Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

Abstract

Objective. To validate the 2011 modification of the 2010 American College of Rheumatology (ACR) preliminary criteria for the diagnosis of fibromyalgia (2011ModCr) and develop alternative criteria in a sample of patients with diverse pain disorders that are commonly seen in everyday practice by pain specialists, rheumatologists, and psychologists. Methods. Eight clinicians from geographically varied locations in the US evaluated patients with chronic pain and psychiatric disorders using a standard set of questions that included the 2011ModCr questions, the Symptom Impact Questionnaire (SIQR), a 28-area pain location inventory (PLI), and the Short Form 36. Alternative diagnostic criteria were developed from the same data set using logistic regression and receiver operating curve analysis. Results. Complete data on 321 patients were evaluated; there were 135 patients with fibromyalgia (according to the 1990 ACR criteria) and 186 patients with 16 other common chronic pain problems. Comparing the 2011ModCr with the 1990 ACR criteria provided a sensitivity of 83%, a specificity of 67%, and a correct classification of 74%. Alternative criteria were derived from the 10-item symptom score from the SIQR symptoms and the 28-area PLI. Maximal diagnostic accuracy was obtained with >17 pain sites (range 0 -28) and an SIQR symptom score of >21 (range 0 -50). These alternative criteria had a diagnostic sensitivity of 81%, a specificity of 80%, and a correct classification of 80%. Conclusion. The 2011ModCr had robust operating characteristics. Alternative criteria based on symptom items from the SIQR and pain locations from the PLI had comparable operating characteristics, with somewhat better specificity and ease of use.

Spondyloarthritis and fibromyalgia: interfering association or differential diagnosis?

“…Fibromyalgia should be ruled out in SpA, using classification criteria [19] or screening tools (FiRST) [20], and this dimension should be taken into account in the diagnosis and mainly in disease evaluation [21] and therapeutic proposals.…”

Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients

“…The Oxford Criteria were used to classify the joint involvement in ESpA patients as follows: type 1 peripheral, type 2 peripheral and type 3 involvement (both axial and peripheral) [8,9]. The CASPAR criteria were used for psoriatic arthritis (PsA) [48], ACR criteria for Rheumatoid Arthritis [49] and EULAR/ACR criteria for Gout [50] Fibromyalgia and Osteoarthritis were diagnosed according with ACR and EULAR classification criteria [51,52]. Disease activity and function in SpA patients were assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS, CRP-based) [53,54], Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [55], Bath Ankylosing Spondylitis Functional Index (BASFI) [56], Disease Activity Score (DAS) and Health Assessment Questionnaire for SpA (HAQ-S) [57].…”

Drs. Friend and Bennett reply

“…This seems odd, given that we independently validated those criteria 3 . Indeed, in contradistinction to Dr. Wolfe's claim, we reviewed that paper and recommended "acceptance with revision."…”

“…Regarding Dr. Wolfe's comments that we might contemplate the specificity of items used in the 2013 criteria, such as stiffness, balance, and environmental sensitivity, we refer him to Figure 1D in our 2013 criteria paper 3 . This figure shows a random forest importance plot, with the 4 most important clinical features being environmental sensitivity, tenderness, cognition, and stiffness.…”