The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee

University of Kansas, Arthritis Center, Wichita 67214.
Arthritis & Rheumatology (Impact Factor: 7.76). 03/1990; 33(2):160-72.
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To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. 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. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

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Available from: Fred Wolfe, Oct 16, 2014
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    • "Written informed consent was obtained from all study participants. In our case-control study we prospectively enrolled 25 patients with fibromyalgia syndrome (23 females, two males; median age: 59 years, range: 50–70 years) diagnosed according to the 1990 American College of Rheumatology criteria (Wolfe et al., 1990). Patients were recruited between 2007 and 2011 from all over Germany by contacting fibromyalgia syndrome self-help organizations. "
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    ABSTRACT: Recent studies have provided evidence of pathology and functional abnormalities of small nerve fibers as a potential correlate of pain in the fibromyalgia syndrome. Here, we aimed to quantify dermal unmyelinated nerve fiber diameter at the electron microscopic level to find a potential morphological correlate of the functional disturbance. Thirty-two patients with fibromyalgia syndrome, twelve patients with small fiber neuropathy and twenty-four healthy controls were prospectively recruited. Skin biopsies of the distal and proximal leg and index finger were taken and processed for immunofluorescence and for electron microscopy. We determined the diameter of small unmyelinated nerve fibers by measuring ten transversely cut axons of each biopsy. The mean axon diameter was reduced in patients with fibromyalgia syndrome compared to patients with small fiber neuropathy and to controls (p<0.05). Furthermore, we confirmed previous findings of disturbed small fiber function in quantitative sensory testing and of reduced intraepidermal nerve fiber density in fibromyalgia patients. Our study provides further evidence of small fiber pathology in fibromyalgia syndrome and discloses differences compared to small fiber neuropathy, indicating that different pathomechanisms may lead to small fiber loss in the two disorders.
    Pain 07/2015; DOI:10.1097/j.pain.0000000000000285 · 5.21 Impact Factor
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    • "The inclusion criteria included age 18 years or older, an FMS diagnosis after a physical assessment by an evaluating rheumatologist (B.W.), and the meeting of either the 1990 or the 2010 American College of Rheumatology (ACR) criteria for FMS. The 1990 ACR criteria required the selfreport of widespread pain in all four quadrants of the body that had persisted for at least 3 months, exhibition of 11/18 tender points on an examination, and the lack of any other reasonable explanation for the symptoms (Wolfe et al., 1990). In 2010, the ACR published preliminary diagnostic criteria that included subjective measurements of fatigue, cognitive dysfunction , sleep problems, and other somatic symptoms and removed the need for measuring tender points (Wolfe et al., 2010). "
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    ABSTRACT: Fibromyalgia syndrome (FMS), a chronic musculoskeletal condition characterized by diffuse pain, fatigue, sleep impairment, and cognitive dysfunction, is associated with significant functional disability. Its underlying biological mechanisms are unknown. This study investigated differentially expressed genes between women with FMS and healthy volunteers. Women who met the 1990 or 2010 American College of Rheumatology fibromyalgia criteria were compared to age- and race-matched pain-free healthy women. Peripheral blood samples were collected, and a full genome microarray gene expression analysis was performed. One-way analysis of variance was used to identify differentially expressed genes using the filtering criterion of 1% false discovery rate. Analysis of canonical pathways associated with these genes was performed. Confirmatory quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay verified microarray results. Independent t-tests compared gene and protein expression between groups. Participants were 54 women with FMS and 25 controls. Expression arrays from a subset of women with FMS (n = 29) and controls (n = 20) showed upregulation of 12 genes (>1.8-fold change, p < .05) in the FMS sample. Differentially expressed genes were related to B-cell development, primary immunodeficiency signaling, and mitotic roles of polo-like kinase. CENPK and HSP90AA1 were the most differentially expressed genes (p < .01). Activity of interrelated pathways related to immune response, and homeostasis appears to be relevant to the experience of FMS. Replication and exploration of the relationship between gene expression and symptom severity will help determine clinical relevance of these findings. © The Author(s) 2015.
    Biological Research for Nursing 05/2015; 17(4). DOI:10.1177/1099800415589785 · 1.43 Impact Factor
    • "Report characteristics Rationale Years considered: 1990e2014 1990 is the year that the ACR fibromyalgia classification criteria was published [1] Language: English, Spanish, Portuguese, and Italian To get an extensive search limiting language restrictions Publication status: peer reviewed articles, doctoral theses, and reports "
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    ABSTRACT: Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lack statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.
    Sleep Medicine Reviews 04/2015; 21:86-99. DOI:10.1016/j.smrv.2014.09.001 · 8.51 Impact Factor
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