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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 > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =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.

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  • Authors+Show Affiliations

    ,

    National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, KS 67214, USA. fwolfe@arthritis-research.org

    , , , , , , , ,

    Source

    Arthritis care & research 62:5 2010 May pg 600-10

    MeSH

    Fibromyalgia
    Health Status Indicators
    Humans
    Medical Informatics
    Pain
    Reproducibility of Results
    Rheumatology
    Sensitivity and Specificity
    Severity of Illness Index
    Societies, Medical
    United States

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20461783

    Citation

    Wolfe, Frederick, et al. "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity." Arthritis Care & Research, vol. 62, no. 5, 2010, pp. 600-10.
    Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600-10.
    Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., ... Yunus, M. B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research, 62(5), pp. 600-10. doi:10.1002/acr.20140.
    Wolfe F, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care Res (Hoboken). 2010;62(5):600-10. PubMed PMID: 20461783.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. AU - Wolfe,Frederick, AU - Clauw,Daniel J, AU - Fitzcharles,Mary-Ann, AU - Goldenberg,Don L, AU - Katz,Robert S, AU - Mease,Philip, AU - Russell,Anthony S, AU - Russell,I Jon, AU - Winfield,John B, AU - Yunus,Muhammad B, PY - 2010/5/13/entrez PY - 2010/5/13/pubmed PY - 2010/6/2/medline SP - 600 EP - 10 JF - Arthritis care & research JO - Arthritis Care Res (Hoboken) VL - 62 IS - 5 N2 - 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 > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =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. SN - 2151-4658 UR - https://www.unboundmedicine.com/medline/citation/20461783/full_citation L2 - https://doi.org/10.1002/acr.20140 DB - PRIME DP - Unbound Medicine ER -