales for pain, fatigue, symptom checklist, self-report painful joint count, and RAPID3 which are similar to the FM criteria questionnaire. We analyzed 5 indices based on MDHAQ scales for agreement with 2011 FM criteria in patients seen in routine clinical care.

Methods:

All patients with all diagnoses complete an MDHAQ at all visits in routine care at one setting. The FM criteria questionnaire was added over a 3-month period to be completed by consecutive patients. The poly symptomatic distress (PSD) scale is derived from the FM questionnaire and indicates degree of FM symptoms. All MDHAQ scores were analyzed initially for agreement with FM Criteria questionnaire according to receiver operator characteristic (ROC) curves for area under the curve (AUC), and compiled into indices of 3 or 4 measures based on the highest results. The indices were then analyzed for AUC and cut points based on specificity and sensitivity identify to score 0 or 1 for a 0-3 index of 3 measures or 0-4 index of 4 measures, and correlations.

Results:

Five different MDHAQ-FM indices were developed form the 5 MDHAQ scales with the highest AUC vs 2011. Criteria: symptom checklist, self-report painful joint count, fatigue, RAPID3, and pain scale. Three indices of 3 measures, termed MDHAQ-FM3, all included symptom checklist and self-report painful joint count; MDHAQ-FM3-P added a pain VAS, MDHAQ-FM3-F a fatigue VAS, and MDHAQ-FM3-R a RAPID3 score. Two MDHAQ-FM4 indices added fatigue VAS to symptom checklist and self-report painful joint count; MDHAQ-FM4-P included a pain VAS, MDHAQ-FM4-R RAPID3. The five different MDHAQ FM indices all agreed with the 2011 criteria with ROC AUC higher than 0.924 (p=0.21 for 5 indices), Correlations for 2011 criteria were all higher than 0.83 (p<0.001), and Agreement of the 5 indices with FM criteria was greater than 84.3% (table), these findings indicates robust capacity to identify FM similarly to the FM Criteria questionnaire.

Conclusion:

The MDHAQ identifies patients with FM similarly to the FM criteria questionnaire. Further longitudinal data will help to identify an optimal MDHAQ–FM index. Since MDHAQ also is useful in all rheumatic diseases in which it is been studied, it would appear a feasible and informative addition to routine clinical care in each patient at each visit.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fibromyalgia-is-identified-in-routine-care-on-indices-derived-from-an-mdhaq-multidimensional-health-assessment-questionnaire-with-robust-agreement-with-2011-revised-fibromyalgia-criteria-questionnai/