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PAINSCAN LITERATURE REVIEW
Issue 2, Volume 1
Fibromyalgia Diagnosis: Where Are We Now?
Implications of the 2010 ACR Fibromyalgia Diagnostic Criteria

Introduction

Welcome from I. Jon Russell, MD, PhD, ACR Master

The purpose of this edition of PainScan is to briefly examine the development of criteria for the diagnosis of fibromyalgia and some of the consequences of that accomplishment.

The story begins with a small group of clinicians and researchers interested in the medical condition at first called fibrositis syndrome and then by consensus changed to the fibromyalgia syndrome.  The group of clinicians were frustrated by the lack of consensus diagnostic criteria. They planned and conducted a study to establish the needed diagnostic criteria for recruitment of fibromyalgia patients into research studies.

The resultant computer-generated criteria were soon accepted by the American College of Rheumatology (ACR) and became the 1990 ACR Research Classification Criteria (1990 ACR RCC). They were designed to facilitate recruitment of fibromyalgia patients for research study. That was what was needed at the time because it was important to have confidence that patients entered into research studies in San Antonio were comparable to those being studied in Boston, Peoria, Portland, or Wichita. As a result of these criteria, research on the fibromyalgia syndrome thrived with a nearly 10-fold increase in publications compared with previous years.

For example, in the calendar year 1975, there were 20 papers published about fibromyalgia.  The pattern of trickling annual publications continued until about 1990 when the new 1990 ACR RCC made it possible for research studies around the globe to depend on validated criteria.

Since then, the numbers of annual publications about fibromyalgia have increased substantially. In addition, the strength of the evidence has improved, as clinical description was supported by convincing data regarding epidemiology, natural history, pathogenesis, neurochemistry, responses to various treatment interventions, and costs of care.

The total number of Medline-referenced fibromyalgia-related publications between 1948 and 2010 is 5,597. Averaged over the past 62 years, this would represent about 90 publications annually. This is not an astounding number, but at a rate of nearly two per week, it is enough so that a busy professional would have difficulty finding every publication and digesting every nuance. 

The 1990 ACR RCC were never validated for use in community clinical care but were eventually used in that way because nothing better was available. New criteria were needed that could be used by busy clinicians in the diagnosis and care of their patients.

That need seemed to conspire with what was believed to be failure of many clinicians to properly use of the examination component of the 1990 ACR RCC, so the new 2010 ACR Fibromyalgia Diagnostic Criteria (2010 ACR FDC) were devised from extensive new research data. These new criteria have been distilled into a questionnaire that can be self-administered by patients to determine a score that is capable of identifying the fibromyalgia syndrome. Of course, legally it is a physician who makes clinical diagnoses, but the questionnaire format of the 2010 ACR FDC provides the data needed by the physician toward that quest.

It is predictable that the merits of the new 2010 ACR FDC will be debated for some time and other criteria will likely surface to challenge its preeminence. Perhaps the more important debate, however, must be whether patients with fibromyalgia syndrome will benefit from this effort to accurately make the diagnosis of fibromyalgia. Two studies have addressed that question and seem to agree that patients with fibromyalgia syndrome benefit clinically from having the diagnosis made with confidence. In addition, everyone benefits because the costs of healthcare for fibromyalgia syndrome patients is reduced by making the diagnosis.

The abstracts selected for this edition of PainScan briefly summarize the original publications to support the historical vignette above. Questions and comments are welcomed.

First Article:
The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia
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