Clues to recognition of secondary fibromyalgia in patients with osteoarthritis according to a fibromyalgia assessment screening tool of scales on a multidimensional health assessment questionnaire (MDHAQ/FAST3)

Abstract

Purpose: To recognize clues to secondary fibromyalgia (FM) in patients with osteoarthritis (OA), as widespread pain of FM often confounds OA pain, which may complicate clinical trials and clinical care. FM was recognized according to a simple FM assessment screening tool with fatigue (FAST3-F) on a multidimensional health assessment questionnaire (MDHAQ), i.e., MDHAQ/FAST3-F, for which >80% agreement is seen with formal FM diagnostic criteria. MDHAQ demographic data and clinical scales were analyzed in OA patients who did or did not have secondary FM according to MDHAQ/FAST3-F. Methods: At one academic rheumatology setting, all patients complete an MDHAQ at all visits, prior to seeing the rheumatologist. The 2-page MDHAQ includes 0-10 scores for physical function (FN), and visual analog scales (VAS) for pain (PN) and patient global assessment (PATGL), which are compiled into a 0-30 composite continuous MDHAQ/RAPID3 (routine assessment of patient index data) scale. Higher scores indicate poorer clinical status. The MDHAQ also includes a 0-10 fatigue VAS, 0-48 self-report painful joint count, and 0-60 symptom checklist, compiled into a cumulative 0-3 MDHAQ/FAST3-F scale of 1 point each for fatigue VAS ≥6, RADAI ≥16, and symptom checklist ≥16, based on area under the curve (AUC) of receiver operator characteristic (ROC) curves. FAST3-F scores of ≥2/3 show >80% agreement with formal FM criteria. A two-sample t test was used to compare the two groups; p values were considered significant if ≤0.05. Results: A total of 173 OA patients were included in this study, of whom 55 (32%) met MDHAQ/FAST3-F criteria for secondary FM. Patients who met or did not meet these criteria for FM did not differ significantly in age, sex, or BMI (Table). Patients who met FAST3-F criteria had a significantly lower formal educational level of 12.0 vs 14.2 in OA patients who did not meet criteria (p=0.01) (Table). MDHAQ scores for physical function, pain VAS, patient global assessment VAS, fatigue VAS, and RAPID3 were significantly higher in the FAST3-F FM group (p<0.001) Table). Patients who met FAST-3 FM criteria also had significantly higher scores for poor sleep quality, anxiety, and depression. Among the 173 OA patients, 13% reported a clinical diagnosis of depression on their MDHAQ past medical history review, including 32% of FAST3-F positive patients and 7% of FAST3-F negative patients (p=0.01) (Table).Table 1Mean values for demographics and clinical variables at baseline of 173 patients with OAMean (standard deviation=SD) or % of variable:All patientsFibromyalgia according to FAST3-FPYesNoN (%)17342 (24%)131 (76%)DemographicsAge (years), mean (SD)66.1 (10.7)64.5 (11.7)66.6 (10.5)0.27Female, %84%88%82%0.38BMI, mean (SD)32.9 (7.8)33.8 (6.8)32.7 (8.0)0.58Educational level (years), mean (SD)13.7 (3.8)12.0 (3.9)14.2 (3.6)0.01Clinical VariablesPhysical function (0-10), mean (SD)3.1 (1.9)4.6 (1.8)2.6 (1.6)<0.001Patient global assessment (0-10), mean (SD)5.9 (2.7)7.8 (1.9)5.3 (2.6)<0.001Pain (0-10), mean (SD)6.9 (2.3)8.2 (1.5)6.5 (2.4)<0.001RAPID3 (0-30), mean (SD)15.8 (6.0)20.4 (4.6)14.4 (5.7)<0.001Poor sleep quality (0-3.3), mean (SD)1.4 (1.0)1.9 (0.9)1.2 (0.9)<0.001Anxiety (0-3.3), mean (SD)0.7 (0.8)1.2 (0.8)0.5 (0.8)0.001Depression/feeling blue (0-3.3), mean (SD)0.6 (0.8)1.2 (0.8)0.5 (0.7)0.001Clinical diagnosis of depression, %13%32%7%0.01Abbreviations: FAST3-F, fibromyalgia assessment screening tool-fatigue, BMI, body mass index Open table in a new tab Abbreviations: FAST3-F, fibromyalgia assessment screening tool-fatigue, BMI, body mass index Conclusions: FAST3-F appears to provide useful clues to identify OA patients with secondary fibromyalgia, who exhibit poorer baseline clinical status, higher distress and lower formal education level, compared with patients who did not meet FAST3-F criteria. These findings may be useful in stratifying patients in clinical trials and other clinical research, recognizing a basis for poor responses in clinical care, and enhancing understanding of pain mechanisms and progression of OA and/or FM and/or comorbid OA and FM.