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==Overview==
==Overview==
The most widely accepted set of diagnostic criteria for fibromyalgia was developed in 2010 by the Multicenter Criteria Committee of the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:<ref name="pmid26035624">{{cite journal |vauthors=Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU |title=Fibromyalgia diagnosis: a review of the past, present and future |journal=Expert Rev Neurother |volume=15 |issue=6 |pages=667–79 |year=2015 |pmid=26035624 |doi=10.1586/14737175.2015.1046841 |url=}}</ref><ref name="pmid21285161">{{cite journal |vauthors=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB |title=Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia |journal=J. Rheumatol. |volume=38 |issue=6 |pages=1113–22 |year=2011 |pmid=21285161 |doi=10.3899/jrheum.100594 |url=}}</ref><ref name="pmid22094193">{{cite journal |vauthors=Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P |title=Chronic widespread pain in the spectrum of rheumatological diseases |journal=Best Pract Res Clin Rheumatol |volume=25 |issue=2 |pages=165–71 |year=2011 |pmid=22094193 |doi=10.1016/j.berh.2010.01.011 |url=}}</ref><ref name="pmid20461783">{{cite journal |vauthors=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB |title=The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity |journal=Arthritis Care Res (Hoboken) |volume=62 |issue=5 |pages=600–10 |year=2010 |pmid=20461783 |doi=10.1002/acr.20140 |url=}}</ref>
*Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9
*Symptoms have been present at a similar level for at least 3 months
*The patient does not have a disorder that would otherwise explain the pain
==Diagnostic Criteria==
==Diagnostic Criteria==
There is still debate over what should be considered essential diagnostic criteria.  The most widely accepted set of classification criteria for research purposes were elaborated in 1990 by the Multicenter Criteria Committee of the [http://www.rheumatology.org/ the American College of Rheumatology]. These criteria, which are known informally as "the ACR 1990" define fibromyalgia according to the presence of the following criteria:
The most widely accepted set of diagnostic criteria for fibromyalgia was developed in 2010 by the Multicenter Criteria Committee of the American College of Rheumatology.<ref name="pmid26035624">{{cite journal |vauthors=Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU |title=Fibromyalgia diagnosis: a review of the past, present and future |journal=Expert Rev Neurother |volume=15 |issue=6 |pages=667–79 |year=2015 |pmid=26035624 |doi=10.1586/14737175.2015.1046841 |url=}}</ref><ref name="pmid21285161">{{cite journal |vauthors=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB |title=Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia |journal=J. Rheumatol. |volume=38 |issue=6 |pages=1113–22 |year=2011 |pmid=21285161 |doi=10.3899/jrheum.100594 |url=}}</ref><ref name="pmid22094193">{{cite journal |vauthors=Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P |title=Chronic widespread pain in the spectrum of rheumatological diseases |journal=Best Pract Res Clin Rheumatol |volume=25 |issue=2 |pages=165–71 |year=2011 |pmid=22094193 |doi=10.1016/j.berh.2010.01.011 |url=}}</ref><ref name="pmid20461783">{{cite journal |vauthors=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB |title=The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity |journal=Arthritis Care Res (Hoboken) |volume=62 |issue=5 |pages=600–10 |year=2010 |pmid=20461783 |doi=10.1002/acr.20140 |url=}}</ref> and updated in 2016<ref name="pmid27916278">{{cite journal| author=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL et al.| title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. | journal=Semin Arthritis Rheum | year= 2016 | volume= 46 | issue= 3 | pages= 319-329 | pmid=27916278 | doi=10.1016/j.semarthrit.2016.08.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27916278  }} </ref>.
 
These criteria are not well used in clinical practice<ref name="pmid30724039">{{cite journal| author=Wolfe F, Schmukler J, Jamal S, Castrejon I, Gibson KA, Srinivasan S et al.| title=Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician-Based Fibromyalgia Diagnosis in a University Clinic. | journal=Arthritis Care Res (Hoboken) | year= 2019 | volume= 71 | issue= 3 | pages= 343-351 | pmid=30724039 | doi=10.1002/acr.23731 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30724039  }} </ref>.
 
