A recent study, published in the journal Rheumatology, suggests that the Fibromyalgia Rapid Screening Tool (FiRST) questionnaire may help rheumatologists in everyday practice, and be particularly useful for patients at risk of treatment failure.
The test is used to potentially exclude or include fibromyalgia (FM) diagnoses in people with rheumatic disease.
In the study “Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases,” researchers compared FiRST results to diagnoses made using standard rheumatology criteria.
Previous studies reported the occurrence of overlapping symptoms between inflammatory rheumatic diseases and FM, which could interfere with correct diagnosis and lead to unjustified therapeutic intensification, especially for patients with spondyloarthritis (a type of arthritis that attacks mainly the spine but can also affect joints of the arms and legs).
The researchers evaluated the performance of the FiRST questionnaire for detecting naturally occurring FM in patients with inflammatory rheumatic disease.
In total, 605 patients performed the FiRST questionnaire, including 279 with rheumatoid arthritis (RA), 271 with spondyloarthrosis (SpA), and 57 patients with connective tissue diseases (CTD).
When compared to the American College of Rheumatology’s (ACR) 1990 criteria, FiRST showed good performance in detecting FM associated with rheumatic disease: 74.5% of sensitivity and 80.4% specificity. The positive and negative predictive values registered 26.6% and 97.1%, respectively.
The predictive values are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results.
When comparing to a rheumatologist’s opinion, FiRST showed a sensitivity of 75.8%, a specificity of 85.1%, a positive predictive value of 48.3% and a negative predictive value of 95%.
In conclusion, the results revealed good performance by the FiRST questionnaire in detecting FM associated with inflammatory rheumatic disease according to ACR 1990 criteria (sensitivity of 74.5% and specificity of 80.4%). The negative predictive value was extremely good (97%), while the positive predictive value was poor (26%).
Future studies are required to evaluate the FiRST questionnaire’s usefulness in patient care.
Scientists also hope to determine the questionnaire’s predictive value for a patient’s potential failure to respond to anti-tumor necrosis factor (TNF)-alpha therapy, widely used to treat inflammatory rheumatic conditions.
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