Rheumatology 2000; 39: 336-337
© 2000 British Society for Rheumatology
Letters to the Editor |
A fibromyalgia scale in a general rheumatology clinic
Department of Rheumatology, Seacroft Hospital, Leeds LS14 6UH, UK
Sir, A self-reported pencil and paper questionnaire capable of differentiating fibromyalgia from inflammatory disease would be useful in a general rheumatology clinic.
Callahan and Pincus devised a scale that generated a ratio of pain:function—the ‘P-VAS:D-ADL ratio’ [1]. In patients already attending a clinic, this ratio proved capable of separating patients with rheumatoid arthritis (RA)—who described poor function and moderate pain—from a fibromyalgic group who recorded great pain and little functional disturbance (this group termed ‘generalized non-inflammatory disease GNID').
Twenty-seven per cent of GNID patients and no patient with inflammatory arthritis had a ratio 
5. A ratio of 
3 was found in 67% of RA patients and 28% of patients with GNID. The use of such a scale in a general rheumatology clinic requires that its discriminatory ability is not confounded by other musculoskeletal conditions or those general medical conditions that may appear in such a clinic.
This scale (with only one change, the word ‘faucets’ replaced by ‘taps’) has been used prospectively in a general rheumatology clinic. All new patients completed the questionnaire—the first 100 whose referral problem included pain in both hands were studied. Diagnoses were reviewed 2 yr after first attendance.
Five (23%) of the 22 fibromyalgic patients had a ratio >5 and only one (3%) of 32 patients with inflammatory arthritis [RA = 27, psoriatic arthritis = 2, systemic lupus erythematosus (SLE) = 3] scored at this level. No patient with fibromyalgia had a score <2 whilst six (18%) inflammatory arthritis patients fell into this group (Table 1
). A ratio of <3 was a less useful discriminator in this population.
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Patients with nerve compression syndromes and one patient with acromegaly scored at intermediate levels. A patient with multiple sclerosis put her pain beyond the upper limit of the 10 cm analogue scale.
In this population of new clinic referrals, the scale proved less discriminatory than in established out-patients [1]. However, newly referred patients with hand pain who score >5 are likely to have fibromyalgia. Those with ratios <2 are more likely to have inflammatory arthritis.
References
- Callahan LF, Pincus T. A clue from a self-report questionnaire to distinguish rheumatoid arthritis from noninflammatory diffuse musculoskeletal pain. The P-VAS:D-ADL Ratio. Arthritis Rheum1990;33:1317–22.[ISI][Medline]
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