Background The Fibromyalgia Rapid Screening Tool (FiRST) has been proposed as a self reported screening questionnaire comprising only 6 questions for detection of fibromyalgia (FM)1. A patient is considered FM in case of answering “yes” at least 5 out of the 6 questions. Such questionnaire is independent from tender points at physical examination and, therefore, of particular interest in Spondyloarthritis (SpA) patients.
Objectives To evaluate the FiRST questionnaire validity and reliability in a SpA population.
Methods Patients: SpA patients (according to the rheumatologist) consecutively consulting at the rheumatology department of a tertiary care university hospital. Data collection: Apart from the FiRST questionnaire other variables were collected: a) Demographics: age, gender. b) SpA characteristics: clinical, imaging and treatment. c) Other collected data: history of depression and the consumption (ever) of psychotropic medication (e.g antidepressants, myorelaxants, anxiolytics, strong opioids). Statistical analysis: The following was evaluated: a) percentage of patients answering “yes” to ≥5/6 questions (here referred as FM+); b) classification performance of each question of the FiRST by assessing the positive likelihood ratio (LR+); c) percentage of patients with history or current intake of psychotropic medication and history of depression in FM+ and FM-groups respectively (χ2); d) reliability of the questionnaire was assessed by the prevalence – adjusted bias – adjusted kappa statistics (PABAK) in 22 patients in two consecutive visits with stable disease activity and no treatment changes.
Results Of the 222 patients who completed the questionnaire, 195 were retained for our analysis and 42 (21.5%) patients were classified as FM+. The LR+ per question was 4.3 [CI 95% 2.85; 6.43], 1.8 [CI 95% 1.52; 2.07], 2.7 [CI 95% 2.17; 3.42], 3.4 [CI 95% 2.44; 4.59], 2.6 [CI 95% 1.99; 3.40] and 2.1 [CI 95% 1.80; 2.51] for questions 1 to 6 respectively; suggesting that question 1 performed the best. The percentage of patients with either history of depression or consumption of psychotropic medication was significantly higher in the FM+ group (67%vs.36%, p≤0.01). Concerning the reliability, agreement was good with a PABAK=0.64 (0.314; 0.958).
Conclusions This study suggests: 1) the acceptable simplicity, feasibility and reliability of the FiRST questionnaire in clinical practice; 2) potentially the first question related to full body pain might be the most relevant; 3) the good external validity of FiRST when considering the higher percentage of patients with either history of depression or consumption of psychotropic medications. Such tool might facilitate the management of SpA in daily practice.
Perrot S, Bouhassira D, Fermanian J. Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain 150, 250–256 (2010).
Acknowledgements N.B wishes to acknowledge to the Spanish Rheumatology Foundation (FER) for a training bursary.
Disclosure of Interest None declared