Competing criteria are by a collaboration between the US [[Food and Drug Administration]] (FDA) and the American Pain Society (APS) called the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks ([http://www.acttion.org/ ACTTION]). These criteria are called the ACTTION-APS Pain Taxonomy (AAPT)<ref name="pmid30453109">{{cite journal| author=Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL et al.| title=AAPT Diagnostic Criteria for Fibromyalgia. | journal=J Pain | year= 2019 | volume= 20 | issue= 6 | pages= 611-628 | pmid=30453109 | doi=10.1016/j.jpain.2018.10.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30453109  }} </ref>. These criteria have been criticized for not including a summary assessment of severity<ref name="pmid30765303">{{cite journal| author=Wolfe F| title=Letter to the editor, "Fibromyalgia Criteria". | journal=J Pain | year= 2019 | volume= 20 | issue= 6 | pages= 739-740 | pmid=30765303 | doi=10.1016/j.jpain.2019.02.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30765303  }} </ref>.
* Multisite pain (MSP) "defined as 6 or more pain sites from a total of 9 possible sites"
* "Moderate to severe sleep problems OR fatigue"
* "MSP plus fatigue or sleep problems must have been present for at least 3 months"
 
===Criteria as of 2016===
A patient satisfies American College of Rheumatology) ACR 2016 diagnostic criteria for fibromyalgia if the following 3 conditions are met<ref name="pmid27916278">{{cite journal| author=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL et al.| title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. | journal=Semin Arthritis Rheum | year= 2016 | volume= 46 | issue= 3 | pages= 319-329 | pmid=27916278 | doi=10.1016/j.semarthrit.2016.08.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27916278  }} </ref>:
* Pain in at least 4 of 5 regions
* Widespread pain index (WPI) >= 7 and symptom severity (SS) scale score >=5 or WPI >= 4 and SS scale score >= 9
* Symptoms have been present at a similar level for at least 3 months
 
====Ascertainment====
1. WPI: Note the number of areas in which the patient has had pain over the last week. In how many areas has the patient had pain?
*Score will be between 0 and 19.
*Areas for pain are: shoulder girdle, left hip (buttock and [[trochanter]]), left jaw, left upper back, shoulder girdle, right hip (buttock and [[trochanter]]), right jaw, right lower back, upper arm, left upper leg, left chest, neck, upper arm, right upper leg, right abdomen, right lower arm, left lower leg, left lower arm, and right lower leg
 
2. Somatic symptoms (SS) scale score: For each of the 3 symptoms below, indicate the level of severity over the past week using the following scale:
*0 = no problem
*1 = slight or mild problems, generally mild or intermittent
*2 = moderate, considerable problems, often present and/or at a moderate level
*3 = severe: pervasive, continuous, life-disturbing problems
Symptoms:
* Fatigue
* Waking unrefreshed
* Cognitive symptoms
 
The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the
extent (severity) of somatic symptoms in general. The final score is between 0 and 12.
 
====History of criteria====
The American College of Rheumatology criteria over time:
ACR1990<ref name="pmid2306288">{{cite journal| author=Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al.| title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. | journal=Arthritis Rheum | year= 1990 | volume= 33 | issue= 2 | pages= 160-72 | pmid=2306288 | doi=10.1002/art.1780330203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2306288  }} </ref>
* "widespread pain" defined as "axial plus upper and lower segment plus left- and right-sided pain"
* "tenderness at 11 or more of the 18 specific tender point sites"
 
ACR2000/2011<ref name="pmid20461783">{{cite journal| author=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P et al.| title=The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. | journal=Arthritis Care Res (Hoboken) | year= 2010 | volume= 62 | issue= 5 | pages= 600-10 | pmid=20461783 | doi=10.1002/acr.20140 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20461783  }} </ref><ref name="pmid21285161">{{cite journal| author=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS et al.| title=Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. | journal=J Rheumatol | year= 2011 | volume= 38 | issue= 6 | pages= 1113-22 | pmid=21285161 | doi=10.3899/jrheum.100594 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21285161  }} </ref>
* Dropped requirement for widespread pain
* Removed requirement for physical examination for tender points and replaced with self-report
* Added fibromyalgia severity score (FSS)
 
