University of New South Wales, Sydney, Australia.
Rheumatology Department, Liverpool Hospital, Liverpool, Australia.
Lupus. 2020 Oct;29(11):1404-1411. doi: 10.1177/0961203320945379. Epub 2020 Aug 2.
Fibromyalgia (FM) is prevalent but often under-recognized in patients with systemic lupus erythematosus (SLE). Patient-reported outcomes (PROs) from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) can identify co-morbid FM in patients with rheumatic diseases. The present study examined the utility of the MDHAQ in recognizing FM in patients with SLE during routine consultations.
Patients with SLE completed an MDHAQ. FM status was determined by the validated 2016 revision of the ACR 2010/2011 preliminary FM criteria. Individual PROs from the MDHAQ and composite Fibromyalgia Assessment Tool (FAST) indices of the discriminatory PROs were compared between patients with and without FM using Student's unpaired -test and receiver operating characteristic curve analysis to determine the area under the curve (AUC). The physician's clinical impression of FM was recorded, and the SLE Disease Activity Index was used to assess disease activity.
Of 88 patients with SLE, 23 (26%) satisfied the 2016 FM criteria. The FAST3 composite measure of two out of three of pain (≥6/10), joint count (≥16/48) and symptom checklist (≥16/60) correctly classified 89% of patients (AUC=0.90, kappa=0.71). Physician diagnosis demonstrated moderate agreement with the 2016 FM criteria (kappa=0.43) but missed 43% of patients with FM. In the presence of active disease, the FAST3 correctly classified 91% of patients.
Co-morbid FM is prevalent in SLE yet often underdiagnosed by physicians. The simple FAST3 index of the MDHAQ provides an easy-to-use self-reported tool to improve identification of FM in patients with SLE.
纤维肌痛（FM）在系统性红斑狼疮（SLE）患者中较为常见，但往往未被识别。多维度健康评估问卷（MDHAQ）中的患者报告结局（PROs）可识别风湿性疾病患者的共患 FM。本研究在常规就诊中检查了 MDHAQ 在识别 SLE 患者 FM 中的效用。
SLE 患者完成 MDHAQ。FM 状态通过经过验证的 ACR 2016 年修订版 2010/2011 年初步 FM 标准确定。使用 Student's 非配对 t 检验和接受者操作特征曲线分析比较 MDHAQ 的个体 PRO 和鉴别 PRO 的复合纤维肌痛评估工具（FAST）指数在有和无 FM 的患者之间的差异，以确定曲线下面积（AUC）。记录医生对 FM 的临床印象，并使用 SLE 疾病活动指数评估疾病活动度。
在 88 例 SLE 患者中，23 例（26%）符合 2016 年 FM 标准。FAST3 复合指标中三个中的两个符合疼痛（≥6/10）、关节计数（≥16/48）和症状检查表（≥16/60）正确分类了 89%的患者（AUC=0.90，kappa=0.71）。医生诊断与 2016 年 FM 标准具有中等一致性（kappa=0.43），但漏诊了 43%的 FM 患者。在存在活动疾病的情况下，FAST3 正确分类了 91%的患者。
共患 FM 在 SLE 中较为常见，但医生常常漏诊。MDHAQ 的简单 FAST3 指数提供了一种易于使用的自我报告工具，可改善 SLE 患者 FM 的识别。
