Background/Purpose: A physician global estimate (DOCGL) is commonly used to assess patients with rheumatic diseases. Fibromyalgia (FM) has been reported as a comorbidity in 10-35% of patients with rheumatoid arthritis (RA), osteoarthritis (OA), and other rheumatic diseases, and may complicate assessment and management in these patients. Formal criteria for fibromyalgia have been described and are included in many research studies. However, these formal criteria generally are not assessed in busy clinical settings, in which FM generally is diagnosed according to “gestalt,” narrative, non-quantitative descriptions. Quantitative standard data on a 1-page physician RheuMetric checklist, which is completed in 20-30 seconds, include a standard 0-10 visual analog scale (VAS) for DOCGL, and 3 further 0-10 VAS for the levels of inflammation or reversible findings (DOCINF), damage or irreversible findings (DOCDAM), and patient distress, e.g. fibromyalgia, depression (DOCDIS). We analyzed RheuMetric VAS for possible value to estimate FM in routine care.

Methods: A RheuMetric checklist is completed by one rheumatologist in all patients in routine care. Mean scores for DOCGL (0-10) and for the DOCINF (0-10), DOCDAM (0-10), and DOCDIS (0-10) subscales were compared in patients with rheumatoid arthritis (RA), other inflammatory arthritides (ankylosing spondylitis, psoriatic arthritis, inflammatory arthritis), and osteoarthritis (OA), who had or did not have a clinical diagnosis of secondary comorbid FM. Statistical significance was analyzed using 2-tailed t-tests.

Results: A total of 82 RA patients – 75 with no FM and 7 with FM, 51 with other inflammatory arthritides – 42 with no and 9 with FM, and 64 OA patients – 49 with no FM and 15 with FM, were studied (Table). Mean DOCGL scores for patients in each group who had or did not have comorbid FM were similar: RA 2.71 vs 2.75 p=0.43; other inflammatory 3.67 vs 2.76 p=0.81; OA 3.43 vs 3.41 p=0.97 (Table). Mean DOCINF and DOCDAM estimates also did not differ significantly between patients with and with no FM in the 3 groups. Mean estimates for DOCDIS differed significantly in each of the 3 diagnostic groups in patients who had or did not have comorbid FM: RA 5.90 vs 2.38 p<0.0001; other inflammatory 5.56 vs 2.63 p=0.004; OA 5.25 vs 2.92 p=0.0008 (Table).

Conclusion: In this study, DOCDIS estimates to quantitate the degree of distress were significantly higher in patients with primary RA, OA or other inflammatory arthritides who also had comorbid FM than in those with no FM. DOCGL, DOCINF, or DOCDAM did not distinguish significantly patients who had or did not have comorbid FM. The DOCDIS scale may help clinicians to recognize and document secondary comorbid FM, without a need to administer other FM specific questionnaires, to help guide diagnosis and optimal patient care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quantitative-clues-to-recognize-and-document-comorbid-fibromyalgia-in-routine-care-of-patients-with-other-rheumatic-diagnoses-on-a-10-cm-distress-visual-analog-scale-found-on-1-page-physician-rheumetr/