The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee
One article on PainSci cites Wolfe 1990: A Rational Guide to Fibromyalgia
PainSci commentary on Wolfe 1990: ?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 wherever possible.
The original 1990 ACR criteria for a diagnosis of fibromyalgia, included in the bibliography mainly for historical significance. They infamously included the “tender points,” which were eventually dropped. For an excellent overview of the evolution of the criteria, see New and Modified Fibromyalgia Diagnostic Criteria. The most recent version of the ACR criteria was published in 2011: see Wolfe.
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.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
related content
- “New and Modified Fibromyalgia Diagnostic Criteria,” Neha Garg, www.rheumatologynetwork.com.
- “The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity,” Wolfe et al, Arthritis Care Res (Hoboken), 2010.
- “Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia,” Wolfe et al, Journal of Rheumatology, 2011.
- “Editorial: the status of fibromyalgia criteria,” Wolfe, Arthritis Rheumatol, 2015.
- “Implications of proposed fibromyalgia criteria across other functional pain syndromes,” Egloff et al, Scandinavian Journal of Rheumatology, 2015.
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- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.