PPM ACCESS
Access to the PPM Journal and newsletters is FREE for clinicians.
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 Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

Arthritis Care Res. 2010;62(5):600-20

Introduction:  Objections to the physical examination component of the 1990 American College of Rheumatology research classification criteria (1990 ACR RCC) for the diagnosis of the fibromyalgia syndrome prompted investigators to examine other diagnostic approaches.  The objective was to create simple, practical criteria for the clinical diagnosis of fibromyalgia that could be used in community medical practice.

There were two main challenges: Since it was perceived that the tender points examination component of the 1990 ACR RCC was not being performed or was not being performed properly in the primary care setting, the new 2010 ACR Fibromyalgia Diagnostic Criteria (2010 ACR FDC) were developed with the objective of eliminating the tender point examination as a necessary component. The second problem was that the 1990 ACR RCC focused only on the pain and tenderness of fibromyalgia without acknowledging any of the other comorbid symptoms that contribute importantly to the suffering fibromyalgia patients.  It was hoped that new criteria could more equally weigh the effects and severity of other symptom components such as poor sleep, fatigue, and dyscognition. Finally, the need to validate the new criteria for use in community clinical medicine was acknowledged.

Methods:  This was a multicenter study which involved 829 patients who had already been diagnosed with fibromyalgia and control patients.  The study was based on questionnaire instruments and physician interview with the study subjects.

Patients were asked to fill out certain forms before seeing the physician.  A widespread pain index (WPI) component was derived when the patients were asked to indicate which of 19 body areas had been painful in the previous week. 

Patients were also asked to score the severity of three specific comorbid symptoms fatigue, daytime tiredness resulting from unrefreshed sleep, and cognitive dysfunction on a scale of  0 (no problem) to 3 (severe, pervasive, continuous, life-disturbing problem). Finally, patients were asked to indicate which somatic symptoms that they’d experienced in the previous 3 months. Together these elements comprised the symptom severity scale (SSS).

The data were analyzed using random forest and recursive partitioning analyses, which aided in the development of a new clinical case definition of fibromyalgia  based on two realms, the WPI and the SSS.

Once the new 2010 ACR FDC were developed, they were validated in community clinical practice.

Results:  When the WPI and the SSS were combined by summing them, a numerical score was created that had diagnostic power for the fibromyalgia syndrome.

With the new 2010 ACR FDC, the diagnosis of fibromyalgia syndrome was supported when:

  • WPI ≥ 7 and SSS ≥ 5 or
  • WPI 3-6 and SSS ≥ 9

Conclusions:  This new case definition of the fibromyalgia syndrome correctly classified 88.1% of patients who had been diagnosed with the 1990 ACR RCC, and it did not necessitate a tender point examination. Finally, it was validated for use in primary community clinical practice.

Next Article:
New American College of Rheumatology Criteria for Fibromyalgia: A Twenty-Year Journey
close X
SHOW MAIN MENU
SHOW SUB MENU