The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity
PainSci summary of Wolfe 2010?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
The original ACR diagnostic criteria for fibromyalgia were published in 1990 (Wolfe). This is the first major revision in 20 years, but it was followed almost immediately by important refinements in 2011 (Wolfe), adding the FMS symptom scale, “which measures what the authors call the overall ‘fibromyalgianess’ of a patient.”
This paper is not directly useful to patients, but Neha Garg does a good job of explaining it: New and Modified Fibromyalgia Diagnostic Criteria. See also Wolfe’s 2015 paper, “Editorial: the status of fibromyalgia criteria”.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
related content
- “New and Modified Fibromyalgia Diagnostic Criteria,” Neha Garg, www.rheumatologynetwork.com.
- “The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee,” F Wolfe, H A Smythe, M B Yunus, R M Bennett, C Bombardier, D L Goldenberg, P Tugwell, S M Campbell, M Abeles, and P Clark, Arthritis and Rheumatism, 1990.
- “Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia,” Frederick Wolfe, Daniel J Clauw, Mary-Ann Fitzcharles, Don L Goldenberg, Winfried Häuser, Robert S Katz, Philip Mease, Anthony S Russell, I Jon Russell, and John B Winfield, Journal of Rheumatology, 2011.
- “Editorial: the status of fibromyalgia criteria,” Frederick Wolfe, Arthritis Rheumatol, 2015.
- “Implications of proposed fibromyalgia criteria across other functional pain syndromes,” N Egloff, R von Känel, V Müller, U T Egle, G Kokinogenis, S Lederbogen, B Durrer, and S Stauber, Scandinavian Journal of Rheumatology, 2015.
One article on PainScience.com cites Wolfe 2010 as a source:
- PS A Rational Guide to Fibromyalgia — The science of the mysterious disease of pain, exhaustion, and mental fog
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