ACR2016<ref name="pmid27916278">{{cite journal| author=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL et al.| title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. | journal=Semin Arthritis Rheum | year= 2016 | volume= 46 | issue= 3 | pages= 319-329 | pmid=27916278 | doi=10.1016/j.semarthrit.2016.08.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27916278  }} </ref>
* Added "generalized pain criterion to insure that regional pain syndromes are not captured by the criteria". This criterion is pain in at least 4 of 5 regions. The five regions are 4-quadrant plus axial:
** Left upper region: jaw, shoulder girdle, upper arm, lower arm
** Right upper region: jaw, shoulder girdle, upper arm, lower arm
** Left lower region: hip (buttock, trochanter), upper leg, lower leg
** Right lower region: hip (buttock, trochanter), upper leg, lower leg
** Axial region: neck, upper back, lower back, chest, abdomen


*A history of widespread pain lasting more than three months—affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
In 2016, authors of the ACR 2016 criteria have proposed shortening the WPI by "combining 4-region pain and a total pain site score ≥7"<ref name="pmid31596726">{{cite journal| author=Wolfe F, Butler SH, Fitzcharles M, Häuser W, Katz RL, Mease PJ et al.| title=Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria. | journal=Scand J Pain | year= 2019 | volume=  | issue=  | pages=  | pmid=31596726 | doi=10.1515/sjpain-2019-0054 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31596726  }} </ref>.
*Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four [[kilogram-force|kilograms-force]] (39 [[newton]]s) of [[force]] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered.<ref>{{cite web |author=National Institute of Arthritis and Musculoskeletal and Skin Diseases |title=Questions and Answers About Fibromyalgia -- How Is Fibromyalgia Diagnosed? |url=http://www.niams.nih.gov/hi/topics/fibromyalgia/fibrofs.htm#fib_d |date=June 2004 |publisher=National Institutes for Health}}</ref> Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. This set of criteria was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes.  While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the ''de facto'' diagnostic criteria in the clinical setting.  It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance. To be diagnosed with fibromyalgia,there must be pain and tenderness in at least 11 of 18 areas, including
**Arms (elbows)
**Buttocks
**Chest
**Knees
**Lower back
**Neck
**Rib cage
**Shoulders
**Thighs
*It is important not to make fibromyalgia a diagnosis of inclusion (anyone with complex or chronic pain is given the diagnosis).mVery often if routine blood work including a rheumatic profile, [[X-Ray]], [[MRI]], Electrodiagnostics ([[EMG]]), [[Diagnostic musculoskeletal ultrasound]] or [[Thermography]] (for patients with weather sensitive pain) is obtained the root cause can be discovered.  


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Rheumatology]]
[[Category:Diseases involving the fasciae]]
[[Category:Syndromes]]
[[Category:Ailments of unknown etiology]]
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Latest revision as of 19:47, 30 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The most widely accepted set of diagnostic criteria for fibromyalgia was developed in 2010 by the Multicenter Criteria Committee of the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:[1][2][3][4]

  • Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9
  • Symptoms have been present at a similar level for at least 3 months
  • The patient does not have a disorder that would otherwise explain the pain

Diagnostic Criteria

The most widely accepted set of diagnostic criteria for fibromyalgia was developed in 2010 by the Multicenter Criteria Committee of the American College of Rheumatology.[1][2][3][4] and updated in 2016[5].

These criteria are not well used in clinical practice[6].

Competing criteria are by a collaboration between the US Food and Drug Administration (FDA) and the American Pain Society (APS) called the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION). These criteria are called the ACTTION-APS Pain Taxonomy (AAPT)[7]. These criteria have been criticized for not including a summary assessment of severity[8].

  • Multisite pain (MSP) "defined as 6 or more pain sites from a total of 9 possible sites"
  • "Moderate to severe sleep problems OR fatigue"
  • "MSP plus fatigue or sleep problems must have been present for at least 3 months"

Criteria as of 2016

A patient satisfies American College of Rheumatology) ACR 2016 diagnostic criteria for fibromyalgia if the following 3 conditions are met[5]:

  • Pain in at least 4 of 5 regions
  • Widespread pain index (WPI) >= 7 and symptom severity (SS) scale score >=5 or WPI >= 4 and SS scale score >= 9
  • Symptoms have been present at a similar level for at least 3 months

Ascertainment

1. WPI: Note the number of areas in which the patient has had pain over the last week. In how many areas has the patient had pain?

