Recognition of Secondary Fibromyalgia Using an Index of 3 Components of the Multi-Dimensional Health Assessment Questionnaire: 90% Agreement with ACR Criteria for Fibromyalgia

Kathryn Gibson^1,2, Isabel Castrejón³, Theodore Pincus³ and Katherine J. Bryant⁴, ¹Liverpool Hospital, Sydney, Sydney, Australia, ²Ingham Research Institute, Liverpool, Australia, ³Rheumatology, Rush University Medical Center, Chicago, IL, ⁴University of New South Wales, Sydney, Australia

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: classification criteria, fibromyalgia, Osteoarthritis, questionnaires and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Session Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes - Poster II: Clinical Focus

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Secondary fibromyalgia (FM) is seen 15-20% of patients with rheumatoid arthritis (RA) (1), systemic lupus erythematosus (SLE) (2), osteoarthritis (OA), and other rheumatic diseases. New formal ACR criteria for FM are available (3), but not used in most routine care, largely because it is not feasible for patients with different diagnoses to complete different questionnaires in busy clinical settings. Scores on a Multidimensional Health Assessment Questionnaire/routine assessment of patient index data (MDHAQ /RAPID3) may provide clues to FM (4, 5). We analyzed MDHAQ/RAPID3 scores in patients with RA or OA, who had or did not have secondary FM, to develop a simple index to identify patients with secondary FM comparable to ACR FM Criteria.

Methods: All patients with all diagnoses at one academic center complete an MDHAQ/RAPID3 at all visits before seeing the rheumatologist. Nine MDHAQ measures were studied: 1. a 0-10 physical function (FN) scale; 2. pain (PN) and 3. patient global estimate (PATGL) on 0-10 visual analog scales (VAS) (compiled into a 0-30 RAPID3); 4. sleep quality; 5. anxiety; 6. depression; 7. 0-10 fatigue VAS; 8. 0-48 RADAI self-report of painful joints; 9. 60 item symptom checklist. Patients in this study also completed a widespread pain questionnaire to assess ACR FM Criteria (6), and the rheumatologist assigned a diagnosis of FM independent of any questionnaire results. The 9 MDHAQ measures were analyzed in patients with primary RA or OA for frequencies and area under receiver-operating-characteristic (ROC) curves for secondary FM according to ACR FM Criteria or clinical criteria, to develop a simple FM index for optimal discrimination of secondary FM vs no secondary FM.

Results: 84 patients with OA or RA were studied; 58 did not have secondary FM by ACR criteria or clinical diagnosis, 16 had FM by both criteria, 6 had FM only by clinical criteria, and 4 only by ACR criteria. Agreement between clinical and ACR Criteria was substantial (kappa 0.68, p<0.001) (6), and only data for ACR Criteria are presented. Patients who had secondary FM had higher mean scores on all 9 MDHAQ scales studied and ROC areas>0.80. A simple MDHAQ 0-3 FM index involves allocating one point each for pain≥6/10, RADAI≥16/48, and symptom checklist≥16/60. A score of 2/3 on the MDHAQ FM index classified identically 90% of patients with FM by ACR Criteria.

Conclusion: A simple 0-3 MDHAQ-FM index based on pain, RADAI self-report joint count, and symptom checklist provides 90% agreement with the new ACR FM criteria. The MDHAQ is feasible in busy clinical settings, as the same questionnaire can provide important clinical information in all patients with all diagnoses, and appears useful to identify secondary FM.

	Cut-off point, sensitivity, and specificity for MDHAQ item and the composite FM in the Liverpool Hospital Australia dataset (N = 84). FM diagnosis by ACR criteria
		Cut-off point	ROC Area	Sensitivity	Specificity	Correctly classified
Symptom checklist (0-60)		≥ 16	0.98	77.3%	83.9%	82.1%
RADAI (0-48)		≥ 16	0.90	84.2%	80.8%	81.7%
MDHAQ-PAIN (0-10)		≥ 6	0.88	86.4%	75.8%	78.6%
Composite FM		≥ 1 ≥ 2 ≥ 3		94.7% 94.7% 63.2%	57.7% 88.5% 96.1%	67.6% 90.1% 87.3%

1. Wolfe et al. Pain. 2011;152:291.

2. Wolfe et al. J Rheumatol. 2009;36:82.

3. Wolfe et al. J Rheumatol. 2011;38;1113.

4. Callahan, Pincus. Arthritis Rheum. 1990;33:1317.

5. DeWalt et al. 2004;22:453.

6. Landis, Koch. Biometrics. 1977;33(1):159-74.

Disclosure: K. Gibson, None; I. Castrejón, None; T. Pincus, Health Report Services Inc., 4; K. J. Bryant, None.

To cite this abstract in AMA style:

Gibson K, Castrejón I, Pincus T, Bryant KJ. Recognition of Secondary Fibromyalgia Using an Index of 3 Components of the Multi-Dimensional Health Assessment Questionnaire: 90% Agreement with ACR Criteria for Fibromyalgia [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/recognition-of-secondary-fibromyalgia-using-an-index-of-3-components-of-the-multi-dimensional-health-assessment-questionnaire-90-agreement-with-acr-criteria-for-fibromyalgia/. Accessed March 20, 2019.

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