Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia
Three articles on PainSci cite Wolfe 2011: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. Quite a Stretch 3. A Rational Guide to Fibromyalgia
PainSci notes on Wolfe 2011:
The original ACR diagnostic criteria for fibromyalgia were published in 1990 (Wolfe) and the first major revision was published in 2010 (Wolfe), and this paper added 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 a fibromyalgia (FM) survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010). We also created a new FM symptom scale to further characterize FM severity.
METHODS: The ACR 2010 consists of 2 scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR 2010 criteria by eliminating the physician's estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. We also created a 0-31 FM Symptom scale (FS) by adding the WPI to the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with FM, 845 with osteoarthritis (OA) or with other noninflammatory rheumatic conditions, 439 with systemic lupus erythematosus (SLE), and 5210 with rheumatoid arthritis (RA).
RESULTS: The modified ACR 2010 criteria were satisfied by 60% with a prior diagnosis of FM, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups based on FM severity variables. An FS score ≥ 13 best separated criteria+ and criteria- patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population.
CONCLUSION: A modification to the ACR 2010 criteria will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies.
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.
- “The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity,” Frederick Wolfe, Daniel J Clauw, Mary-Ann Fitzcharles, Don L Goldenberg, Robert S Katz, Philip Mease, Anthony S Russell, I Jon Russell, John B Winfield, and Muhammad B Yunus, Arthritis Care Res (Hoboken), 2010.
- “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.
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