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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
9 Articles in this Series
Introduction
The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia
The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity
New American College of Rheumatology Criteria for Fibromyalgia: A Twenty-Year Journey
Development of the Fibromyalgia Survey Diagnostic Criteria: A Modification of the ACR (2010) Preliminary Diagnostic Criteria for Fibromyalgia
Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols—A Consensus Document
Diagnosis of Fibromyalgia Syndrome—A Comparison of Association of the Medical Scientific Societies in Germany, Survey, and American College of Rheumatology Criteria
Chronic Widespread Pain and Fibromyalgia: Two Sides of the Same Coin?
Does the Label “Fibromyalgia” Alter Health Status, Function, and Health Service Utilization? A Prospective, Within-Group Comparison in a Community Cohort of Adults with Chronic Widespread Pain
The Impact of a Diagnosis of Fibromyalgia on Health Care Resource Use by Primary Care Patients in the UK

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia

Arthritis Rheum. 1990;33(2):160-172

Introduction: The investigators involved in this study hoped to develop clinical criteria that would, for the first time, make it possible to have a consensus diagnosis of the fibromyalgia syndrome.

Methods: Starting in the fall of 1986, 22 investigators were part of an effort to classify the fibromyalgia syndrome.  All 22 had a known interest in the syndrome, and they worked to plan the trial.

A draft of a protocol and study questionnaire was prepared, reviewed, and revised, and then in November 1986, investigators were trained in how to perform a physical examination as part of the trial.  This helped further refine the process, leading to the final version of the questionnaire and physical examination protocol.

Only 16 centers actually participated in the clinical trial, representing various North American states and provinces.

In total, 558 consecutive patients were studied; 293 had fibromyalgia, and 265 were control patients early in their course of a rheumatic disease (eg, rheumatoid arthritis, neck pain syndrome, or systemic lupus erythematosus). These control patients had disorders that it was believed could be confused with primary fibromyalgia. The control patients were matched for age and sex to patients in the primary fibromyalgia group. 

The fibromyalgia syndrome patients were conceptually divided into two groups: those with primary fibromyalgia syndrome (lacking any concomitant inflammatory or painful condition) and those with secondary fibromyalgia syndrome (exhibiting an associated inflammatory or painful condition). For the secondary (or concomitant) fibromyalgia group, controls were matched for age, sex, and concomitant rheumatic disorders.

Trained assessors, who were blinded to the diagnosis group, performed the clinical interviews and physical examinations on the study patient participants.

Results: In 97.6% of the patients with fibromyalgia, widespread pain was noted; this is axial plus upper and lower segment plus left- and right-sided pain.  Widespread pain was seen in 69.1% of the control patients.

The presence of widespread pain and mild or greater tenderness in at least 11 of 18 tender points had a sensitivity of 88.4% and a specificity of 81.1% for identification of the fibromyalgia syndrome patients.

The two fibromyalgia groups—primary fibromyalgia and secondary (concomitant) fibromyalgia—were not statistically different on any major study variable.  For those with or without concomitant rheumatic conditions, the diagnostic criteria (summarized below) performed equally well.

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia (1990 ACR RCC):

  • Widespread pain in combination with
  • Tenderness at ≥ 11 out of 18 specific tender points
    • Digital palpation should be done with about 4 kg of force.
    • The patient must state that the palpation was painful for the tender point to be considered positive.

Concomitant radiographic or laboratory abnormalities do not lead to exclusions.

In terms of diagnosis or classification, there is no distinction between primary fibromyalgia and secondary (or concomitant) fibromyalgia.

Conclusions: This study was the first to develop consensus criteria to make the diagnosis of fibromyalgia for the purpose of research study recruitment. The new criteria had only two components which were deemed to be easy to use.

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