Fibromyalgia

You have full text access to this OnlineOpen article

The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

  1. Frederick Wolfe1,*,
  2. Daniel J. Clauw2,†,
  3. Mary-Ann Fitzcharles3,‡,
  4. Don L. Goldenberg4,§,
  5. Robert S. Katz5,
  6. Philip Mease6,
  7. Anthony S. Russell7,¶,
  8. I. Jon Russell8,‖,
  9. John B. Winfield9,††,
  10. Muhammad B. Yunus10,‡‡

Article first published online: 23 FEB 2010

DOI: 10.1002/acr.20140

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 62, Issue 5, pages 600–610, May 2010

Additional Information

How to Cite

Wolfe, F., Clauw, D. J., Fitzcharles, M.-A., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Winfield, J. B. and Yunus, M. B. (2010), The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research, 62: 600–610. doi: 10.1002/acr.20140

Author Information

  1. 1

    National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita

  2. 2

    University of Michigan Medical School, Ann Arbor

  3. 3

    Montreal General Hospital and McGill University, Montreal, Quebec, Canada

  4. 4

    Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, Massachusetts

  5. 5

    Rush University Medical Center, Chicago, Illinois

  6. 6

    Seattle Rheumatology Associates and Swedish Medical Center, Seattle, Washington

  7. 7

    University of Alberta, Edmonton, Alberta, Canada

  8. 8

    University of Texas Health Sciences Center, San Antonio

  9. 9

    University of North Carolina, Chapel Hill

  10. 10

    The University of Illinois College of Medicine, Peoria

  1. †

    Dr. Clauw has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Pfizer, Lilly, Forest, Cypress Biosciences, Pierre Fabre, UCB, and AstraZeneca.

  2. ‡

    Dr. Fitzcharles has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Pfizer, Lilly, and Boehringer Ingelheim, and has given expert testimony for various medicolegal and law firms and received a fee.

  3. §

    Dr. Goldenberg has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Forest, Pfizer, and Lilly.

  4. Dr. Anthony S. Russell has received consultant fees (less than $10,000 each) from Amgen/Wyeth, Schering-Plough, UCB, and Abbott Canada, and speaking fees (less than $10,000 each) from Roche and BMS.

  5. ‖

    Dr. I. Jon Russell has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Johnson & Johnson and UCB, and (more than $10,000 each) from Pfizer, Lilly, and Jazz.

  6. ††

    Dr. Winfield has received consultant fees, speaking fees, and/or honoraria (more than $10,000 each) from Lilly, Pfizer, Forest, and Jazz, and has given expert testimony for medicolegal and various law firms and received a fee.

  7. ‡‡

    Dr. Yunus has received speaking fees (more than $10,000) from Forest Laboratories.

*National Data Bank for Rheumatic Diseases, 1035 North Emporia, Suite 288, Wichita, KS 67214

Publication History

  1. Issue published online: 29 APR 2010
  2. Article first published online: 23 FEB 2010
  3. Accepted manuscript online: 23 FEB 2010 12:00AM EST
  4. Manuscript Accepted: 10 FEB 2010
  5. Manuscript Received: 24 AUG 2009

Funded by

  • Lilly Research Laboratories

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article with Supporting Information (HTML) Get PDF (137K)

Abstract

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 ≥7 AND SS ≥5) OR (WPI 3–6 AND SS ≥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.

View Full Article with Supporting Information (HTML) Get PDF (137K)