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MDHAQ questionnaire effective in identifying fibromyalgia
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CHICAGO — The multidimensional health assessment questionnaire is as effective in identifying fibromyalgia as the 2011 fibromyalgia criteria questionnaire and can be a feasible addition to routine care, according to data presented at the ACR/ARHP 2018 Annual Meeting.
“The criteria for fibromyalgia were revised in 2011, based entirely on a patient self-report questionnaire, which is used in clinical trials and other research but not in routine care,” Juan Schmukler, MD, of the Rush University Medical Center, told attendees. “MDHAQ/RAPID3 is informative in RA, as well as in lupus, ankylosing spondylitis, psoriatic arthritis, gout, vasculitis and is used in routine care of all rheumatology patients, including at Rush University. Three reports have suggested MDHAQ may provide clues to the presence of fibromyalgia.”
Schmukler and colleagues evaluated five indices based on the multidimensional health assessment questionnaire (MDHAQ) — which includes scales for pain, fatigue, symptom checklist, self-report painful joint count and RAPID3 — for agreement with the revised 2011 fibromyalgia criteria among patients in routine clinical care. All participating patients, recruited at a single setting, with all diagnoses, completed an MDHAQ at all routine care visits. The 2011 fibromyalgia criteria questionnaire was added during a period of 3 months, completed by consecutive patients.
The researchers initially evaluated all MDHAQ scores for agreement with the fibromyalgia criteria questionnaire according to receiver operator characteristic curves for area under the curve (AUC), and compiled into indices of three or four measures based on the highest results. Schmukler and colleagues then analyzed these indices for AUC and cut points based on specificity and sensitivity identify, to score 0 or 1 for a 0-to-3 index of three measures or 0-to-4 index of four measures, and correlations.
The researchers ultimately developed five MDHAQ fibromyalgia indices from the questionnaire’s five scales with the highest AUC compared to the 2011 criteria. The criteria used were symptom checklist, self-reported painful joint count, fatigue, RAPID3 and pain scale. Three indices of three measures, called MDHAQ-FM3, all included symptom checklist and self-reported painful joint count. Another, termed MDHAQ-FM3-P, added a pain visual analogue scale (VAS). Meanwhile, MDHAQ-FM3-F added a fatigue VAS, and MDHAQ-FM3-R added a RAPID3 score. In addition, two MDHAQ-FM4 indices added fatigue VAS to symptom checklist and self-report painful joint count, while MDHAQ-FM4-P included a pain VAS and MDHAQ-FM4-R included RAPID3.
According to Schmukler, all five MDHAQ indices for fibromyalgia agreed with the 2011 criteria questionnaire with receiver operator characteristic curves for AUC higher than 0.924 (P = 0.21 for all indices). In addition, correlations among the MDHAQ indices for the 2011 criteria were all higher than 0.83 (P < .001), and agreement was greater than 84.3%.
“Several pragmatic fibromyalgia assessment screening tool indices, derived from the same MDHAQ used in routine care, identify fibromyalgia similarly to the 2011 criteria,” Schmukler said. “There is minimal interference with practice workflow — none if MDHAQ is routinely used — and minimal additional physician time required.” – by Jason Laday
Disclosure: Schmukler reports no relevant financial disclosures. Please see the full study for additional authors’ disclosures.
Reference :
Schmukler J. Abstract 839. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.