Background/Purpose: An MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data) is a 2 sided, 1 page questionnaire which is completed by patients in 5-10 minutes, while waiting to see the doctor in the waiting room in routine clinical care. RAPID3 is an index which is informative in RA and other rheumatic diseases. MDHAQ also includes a 0-10 visual analog scale for fatigue and a 60 symptom checklist, which may provide clues to recognize comorbid fibromyalgia (FM) (1). Comorbid FM is seen in about 10-25% of patients with RA and may complicate assessment and management. Formal criteria for fibromyalgia are included in many research studies, but generally are not assessed in busy clinical settings, in which primary or secondary FM generally is diagnosed according to “gestalt,” narrative, non-quantitative descriptions. A simple quantitative tool to recognize and document clues to comorbid FM could be of value in routine care in busy clinical settings.

Methods: MDHAQ is completed by all patients seen by a rheumatologist in routine care. MDHAQ includes scores for physical function (0-10), pain (0-10), patient global assessment (0-10), RAPID3 (0-30 sum of physical function, pain, and patient global estimate), fatigue (0-10), and total number of symptoms (0-60). Mean MDHAQ scores were compared in patients with primary diagnoses of either RA or osteoarthritis (OA) who did or did not have a secondary diagnosis of comorbid FM. Statistical significance of differences in patients with no FM vs with comorbid FM was analysed using 2-tailed t-tests, with significance at p<0.05.

Results: A total of 82 RA patients – 75 with no FM and 7 with FM, and 64 OA patients – 49 with no FM and 15 with FM, were studied (Table). The mean number of symptoms reported by patients with a clinical diagnosis of FM was significantly higher than reported by those who did not have secondary FM – RA 19.5 vs 7.97 P=0.0001; OA 19.5 vs 8.3 P<0.0001. The mean fatigue scores of patients with and with no secondary FM also differed significantly – RA 6.8 vs 3.86 P=0.004; OA 6.39 vs 3.82 P=0.0049. The mean physical function, pain, patient global estimate and RAPID3 scores did not differ significantly between patients with and with no secondary FM in either diagnostic group.

Conclusion: MDHAQ scales for fatigue and number of symptoms, which are found on the questionnaire to assess RAPID3 in patients with rheumatic diseases as part of routine clinical care, can provide clues to identify comorbid FM. Recognition and documentation of comorbid FM in patients with primary RA or OA may support the complexity of rheumatology visits and assist in management decisions in busy clinical settings.

Reference: 1)  DeWalt DA, et al. Clin Exp Rheumatol. 2004;22(4):453-61.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-same-multidimensional-patient-health-assessment-questionnaire-used-to-assess-rapid3-in-rheumatoid-arthritis-osteoarthritis-and-other-rheumatic-diseases-can-provide-quantitative-clues-to-recognize/