ab224011

Further clues to recognition of patients with fibromyalgia from a simple 2-page patient multidimensional health assessment questionnaire (MDHAQ)

D.A. DeWalt¹, G.W. Reed², T. Pincus²

¹University of North Carolina School of Medicine, Chapel Hill, North Carolina; ²University of Massachusetts School of Medicine, Worcester, Massachuetts; ³Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

ABSTRACT
Objective
To analyze quantitative scores for pain, fatigue, functional disability, and the number of symptoms on a review of systems on a multidimensional health assessment questionnaire (MDHAQ), including the ratios of scores for pain to physical function and fatigue to physical function, and to further study how these scores can help to identify patients with fibromyalgia.

Methods
All consecutive patients seen at a rheumatology clinic completed a 2-sided, 1-page MDHAQ at each visit to assess physical function, pain, fatigue, global status, helplessness and review of systems, and had their erythrocyte sedimentation rate (ESR) measured. Scores for these variables were analyzed in 78 consecutive patients with fibromyalgia over a two-year period, and in 149 patients with rheumatoid arthritis (RA) as a "control" group. A subset analysis was conducted in patients with RA who were classified independently according to clinical criteria as having or not having coexistent fibromyalgia. Descriptive statistics, logistic regression, and receiver-operating-characteristic curves were computed for patients with fibromyalgia and compared to patients with RA.

Results
Patients with fibromyalgia had high ratios of pain:physical function and fatigue:physical function scores, and a high number of reported symptoms. These quantitative data differed significantly from patients with RA. Patients with fibromyalgia also had a lower ESR than patients with RA, whose scores were similar whether or not there was coexistent fibromyalgia. Patients with fibromyalgia were distinguished equally well from patients with RA by patient questionnaire data as by the ESR.

Conclusion
A simple 1-page, 2-sided patient questionnaire provides quantitative information which may contribute to identify patients with fibromyalgia, including patients with RA who may also have coexistent fibromyalgia.

Key words
Symptoms, rheumatoid arthritis (RA), fibromyalgia, patient questionnaires, erythrocyte sedimentation rate (ESR).

Supported in part by the Arthritis Foundation, Jack C. Massey Foundation, the Maury County Lupus Fund, and the Showa Denko Corporation.
Please address correspondence and reprint requests to: Theodore Pincus, MD, Professor of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, 203 Oxford House, Box 5, Nashville, Tennessee, USA.
E-mail: t.pincus@vanderbilt.edu