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Objective Fibromyalgia (FM) is prevalent but often under-recognized in patients with systemic lupus erythematosus (SLE). Patient-reported outcomes (PROs) from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) can identify co-morbid FM in patients with rheumatic diseases. The present study examined the utility of the MDHAQ in recognizing FM in patients with SLE during routine consultations. Methods Patients with SLE completed an MDHAQ. FM status was determined by the validated 2016 revision of the ACR 2010/2011 preliminary FM criteria. Individual PROs from the MDHAQ and composite Fibromyalgia Assessment Tool (FAST) indices of the discriminatory PROs were compared between patients with and without FM using Student’s unpaired t-test and receiver operating characteristic curve analysis to determine the area under the curve (AUC). The physician’s clinical impression of FM was recorded, and the SLE Disease Activity Index was used to assess disease activity. Results Of 88 patients with SLE, 23 (26%) satisfied the 2016 FM criteria. The FAST3 composite measure of two out of three of pain (≥6/10), joint count (≥16/48) and symptom checklist (≥16/60) correctly classified 89% of patients (AUC=0.90, kappa=0.71). Physician diagnosis demonstrated moderate agreement with the 2016 FM criteria (kappa=0.43) but missed 43% of patients with FM. In the presence of active disease, the FAST3 correctly classified 91% of patients. Conclusions Co-morbid FM is prevalent in SLE yet often underdiagnosed by physicians. The simple FAST3 index of the MDHAQ provides an easy-to-use self-reported tool to improve identification of FM in patients with SLE.

Background: Fibromyalgia (FM) and systemic lupus erythematosus (SLE) are both characterised by non-specific symptoms such as pain and fatigue. To make diagnosis even more challenging, fibromyalgia is overrepresented in the SLE population. Objectives: To identify which symptoms can discriminate between patients with comorbid FM and patients without comorbid FM in the SLE population, using a routinely distributed questionnaire. Methods: Patients with SLE (n=88) completed a Multi-Dimensional Health Assessment Questionnaire (MDHAQ) [1] and the 2011 FM Criteria questionnaire [2]. FM status was determined using the 2016 modification of the 2010/2011 FM criteria [3]. The MDHAQ contains a 60-item symptom checklist section, giving a score of 0-60. Patients with complete data were analysed for specific symptoms that were discriminating for FM using student’s t test with Bonferroni correction. Results: SLE patients with FM reported a higher prevalence of positive responses for every symptom except for ‘dark or bloody stools’ and ‘burning in sexual organs’. Nineteen symptoms demonstrated a significant difference between those with and without FM. The most discriminating symptoms were muscle pain, swelling (of hands, ankles and in other joints), back pain, neck pain, problems with thinking and dry mouth (all p Conclusion: The symptom checklist section of the MDHAQ can provide clues that help discriminate between SLE patients with and without FM. Clinicians can find valuable information in the specific symptoms experienced by the patient, as well as the overall number of symptoms. Grouping the discriminatory symptoms together in the questionnaire may assist clinicians to consider the diagnosis of FM more easily in patients with SLE. References [1] Pincus, T., Y. Yazici, and M. Bergman, Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clinical & Experimental Rheumatology,2005. 23(5Suppl 39): p.S19-28. [2] Wolfe, F., et al., Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol, 2011. 38(6): p.1113-22. [3] Wolfe, F., et al. 2016Revisions to the 2010/2011 fibromyalgia diagnostic criteria. in Seminars in arthritis and rheumatism. 2016. Elsevier. Disclosure of Interests: Frank Huang: None declared, Sean O’Neill: None declared, Ray Fang: None declared, Matthew Nguyen: None declared, Kathryn Gibson Grant/research support from: UCB, Abbvie, Speakers bureau: UCB, Janssen

Background: Fibromyalgia (FM) is disproportionately common in patients with systemic lupus erythematosus (SLE) and difficult to diagnose on a background of classical SLE symptoms [1]. The Multi-Dimensional Health Assessment Questionnaire (MDHAQ) has been shown to be useful to recognise improvement over 2 months in a variety of rheumatic conditions including SLE [2] but has not previously been shown to be useful to alert the clinician to comorbid FM in the latter condition. Conversely, the 2011 FM self-report questionnaire is disease-specific and available for use in clinical and epidemiological studies. Administration of multiple forms may be difficult in a busy clinical setting. Objectives: To identify comorbid FM in patients with SLE using patient-reported outcomes (PROs) from the routinely distributed MDHAQ, in comparison to the 2016 revision of the 2010/2011 FM criteria. Methods: Patients with SLE completed an MDHAQ and the 2011 FM Criteria questionnaire. FM status was assigned using the 2016 revision of the 2010/2011 FM criteria as the gold standard. The MDHAQ features six main PROs: body pain, patient global and fatigue score on a 0-10 visual analogue scale, as well as a functional impact score, self-report joint count and symptom checklist which have a range of 0-10, 0-48 and 0-60 respectively. Composite indices consisting of either two or three of patient pain score 6, self-report joint count 16 and symptom checklist 16 or three of four of the same measures plus a fatigue score 6 have been described previously to provide clues to comorbid FM in other rheumatic diseases [3,4]. Individual PROs and these composite indices were compared between patients with and without FM by student’s unpaired t-test and Area Under the Curve (AUC) analysis. The physician’s diagnosis of FM was analysed against the FM criteria using Cohen’s kappa. Physicians were blinded to the results of the 2016 FM criteria. Results: 88 patients with SLE were studied, of whom 23 (26%) satisfied FM criteria. Those with FM reported higher scores in all PROs. A patient global of 6 could correctly classify 90% of patients and provided the highest AUC of 0.95, followed by the symptom checklist and body pain. An index of three measures (pain score, self-report joint count and symptom checklist) gave an AUC of 0.90. An index of four measures (additional fatigue criterion) gave an AUC of 0.93. Both indices correctly classified 89% of patients with a cut-off of 2 and 3 respectively. The physician’s diagnoses had moderate agreement with the FM criteria (kappa = 0.43). Conclusion: Comorbid FM is prevalent in SLE yet often missed by physicians. In busy clinical settings, composite indices provide useful clues to coexisting FM in SLE, although a simple MDHAQ patient global is quick and potentially just as valuable in this patient group. These findings require further validation in a larger cohort. References: [1] Wolfe F, Petri M, Alarcon GS, Goldman J, Chakravarty EF, Katz RS, et al. Fibromyalgia, systemic lupus erythematosus (SLE), and evaluation of SLE activity. J Rheumatol. 2009;36(1):82-8. [2] Castrejon, I., M.J. Bergman, and T. Pincus, MDHAQ/RAPID3 to recognise improvement over 2 months in usual care of patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, as well as rheumatoid arthritis. J Clin Rheumatol, 2013. 19(4):p.169-74 [3] Gibson K et al. 2016 MDHAQ as a useful screening tool for fibromyalgia in busy clinical settings Ann Rheum Dis, volume 75, supplement 2, page 88 [4] Schmuckler J, et al. 2018 A simple index based on scores on a multidimensional health assessment questionnaire (MDHAQ) provides information quite similar to ACR criteria for fibromyalgia in routine care Ann Rheum Dis, volume 77, Suppl, page A465 Disclosure of Interests: Frank Huang: None declared, Sean O’Neill: None declared, Ray Fang: None declared, Matthew Nguyen: None declared, Kathryn Gibson Grant/research support from: UCB, Abbvie, Speakers bureau: UCB, Janssen

Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.