Article

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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ABSTRACT

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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    • "Three groups were defined: those experiencing no pain, those with some pain and those with CWP. The latter defined as those meeting the American College of Rheumatology 1990 criteria for fibromyalgia[28]: pain involving the axial skeleton, both sides of the body and above and below the waist lasting for at least 3 months. This method to assess pain has been used widely in population studies and has construct validity[27,29,30]. "
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    ABSTRACT: Background: The association between low levels of vitamin D and the occurrence of chronic widespread pain (CWP) remains unclear. The aim of our analysis was to determine the relationship between low vitamin D levels and the risk of developing CWP in a population sample of middle age and elderly men. Methods: Three thousand three hundred sixty nine men aged 40-79 were recruited from 8 European centres for a longitudinal study of male ageing, the European Male Ageing Study. At baseline participants underwent assessment of lifestyle, health factors, physical characteristics and gave a fasting blood sample. The occurrence of pain was assessed at baseline and follow up (a mean of 4.3 years later) by shading painful sites on a body manikin. The presence of CWP was determined using the ACR criteria for fibromyalgia. Serum 25-hydroxyvitamin D (25-(OH) D) was assessed by radioimmunoassay. Logistic regression was used to determine the relationship between baseline vitamin D levels and the new occurrence of CWP. Results: Two thousand three hundred thirteen men, mean age 58.8 years (SD = 10.6), had complete pain and vitamin data available and contributed to this analysis. 151 (6.5 %) developed new CWP at follow up and 577 (24.9 %) were pain free at both time points, the comparator group. After adjustment for age and centre, physical performance and number of comorbidities, compared to those in upper quintile of 25-(OH) D ( ≥36.3 ng/mL), those in the lowest quintile (<15.6 ng/mL) were more likely to develop CWP (Odds Ratio [OR] = 1.93; 95 % CI = 1.0-3.6). Further adjustment for BMI (OR = 1.67; 95 % CI = 0.93-3.02) or depression (OR = 1.77; 95 % CI = 0.98-3.21), however rendered the association non-significant. Conclusions: Low vitamin D is linked with the new occurrence of CWP, although this may be explained by underlying adverse health factors, particularly obesity and depression.
    Full-text · Article · Dec 2016 · BMC Musculoskeletal Disorders
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    • "Normal controls were previously described in detail elsewhere [Bosma et al., 2015]. All FM subjects were assessed with an algometer (FPK 10 pain test algometer, Wagner instruments) to see if they fulfilled the 1990 American College of Rheumatology Criteria for FM [Wolfe et al., 1990]. "
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    ABSTRACT: Fibromyalgia syndrome (FM) is a debilitating chronic pain condition, which afflicts primarily females. Although the etiology of this illness is not completely understood, FM pain is thought to rely on enhanced pain sensitivity maintained by central mechanisms. One of these mechanisms is central pain amplification, which is characterized by altered temporal summation of second pain (TSSP). Here we use a TSSP paradigm and functional MRI (fMRI) of the spinal cord, brainstem, and brain to noninvasively examine the central nervous system contributions to TSSP in FM patients and normal controls (NC). Functional MRI of pain-free female adults (N = 15) and FM patients (N = 14) was conducted while brief, repetitive heat pain stimuli (0.33 Hz) were applied to the thenar eminence of the hand (C6 dermatome). The stimulus intensity was adjusted to each participant's heat pain sensitivity to achieve moderate pain. Data were analyzed by means of a General Linear Model and region-of-interest analyses. All participants demonstrated significant pain summation in the TSSP condition. FM subjects, however, required significantly lower stimulus intensities than NC to achieve similar TSSP. fMRI analyses of perceptually equal TSSP identified similar brain activity in NC and FM subjects; however, multiple areas in the brainstem (rostral ventromedial medulla and periaqueductal grey region) and spinal cord (dorsal horn) exhibited greater activity in NC subjects. Finally, increased after-sensations and enhanced dorsal horn activity was demonstrated in FM patients. In conclusion, the spinal and brainstem BOLD responses to TSSP are different between NC and FM patients, which may indicate alterations to descending pain control mechanisms suggesting contributions of these mechanisms to central sensitization and pain of FM patients. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.
    Full-text · Article · Jan 2016 · Human Brain Mapping
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    • "Random selection was made by systematic sampling considering an equal probability of selection for each patient. CWP was classified using the definition included in the American College of Rheumatology (ACR) criteria for fibromyalgia [65]. "
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    ABSTRACT: The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality of life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population.A multicenter case-control study was conducted at three primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect healthcare costs.CWP criteria were found in 168 patients (92.3% female, prevalence 5.51% (95%CI: 4.75% - 6.38%)). CWP patients had worse QoL (34.2 vs 44.1, p<0.001), and greater disability (1.04 vs 0.35; p<0.001), anxiety (43.9% vs 13.3%; p<0.001), depression (27% vs 5.8%; p<0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus and number of cardiovascular events (13.1% vs 4.8%; p = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556; 3,751 per year in CWP patients vs. &OV0556; 1,397 in controls (p<0.001).In conclusion, the average CWP patient has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly three times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.
    Full-text · Article · Dec 2015 · Pain
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