THU0521 A simple index based on scores on a multidimensional health assessment questionnaire (MDHAQ) provides information quite similar to acr criteria for fibromyalgia in routine care
Authors: J. Schmukler, I. Castrejon, T. Pincus
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fibromyalgia (FM) is common in the general population, easily identified in many patients, but subtle in some, particularly when patients meet criteria for rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), and others. American College of Rheumatology (ACR) FM criteria were reported in 1990 (Arth Rheum 33:160, 1990) and 2010 (Arth Care Res 62:600, 2010) as "preliminary diagnostic criteria," modified for patient self-report in 2011 (Ann Med 43:495, 2011), and in 2016 as the "2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria" (Sem Arth Rheum 46:319, 2016). These FM criteria are not used in most routine care settings. A multidimensional health assessment questionnaire (MDHAQ) is more-widely used in the USA (Arth Care Res 64:640, 2012), and is informative in RA, OA, SLE, and most rheumatic diseases (J Clin Rheumatol 19:169, 2013). MDHAQ may provide clues to primary and secondary FM in routine care, EULAR 2016, 2017 <h3>Objectives</h3> To compared 2 indices of MDHAQ scales to the 2011 and 2016 FM criteria to identify patients with possible primary or secondary FM in routine care. <h3>Methods</h3> All patients with all diagnoses seen at an academic rheumatology clinic complete an MDHAQ at each visit. The modified FM criteria questionnaire was added from April-July 2017. Two MDHAQ scales were studied: MDHAQ-FM3 includes a 0–10 pain visual analogue scale (VAS), 0–48 self-report rheumatoid arthritis disease activity index (RADAI) painful joint count, and 0–60 symptom checklist; one point each is scored for pain ≥6/10, RADAI ≥16/48, symptom checklist ≥16/60 – total=0–3. MDHAQ-FM4 adds a MDHAQ fatigue VAS; 6/10 is scored 1 (Total 0–4). Both MDHAQ indices were compared to both modified 2011 and 2016 FM criteria using kappa statistics and the proportion correctly classified ("Correct"). <h3>Results</h3> We studied 502 patients; primary diagnoses (ICD10 in the medical record) included FM in 49, OA in 74, RA in 78, SLE in 88, others in 213. Overall, 131 patients (26.1%) met 2011 modified FM criteria and 112 (22.3%) 2010 modified FM criteria. Agreement between physician diagnosis of FM and 2016 modified criteria was 80.9% (kappa 0.44, p&lt;0.001), and with 2011 modified criteria was 80.3% (kappa 0.45, p&lt;0.001). Agreement of MDHAQ-FM3 score ≥2 with 2011 modified FM criteria was 84.3% (kappa 0.63, p≤0.001), and with 2016 FM criteria 81.7% (kappa 0.56, p≤0.0001). MDHAQ-FM4 increased the level of agreement only slightly (table 1). <h3>Conclusions</h3> Two indices derived from MDHAQ variables for pain, painful joints, somatic symptoms, and fatigue, provide a useful clue to FM in routine rheumatology care. <h3>Disclosure of Interest</h3> J. Schmukler: None declared, I. Castrejon: None declared, T. Pincus Shareholder of: Dr. Pincus holds a copyright and trademark for MDHAQ and RAPID3 for which he receives royalties and license fees. All revenue is used to support further development of quantitative questionnaire measures for patients and doctors in clinical rheumatology care.