Background About 20-40% of patients with various rheumatic conditions are recognized to have concomitant comorbid fibromyalgia (FM), which often complicates patient management. Secondary FM may be difficult to recognize in patients who meet criteria for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and other diseases. A 2-page multidimensional health assessment questionnaire (MDHAQ) and 2-page RHEUMETRIC checklist include scales that provide clues to FM.
Objectives To analyze MDHAQ and RHEUMETRIC scales to assess overall patient status (DOCGL), inflammation (reversible signs) (DOCINF), damage (irreversible signs) (DOCDAM) and neither inflammation nor damage (DOCNON), e.g., fibromyalgia.
Methods All patients seen in a clinical setting complete a 2-page MDHAQ in 5-10 minutes in the waiting area, prior to seeing the rheumatologist in routine care. The MDHAQ includes scores for physical function (FN) in 10 activities scored 0-3, total 0-30 converted to 0-10, three 0-10 visual analog scales (VAS) for pain (PN), patient global score (PATGL) and fatigue (FT), and a 0-60 item symptom checklist and demographic data. RAPID 3 (0-30) is the sum of scores for FN, PN and PATGL. RHEUMETRIC is a one-page physician checklist with four 0-10 VAS physician global estimates to assess DOCGL, DOCINF, DOCDAM, and DOCNON, e.g., fibromyalgia in patients with various rheumatic diseases who were designated by their rheumatologists as having or not having secondary FM. All patients were classified as having or not having a secondary diagnosis of FM, and compared for mean scores on MDHAQ and RHEUMETRIC scales, using t tests to analyze statistical significance.
Results Of 311 patients with various rheumatic diagnoses other than FM, 294 (94.5%) did not and 17 (5.6%) did have a diagnosis of secondary FM - a likely underestimate of the true prevalence. Mean scores on each of the MDHAQ scales were 1.5-3 fold higher in patients with secondary FM versus no FM (Table). DOCGL was higher in patients with secondary FM compared to those with no FM, while DOCINF and DOCDAM did not differ significantly in the 2 groups (Table). Mean DOCNON on RHEUMETRIC was 5.4 in patients with FM, versus 1.3 in those with no FM, a 4-fold difference (p<0.001).
Conclusions Simple patient and physician questionnaires can provide useful clues to recognize secondary FM in patients with other primary rheumatic diagnoses.
Disclosure of Interest None declared
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