Simple tool can identify fibromyalgia in SLE patients

Fibromyalgia is a common co-morbidity in patients with SLE yet often underdiagnosed by physicians, Australian research has shown.

But an easy-to-use patient-reported outcome (PRO) tool can aid the clinician in identifying the presence of coexistent  fibromyalgia patients with SLE, according to a study led by Dr Frank Huang and Dr Sean O’Neill of the Department of Rheumatology, Royal North Shore Hospital, Sydney.

Writing in the journal Lupus the clinicians say fibromyalgia is difficult to identify in patients with SLE because of the overlap of symptoms such as fatigue and widespread pain, but it is important to differentiate between inflammatory and non-inflammatory symptoms to avoid unnecessary immunosuppression.

In their study they found that 23 of 88 patients with SLE (26%) met the 2016 criteria for fibromyalgia when assessed using the Multi-Dimensional Health Assessment Questionnaire (MDHAQ).

The double-sided one-page patient-reported outcome (PRO) questionnaire was used in routine consultations and the patients’ answers were then used in as part of the Fibromyalgia Assessment Screening Tool (FAST).

The FAST3 composite measure was found to have good ability to identify patients according to the validated 2016 revision of the ACR 2010/2011 preliminary fibromyalgia criteria

With a cutoff of two out of three for pain score (≥6/10), joint count (≥6/48) and symptom checklist (≥16/60), the FAST3 measure correctly classified 89% of patients (AUC. 0.90), with a sensitivity of 78% and specificity of 92%.

The FAST indices performed substantially better than physician diagnosis of fibromyalgia, which had only moderate agreement with 2016 FM criteria and which missed 43% of all SLE patients with fibromyalgia.

About one in four SLE patients had active disease (SLEDAI  ≥ 6), and in this group the FAST3 correctly classified 91% of patients with fibromyalgia, with a sensitivity of 83% and a specificity of 94%.

The study investigators said their findings showed that a simple tool could help clinicians with the challenging issue of identifying fibromyalgia in lupus patients, which would often go undiagnosed for years.

“Co-morbid fibromyalgia is prevalent in SLE but is often missed by physicians. The MDHAQ is a simple self-reported questionnaire that is easy to administer and interpret in busy clinical settings,” they wrote.

“The FAST indices of the MDHAQ can supplement traditional history and examination to provide useful clues to the presence of co-morbid fibromyalgia in patients with SLE. This in turn ensures that fibromyalgia symptoms can be managed appropriately and that over-treatment with immunosuppression may be avoided.”

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