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

Authors

  • Frederick Wolfe,

    Corresponding author
    1. National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita
    • National Data Bank for Rheumatic Diseases, 1035 North Emporia, Suite 288, Wichita, KS 67214
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  • Daniel J. Clauw,

    1. University of Michigan Medical School, Ann Arbor
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    • 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.

  • Mary-Ann Fitzcharles,

    1. Montreal General Hospital and McGill University, Montreal, Quebec, Canada
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    • 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.

  • Don L. Goldenberg,

    1. Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, Massachusetts
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    • Dr. Goldenberg has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Forest, Pfizer, and Lilly.

  • Robert S. Katz,

    1. Rush University Medical Center, Chicago, Illinois
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  • Philip Mease,

    1. Seattle Rheumatology Associates and Swedish Medical Center, Seattle, Washington
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  • Anthony S. Russell,

    1. University of Alberta, Edmonton, Alberta, Canada
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    • 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.

  • I. Jon Russell,

    1. University of Texas Health Sciences Center, San Antonio
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    • 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.

  • John B. Winfield,

    1. University of North Carolina, Chapel Hill
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    • 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.

  • Muhammad B. Yunus

    1. The University of Illinois College of Medicine, Peoria
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    • Dr. Yunus has received speaking fees (more than $10,000) from Forest Laboratories.


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.

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