The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

Abstract

Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3-6 AND SS >9). Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.

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

“…The diagnostic sensitivity of the 2011ModCr was 83% and the specificity was 67%. The rather low specificity was expected, considering the 2011ModCr were designed to encompass a wider spectrum of patients with FM (8). This wider spectrum of FM diagnoses was also seen with the use of the 2013AltCr.…”

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

“…Because widespread pain has been associated with poor outcome in various diseases [4,12,13,24,28], and because widespread pain is often clinically understood as a sign of psychologic distress [15,19,23,27,28,33,34], we posited that widespread pain, as documented on a pain diagram, would be associated with catastrophizing and depression and poor functional status.…”

Fibromyalgia: Do not give up the tender point count too easily: Comment on the article by Wolfe et al

“…We read with interest the article by Wolfe et al (1) and the editorial by Wolfe (2), published recently in Arthritis Care & Research, introducing new diagnostic criteria for the fibromyalgia syndrome. These preliminary diagnostic criteria (including a widespread pain index [WPI] Ն7 and a symptom severity [SS] scale score of Ն5, or a WPI of 3-6 and an SS scale score of Ն9) raise important concerns.…”