THU0477 A FIBROMYALGIA ASSESSMENT SCREENING TOOL ON A MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE (MDHAQ) WHICH DOES NOT INCLUDE A SELF-REPORT PAINFUL JOINT COUNT (PAINFUL JC), FAST3NJC, RECOGNIZES FIBROMYALGIA SIMILARLY TO OTHER FAST3 INDICES WHICH INCLUDE A PAINFUL JC
Authors: Theodore Pincus, Isabel Castrejon
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Fibromyalgia (FM) generally is easily recognized, but a diagnosis may be difficult, particularly in patients with secondary FM who have other primary diagnoses. Criteria for FM initially were reported in 2000, and revised in 2011 and 2016, based entirely on a patient self-report questionnaire. However, FM criteria are not collected in most routine clinical care, as it is not feasible to use multiple patient questionnaires in busy clinical settings. MDHAQ/RAPID3 (multi-dimensional health assessment questionnaire/routine assessment of patient index data) has been found informative in all diseases in which it has been studied. Cumulative indices based on MDHAQ scales known as FAST3 (fibromyalgia assessment screening tool3) recognize FM at levels of agreement with revised FM criteria of &gt;80% and correlations of &gt;0.80, p&lt;0.001). Pragmatic recognition of FM in non-rheumatic diseases based on MDHAQ may be possible, as most components of the MDHAQ (as well as the HAQ) appear generic rather than disease-specific. One component of MDHAQ/FAST indices, a self-report painful joint count (painful JC), is rheumatology-specific. Therefore, a FAST3-nJC (no painful JC) index was analyzed vs revised FM criteria as gold standards for possible use in non-rheumatology patients to recognize FM. <h3>Objectives</h3> To analyze FAST3-nJC versus 2011 and 2016 FM criteria, and compared to other FAST3 indices which include a painful JC, to recognize FM. <h3>Methods</h3> All patients with all diagnoses complete an MDHAQ at all visits in routine care at one setting. The self-report questionnaire to recognize the 2011 and 2016 FM Criteria was added over a 6-month period to be completed by consecutive patients. The MDHAQ includes 0-10 scores for physical function, pain and patient global visual analog scales (VAS), compiled into 0-30 RAPID3, as well as a 0–10 fatigue VAS, 0–54 self-report painful joint count, and 0–60 symptom checklist. All MDHAQ scales were analyzed for agreement with FM Criteria according to receiver-operator-characteristic (ROC) curves for area under the curve (AUC). Optimal cut points for each measure were identified, based on specificity and sensitivity, to develop optimal cumulative indices for clues to FM versus the 2011 and 2016 Criteria as gold standards. <h3>Results</h3> Among 502 patients with complete data, primary ICD-10 diagnoses were FM in 49, OA in 74, RA in 78, SLE 88 and other rheumatic diseases in 213. Primary or secondary FM was identified in 131 (26%) who met 2011 FM criteria, and 112 (22%) who met 2016 FM criteria. The 4 MDHAQ scales with the highest AUC vs FM Criteria (0.829-0.889) were symptom checklist, painful JC, fatigue, and pain. Three cumulative FAST3 measures were: FAST3-P with symptom checklist, painful JC and pain VAS; FAST3-F with symptom checklist, painful JC and fatigue VAS; FAST3nJC with symptom checklist, pain and fatigue VAS, but no painful JC. All FAST3 indices agreed with FM Criteria &gt;79% and kappas were &gt;0.52, indicating good agreement (Table). As expected, lowest agreement was seen for FAST3nJC, since the FM criteria include a self-report painful joint count, but differences are quite small. <h3>Conclusion</h3> FAST3nJC had slightly lesser agreement with 2011 and 2016 FM criteria than FAST3-P and FAST3-F but would appear satisfactory as a candidate for clues to recognize FM in patients with non-rheumatic diseases, as a diagnosis of FM ultimately is made by a physician. <h3><b>Disclosure of Interests:</b>&nbsp;</h3> None declared