Jul 9

2010 ACR Criteria for the Diagnosis of Fibromyalgia

To purchase the Full Text of the study article from Wiley InterScience, see here.

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 validation based on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.

Please note that these criteria are not meant to replace the 1990 ACR classification criteria, but to represent an alternative method of diagnosis that is more suitable for use in primary care and helpful in following patients longitudinally

Criteria

A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

  1. Widespread pain index (WPI)7 and symptom severity (SS) scale score5
    or WPI 3–6 and SS scale score9.
  2. Symptoms have been present at a similar level for at least 3 months.
  3. The patient does not have a disorder that would otherwise explain the pain.

It is important for physicians to perform an appropriate clinical assessment to exclude other diagnoses, and/or to identify potential coexisting rheumatic diseases that may require treatment themselves. It is also important that patients with comorbid conditions can differentiate between those symptoms caused by possible Fibromyalgia and those symptoms caused by comorbid conditions. If this is not the case, then the use of this criteria as a diagnostic method may not be possible.

Ascertainment

WPI: note the number of areas (below) in which the patient has had pain over the last week. In how many areas has the patient had pain? Score will be between 0 and 19.

Shoulder girdle, left; Hip (buttock, trochanter), left; Jaw, left; Upper back; Shoulder girdle, right; Hip (buttock, trochanter), right; Jaw, right; Lower back; Upper arm, left; Upper leg, left; Chest; Neck; Upper arm, right; Upper leg, right; Abdomen; Lower arm, left; Lower leg, left; Lower arm, right; Lower leg, right.

SS scale score:

Fatigue, Waking unrefreshed, Cognitive symptoms

For the each of the 3 symptoms above, indicate the level of severity over the past week using the following scale:
0 = no problem
1 =slight or mild problems, generally mild or intermittent
2 =moderate, considerable problems, often present and/or at a moderate level
3 = severe: pervasive, continuous, life-disturbing problems

Considering somatic symptoms in general, indicate whether the patient has:*
0 = no symptoms
1 = few symptoms
2 = a moderate number of symptoms
3 = a great deal of symptoms

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.

*Somatic symptoms that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.

Reference:

  1. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.