Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia

National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 288, Wichita, KS 67214, USA.
The Journal of Rheumatology (Impact Factor: 3.17). 02/2011; 38(6):1113-22. DOI: 10.3899/jrheum.100594
Source: PubMed

ABSTRACT To develop a fibromyalgia (FM) survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010). We also created a new FM symptom scale to further characterize FM severity.
The ACR 2010 consists of 2 scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR 2010 criteria by eliminating the physician's estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. We also created a 0-31 FM Symptom scale (FS) by adding the WPI to the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with FM, 845 with osteoarthritis (OA) or with other noninflammatory rheumatic conditions, 439 with systemic lupus erythematosus (SLE), and 5210 with rheumatoid arthritis (RA).
The modified ACR 2010 criteria were satisfied by 60% with a prior diagnosis of FM, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups based on FM severity variables. An FS score ≥ 13 best separated criteria+ and criteria- patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population.
A modification to the ACR 2010 criteria will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies.

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    ABSTRACT: IntroductionPain remains the most important problem for people with rheumatoid arthritis (RA). Active inflammatory disease contributes to pain, but pain due to non-inflammatory mechanisms can confound the assessment of disease activity. We hypothesise that augmented pain processing, fibromyalgic features, poorer mental health and patient-reported 28 joint disease activity score (DAS28) components are associated in RA.MethodsA total of 50 people with stable, longstanding RA recruited from a rheumatology outpatient clinic were assessed for pain pressure thresholds (PPT) at three separate sites (knee, tibia and sternum), DAS28, fibromyalgia and mental health status. Multivariable analysis was performed to assess the association between PPT and DAS28 components, DAS28-P (the proportion of DAS28 derived from the patient-reported components of visual analogue score and tender joint count) or fibromyalgia status.ResultsMore sensitive PPTs at sites over or distant from joints were each associated with greater reported pain, higher patient-reported DAS28 components and poorer mental health. A high proportion of participants (48%) satisfied classification criteria for fibromyalgia, and fibromyalgia classification or characteristics were each associated with more sensitive PPTs, higher patient-reported DAS28 components and poorer mental health.Conclusions Widespread sensitivity to pressure-induced pain, a high prevalence of fibromyalgic features, higher patient-reported DAS28 components and poorer mental health are all linked in established RA. The increased sensitivity at non-joint sites (sternum and anterior tibia) as well as over joints indicates that central mechanisms may contribute to pain sensitivity in RA. The contribution of patient reported components to high DAS28 should inform decisions on disease modifying or pain management approaches in the treatment of RA when inflammation may be well-controlled.
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    ABSTRACT: We aimed to evaluate the sociodemographic and clinical characteristics as well as the quality of life of patients with fibromyalgia (FM). A total of 37 female patients diagnosed with FM and 31 healthy females were included into the study. Individuals were asked about their demographic characteristics. The number of sensitive points (NSP), skin fold sensitivity, cutaneous hyperemia and reticular skin changes of patients and healthy controls were evaluated during physical examination. Individuals were evaluated for pain severity using the Visual Analogue Scale (VAS), for psychological states using the Beck Depression Scale (BDS), for quality of life using the Short Form-36 (SF-36) and for functional status using the Fibromyalgia Impact Questionnaire (FIQ). The mean age of FM patients was 39.2±6.5 years versus 39.1±6.2 years in the controls. The most frequently encountered FM symptoms were fatigue (94.6%), sleep disturbances (86.5%) and anxiety (86.5%). Differences between FM patients and controls were statistically significant for NSP (p=0.001), VAS (p=0.001), FIQ (p=0.001), BDS (p=0.001) and SF-36 (p=0.003), and FIQ subgroups were also different between the two groups (p<0.001). In the SF-36 survey, FM patients were different from the control in the physical function (p=0.001), pain (p=0.005), general health (p=0.017), physical fitness (p=0.003), and mental health (p=0.008) portions of the survey. Fibromyalgia has distinct clinical features that lead to low functional capacity and quality of life. Thus, patients' sociodemographic characteristics and the evaluation of their quality of life may be important in the diagnosis and monitoring of treatment progress.
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    ABSTRACT: The objective of this study was to evaluate the problem of multiple chronic conditions and polypharmacy in patients with fibromyalgia. Retrospective medical record review. Olmsted County, Minnesota. 1111 adults with fibromyalgia. Number and type of chronic medical and psychiatric conditions, medication use. Medical record review demonstrated that greater than 50% of the sample had seven or more chronic conditions. Chronic joint pain/degenerative arthritis was the most frequent comorbidity (88.7%), followed by depression (75.1%), migraines/chronic headaches (62.4%) and anxiety (56.5%). Approximately, 40% of patients were taking three or more medications for symptoms of fibromyalgia. Sleep aids were the most commonly prescribed medications in our sample (33.3%) followed by selective serotonin reuptake inhibitors (28.7%), opioids (22.4%) and serotonin norepinephrine reuptake inhibitors (21.0%). The results of our study highlight the problem of multiple chronic conditions and high prevalence of polypharmacy in fibromyalgia. Clinicians who care for patients with fibromyalgia should take into consideration the presence of multiple chronic conditions when recommending medications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 01/2015; 5(3):e006681. DOI:10.1136/bmjopen-2014-006681 · 2.06 Impact Factor


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May 16, 2014