From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.
K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center.
J Rheumatol. 2020 May 1;47(5):761-769. doi: 10.3899/jrheum.190277. Epub 2019 Sep 1.
To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied.
All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST).
In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria.
FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.
仅基于自我报告的多维健康评估问卷（MDHAQ）评分，为各种风湿病患者的常规护理制定可行的指标作为共患纤维肌痛（FM）的线索，这些评分在所有研究的风湿病诊断中都具有信息性。
所有患者在每次就诊时都要填写 MDHAQ；2011 年 FM 标准问卷于 2013 年 2 月至 2016 年 8 月添加到标准 MDHAQ 中。计算符合 2011 年 FM 标准或临床诊断为 FM 的患者比例。使用受试者工作特征（ROC）曲线比较单个候选 MDHAQ 指标与 2011 年 FM 标准；从曲线下面积（AUC）中选择识别 FM 的切点，以在敏感性和特异性之间达到最佳权衡。分析 3 或 4 个 MDHAQ 指标的累积指数作为纤维肌痛评估筛查工具（FAST）。
在 148 名患者中，与 2011 年 FM 标准相比，ROC 分析中 MDHAQ 症状清单、自我报告的疼痛关节计数、疼痛视觉模拟量表（VAS）和疲劳 VAS 的 AUC 最高。最佳切点为症状清单≥16/60，自我报告的疼痛关节计数≥16/48，疼痛和疲劳 VAS 均≥6/10。2/3 或 3/4 MDHAQ 测量的累积 FAST 指数正确分类了符合 2011 年 FM 标准的 89.4-91.7%的患者。
仅从 MDHAQ 评分得出的 FAST3 和 FAST4 累积指数正确识别了大多数符合 2011 年 FM 标准的患者。FAST 指数可以帮助临床医生在常规护理中作为一般风湿病而不是 FM 特异性问卷的 FM 线索。
