Fibromyalgia, according to the American College of
Rheumatology 1990 Criteria for the Classification of Fibromyalgia in 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(a) as a result in responding to pressure.
IV. Diagnosis
In the narrative review of the literature, consensus documents by the
American College of Rheumatology (ACR), evidence-based interdisciplinary
German guidelines on the diagnosis and management of FMS by Klinikum
Saarbrücken Internal Medicine 1 Winterberg 1 D-66119 Saarbrücken, the
recommendations of a stepwise diagnostic work-up of patients with
chronic widespread pain (CWP) in primary care include: Complete medical
history including medication, complete medical examination, basic
laboratory tests to screen for inflammatory or endocrinology diseases,
referral to specialists only in case of suspected somatic diseases,
assessment of limitations of daily functioning, screening for other
functional somatic symptoms and mental disorders, and referring to
mental health specialists in case of mental disorder(20). Other study
suggested of 4 phased diagnosis. In phase one, physicians undertook a self-assessment of their practice. Phase two of the study involved diagnosis and treatment of a virtual case vignette. The third phase consisted of analysis of the data from phase two and providing feedback from an expert rheumatologist, and the fourth phase was to complete patient report forms for five patients in their practice(21).
Here we quote the text from the study of The American College of
Rheumatology Preliminary Diagnostic Criteria for Fibromyalgiaand
Measurement of Symptom Severity by FREDERICK WOLFE,1 DANIEL J. CLAUW,2
MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4
ROBERT S. KATZ,5 PHILIP MEASE,6 ANTHONY S. RUSSELL,7 I. JON RUSSELL,8 JOHN B. WINFIELD,9 AND MUHAMMAD B. YUNUS10
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.
Please note:
This criteria set has been approved by the American College of
Rheumatology (ACR) Board of Directors as Provisional.This signifies that
the criteria set has been quantitatively validated using patient data,
but it has not undergone validationbased on an external data set. All
ACR-approved criteria sets are expected to undergo intermittent
updates.As disclosed in the manuscript, these criteria were developed
with support from the study sponsor, Lilly Research Laboratories.The
study sponsor placed no restrictions, offered no input or guidance on
the conduct of the study, did not participatein the design of the study,
see the results of the study, or review the manuscript or submitted
abstracts prior to thesubmission of the paper. The recipient of the
grant was Arthritis Research Center Foundation, Inc. The authors
receivedno compensation. The ACR found the criteria to be
methodologically rigorous and clinically meaningful.ACR is an
independent professional, medical and scientific society which does not
guarantee, warrant or endorse anycommercial product or service. The ACR
received no compensation for its approval of these criteria(22).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(21) http://www.ncbi.nlm.nih.gov/pubmed/23118542
(22) http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf
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