Do Rheumatologists Need More Clues to Diagnose Fibromyalgia?

Abstract

In this issue of The Journal , Gibson, et al have demonstrated that certain subscales of the Multidimensional Health Assessment Questionnaire (MDHAQ) can be combined to provide clues to the diagnosis of comorbid fibromyalgia (FM) in patients with rheumatic diseases1. An FM assessment screening tool (FAST) compared favorably to the 2011 self-report FM criteria, developed for clinical and epidemiologic studies2, and both agreed moderately with the clinical diagnosis of FM. The authors suggest that because MDHAQ is already frequently used in rheumatology centers, adapting the FAST indices can alert clinicians to concurrent FM without adding new self-administered screening instruments. This paper also reconsiders a number of important issues involving rheumatologists and FM. First, rheumatologists have become more aware of the frequency and effect of FM in every rheumatic disease. Whether using the FAST indices, the 2011 FM criteria, or the gold standard (Dr. Gibson’s clinical diagnosis), FM was present in about 20–30% of patients with rheumatic disease. This is consistent with reports of FM in 13–40% of cases of rheumatoid arthritis (RA)3,4, 10–20% of osteoarthritis (OA)5, 10–30% with psoriatic arthritis or a spondyloarthropathy [SpA; such … Address correspondence to Dr. D.L. Goldenberg, 1125 NW 12th Ave., Unit 107, Portland, Oregon 97209, USA. E-mail: dongoldenberg44{at}gmail.com