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:functionthe 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 painfrom 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 questionnairethe 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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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.
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