Fausto Salaffi1, Marco Di Carlo1, Laura Bazzichi2, Fabiola Atzeni3, Marcello Govoni4, Giovanni Biasi5, Manuela Di Franco6, Flavio Mozzani7, Elisa Gremese8, Lorenzo Dagna9, Alberto Batticciotto10, Fabio Fischetti11, Roberto Giacomelli12, Serena Guiducci13, Giuliana Guggino14, Mario Bentivegna15, Roberto Gerli16, Carlo Salvarani17, Gianluigi Bajocchi18, Marco Ghini19, Florenzo Iannone20, Valeria Giorgi21, Sonia Farah1, Mariateresa Cirillo3, Sara Bonazza4, Stefano Barbagli5, Chiara Gioia6, Daniele Santilli7, Annunziata Capacci8, Giulio Cavalli9, Francesco Carubbi12, Francesca Nacci13, Ilenia Riccucci16, Luigi Sinigaglia22, Maurizio Masullo23, Bianca Maria Polizzi23, Maurizio Cutolo24, Piercarlo Sarzi-Puttini21. 1. Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy. 2. Rheumatology Unit, AOU Pisana, Pisa, Italy. 3. Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy. 4. Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy. 5. Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy. 6. Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences Rheumatology Unit- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. 7. Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 8. UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 9. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy. 10. Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo - Fondazione Macchi, Varese, Italy. 11. Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy. 12. Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy. 13. Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy. 14. Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy. 15. Integrated Reference Center of Rheumatology, ASP 7, Scicli Hospital, Ragusa, Italy. 16. Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy. 17. University of Modena and Reggio Emilia, Azienda USL-IRCCS di Reggio Emilia, Modena, Italy. 18. Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia, Italy. 19. Rheumatology Unit, Azienda USL di Modena, Modena, Italy. 20. Rheumatology Unit, Department of Emergency and Organ Transpantations, University of Bari, Bari, Italy. 21. Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan State University School of Medicine, Milan, Italy. 22. Division of Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy. 23. Ministry of Health, General Directorate of Health Care, Rome, Italy. 24. Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino, University of Genova, Genova, Italy.
Abstract
OBJECTIVE: To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. METHODS: Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'-which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. RESULTS: The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th-75th percentiles) were respectively 61.16 (41.16-77.00), 27.00 (19.00-32.00) and 19.0 (13.00-24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0-23 for remission, 24-40 for mild disease, 41-63 for moderate disease, 64-82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0-12 for remission, 13-20 for mild disease, 21-28 for moderate disease, 29-33 for severe disease and >33 for very severe disease; PDS: 0-5 for remission, 6-15 for mild disease, 16-20 for moderate disease, 21-25 for severe disease and >25 for very severe disease. CONCLUSIONS: Disease severity cut-offs can represent an important improvement in interpreting FM.
OBJECTIVE: To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. METHODS: Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'-which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. RESULTS: The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th-75th percentiles) were respectively 61.16 (41.16-77.00), 27.00 (19.00-32.00) and 19.0 (13.00-24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0-23 for remission, 24-40 for mild disease, 41-63 for moderate disease, 64-82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0-12 for remission, 13-20 for mild disease, 21-28 for moderate disease, 29-33 for severe disease and >33 for very severe disease; PDS: 0-5 for remission, 6-15 for mild disease, 16-20 for moderate disease, 21-25 for severe disease and >25 for very severe disease. CONCLUSIONS: Disease severity cut-offs can represent an important improvement in interpreting FM.