  • Score will be between 0 and 19.
  • Areas for pain are: shoulder girdle, left hip (buttock and trochanter), left jaw, left upper back, shoulder girdle, right hip (buttock and trochanter), right jaw, right lower back, upper arm, left upper leg, left chest, neck, upper arm, right upper leg, right abdomen, right lower arm, left lower leg, left lower arm, and right lower leg

2. Somatic symptoms (SS) scale score: For each of the 3 symptoms below, indicate the level of severity over the past week using the following scale:

  • 0 = no problem
  • 1 = slight or mild problems, generally mild or intermittent
  • 2 = moderate, considerable problems, often present and/or at a moderate level
  • 3 = severe: pervasive, continuous, life-disturbing problems

Symptoms:

  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.

History of criteria

The American College of Rheumatology criteria over time: ACR1990[9]

  • "widespread pain" defined as "axial plus upper and lower segment plus left- and right-sided pain"
  • "tenderness at 11 or more of the 18 specific tender point sites"

ACR2000/2011[4][2]

  • Dropped requirement for widespread pain
  • Removed requirement for physical examination for tender points and replaced with self-report
  • Added fibromyalgia severity score (FSS)

ACR2016[5]

  • Added "generalized pain criterion to insure that regional pain syndromes are not captured by the criteria". This criterion is pain in at least 4 of 5 regions. The five regions are 4-quadrant plus axial:
    • Left upper region: jaw, shoulder girdle, upper arm, lower arm
    • Right upper region: jaw, shoulder girdle, upper arm, lower arm
    • Left lower region: hip (buttock, trochanter), upper leg, lower leg
    • Right lower region: hip (buttock, trochanter), upper leg, lower leg
    • Axial region: neck, upper back, lower back, chest, abdomen

In 2016, authors of the ACR 2016 criteria have proposed shortening the WPI by "combining 4-region pain and a total pain site score ≥7"[10].

References

  1. ↑ 1.0 1.1 Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU (2015). "Fibromyalgia diagnosis: a review of the past, present and future". Expert Rev Neurother. 15 (6): 667–79. doi:10.1586/14737175.2015.1046841. PMID 26035624.
  2. ↑ 2.0 2.1 2.2 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB (2011). "Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia". J. Rheumatol. 38 (6): 1113–22. doi:10.3899/jrheum.100594. PMID 21285161.
  3. ↑ 3.0 3.1 Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P (2011). "Chronic widespread pain in the spectrum of rheumatological diseases". Best Pract Res Clin Rheumatol. 25 (2): 165–71. doi:10.1016/j.berh.2010.01.011. PMID 22094193.
  4. ↑ 4.0 4.1 4.2 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010). "The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity". Arthritis Care Res (Hoboken). 62 (5): 600–10. doi:10.1002/acr.20140. PMID 20461783.
  5. ↑ 5.0 5.1 5.2 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL; et al. (2016). "2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria". Semin Arthritis Rheum. 46 (3): 319–329. doi:10.1016/j.semarthrit.2016.08.012. PMID 27916278.
  6. ↑ Wolfe F, Schmukler J, Jamal S, Castrejon I, Gibson KA, Srinivasan S; et al. (2019). "Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician-Based Fibromyalgia Diagnosis in a University Clinic". Arthritis Care Res (Hoboken). 71 (3): 343–351. doi:10.1002/acr.23731. PMID 30724039.
  7. ↑ Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL; et al. (2019). "AAPT Diagnostic Criteria for Fibromyalgia". J Pain. 20 (6): 611–628. doi:10.1016/j.jpain.2018.10.008. PMID 30453109.
  8. ↑ Wolfe F (2019). "Letter to the editor, "Fibromyalgia Criteria"". J Pain. 20 (6): 739–740. doi:10.1016/j.jpain.2019.02.002. PMID 30765303.
  9. ↑ Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL; et al. (1990). "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee". Arthritis Rheum. 33 (2): 160–72. doi:10.1002/art.1780330203. PMID 2306288.
  10. ↑ Wolfe F, Butler SH, Fitzcharles M, Häuser W, Katz RL, Mease PJ; et al. (2019). "Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria". Scand J Pain. doi:10.1515/sjpain-2019-0054. PMID 31596726.
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