Fibromyalgia diagnostic criteria: Difference between revisions

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Revision as of 15:07, 14 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Diagnostic Criteria

The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology.

Criteria

A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

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

Ascertainment

1) WPI: note the number 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.
Shoulder girdle, left Hip (buttock, trochanter), left Jaw, left Upper back, Shoulder girdle, right Hip (buttock, trochanter), right Jaw, right Lower back, Upper arm, left Upper leg, left Chest Neck, Upper arm, right Upper leg, right Abdomen, Lower arm, left Lower leg, left, Lower arm, right Lower leg, right

2) SS scale score:

Fatigue
Waking unrefreshed
Cognitive symptoms

For the each of the 3 symptoms above, 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

Considering somatic symptoms in general, indicate whether the patient has:

0 = no symptoms
1 = few symptoms
2 = moderate number of symptoms
3 = Severe 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.

References

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 ==Overview==
 ==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 elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology.
+===Criteria===
-*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.
+A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
-*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
+*1) Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9.
-**Arms (elbows)
+*2) Symptoms have been present at a similar level for at least 3 months.
-**Buttocks
+*3) The patient does not have a disorder that would otherwise explain the pain.
-**Chest
+===Ascertainment===
-**Knees
+) WPI: note the number areas in which the patient has had pain over the last week. In how many areas has the patient had pain?
-**Lower back
+*Score will be between 0 and 19.
-**Neck
+*Shoulder girdle, left Hip (buttock, trochanter), left Jaw, left Upper back, Shoulder girdle, right Hip (buttock, trochanter), right Jaw, right Lower back, Upper arm, left Upper leg, left Chest Neck, Upper arm, right Upper leg, right Abdomen, Lower arm, left Lower leg, left, Lower arm, right Lower leg, right
-**Rib cage
+) SS scale score:
-**Shoulders
+*Fatigue
-**Thighs
+*Waking unrefreshed
-*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.
+*Cognitive symptoms
+For the each of the 3 symptoms above, 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
+Considering somatic symptoms in general, indicate whether the patient has:
+*0 = no symptoms
+*1 = few symptoms
+*2 = moderate number of symptoms
+*3 = Severe 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.
 ==References==