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THU0669 A self-report symptom checklist on a multidimensional health assessment questionnaire (MDHAQ) to capture a “positive review of systems” as a standard, quantitative, and informative “scientific” clue to fibromyalgia similar to modified criteria for fibromyalgia

Background The scientific method is based on recording information as quantitative standard data rather than as narrative descriptions, to test possible value in diagnosis, management, and outcomes. This approach generally is applied to laboratory tests and other data from high technology sources. However, information from a patient history and physical examination can be analysed for scientific validity if collected in as standard, quantitative and reproducible data. A symptom checklist of 60 items was initially designed as a review of systems to screen for symptoms and possible adverse events of medications, for which it has been helpful. It has also been observed that patients who report a large number of symptoms may provide a clue to the presence of fibromyalgia (FM);Clin Exp Rheumatol. 2004. 22:453–61). Objectives To compare results of a 60-item symptom checklist on a multidimensional health assessment questionnaire (MDHAQ) vs the modified 2016 revised preliminary diagnostic criteria for fibromyalgia (Sem Arth Rheum 46:319–329, 2016). Methods All patients seen at an academic rheumatology clinic complete an MDHAQ;J Rheumatol 2005 32:1432–9) at each visit, which includes a 60-item symptom checklist. In April-July 2017, patients also completed a questionnaire to identify the 2016 revised preliminary diagnostic criteria for FM. The likelihood of reporting each symptom by a patient with RA who did not have FM was compared to patients who met 2016 criteria for FM using a chi-square test. Receiver operator characteristic (ROC) curves were performed of the 60 symptom checklist as well as the 10 most discriminatory symptoms vs the FM criteria.Abstract THU0669 – Table 1 Proportion of patients with rheumatoid arthritis (RA) who did not meet fibromyalgia criteria versus patients with primary or secondary fibromyalgia to meet fibromyalgia criteria who responded positively regarding the 10 most discriminatory symptoms on a symptom checklist Symptom RA (84) FM (110) Chi2* Muscle pain, aches, or cramps 30 (35) 100 (31) 65.6367 Muscle weakness 16 (19) 82 (75) 58.6852 Dizziness 11 (13) 65 (59) 42.2875 Headaches 25 (30) 84 (76) 42.0177 Problems with thinking 7 (8) 57 (52) 40.7405 Problems with memory 12 (14) 65 (59) 39.9442 Neck pain 29 (35) 87 (79) 39.3505 Problems with sleeping 30 (36) 88 (80) 39.2017 Numbness or tingling of arms or legs 16 (19) 70 (64) 38.3709 Unusual fatigue 23 (27) 79 (72) 37.7207 *all p<0.001 Results We studied 84 patients with RA who did not meet FM criteria vs 110 patients who met FM criteria – no differences were seen between patients with primary or secondary FM who met criteria. Patients who met FM criteria were more likely to report each of the 60 symptoms. The 10 symptoms that were most discriminatory of RA vs FM are illustrated in the table 1. A ROC curve for the 60 symptoms vs the FM Criteria had an area of 0.896 (Confidence interval 0.872–0.925), and for the 10 most discriminatory symptoms of 0.8975 (Confidence interval 0.8667–0.928). Conclusions A simple MDHAQ symptom checklist may be informative in routine rheumatology care to identify possible primary and secondary FM in agreement with FM criteria. The MDHAQ may provide a useful and feasible alternative to FM Criteria for busy clinical settings. Disclosure of Interest T. Pincus Shareholder of: Dr. Pincus holds a copyright and trademark on MDHAQ and RAPID3 for which he receives royalties and license fees. All revenue is used to support further development of quantitative questionnaire measures for patients and doctors in clinical rheumatology care., S. Jamal: None declared, I. Castrejon: None declared