Korean J Pain.  2012 Jul;25(3):173-182. 10.3344/kjp.2012.25.3.173.

Applying the ACR Preliminary Diagnostic Criteria in the Diagnosis and Assessment of Fibromyalgia

• Kim SM
• Lee SH
• Kim HR

• KMID: 2278152
• DOI: http://doi.org/10.3344/kjp.2012.25.3.173

Abstract

BACKGROUND
Fibromyalgia (FM) is characterized by chronic widespread pain with a low pain threshold. The aim of this study was to compare two criteria for the diagnosis and assessment of FM and to analyze the correlation and agreement between the 1990 and 2010 American College of Rheumatology (ACR) preliminary diagnostic criteria for FM.
METHODS
We studied 98 patients who had already been diagnosed as having FM using the 1990 criteria or 2010 preliminary criteria. Tender point examination, FM impact questionnaire (FIQ) and pain visual analog scale (VAS) were obtained. According to the preliminary criteria, FM was quantified as WPI (widespread pain index) and the SS scale (symptom severity) and the two criteria were compared.
RESULTS
Among 98 patients, 78.6% of the patients were diagnosed with the 1990 ACR criteria and 93.9% of the patients were diagnosed with the ACR preliminary diagnostic criteria, and there was also significant agreement between the two criteria (P < 0.01). There was a correlation with the WPI and the tender point, with the SS and the FIQ, and with the sum of the WPI and SS and the FIQ.
CONCLUSIONS
The ACR preliminary diagnostic criteria for FM were in agreement with the 1990 ACR criteria during the disease course. The preliminary criteria were the more sensitive method than the 1990 criteria. In addition, the 2010 criteria might have advantages since it is easy to assess the physical and psychological symptoms and can be quantified. Therefore, the ACR preliminary diagnostic criteria for FM could be used more conveniently for clinical diagnosis and follow up evaluation after starting management of FM.

Keyword

fibromyalgia; 1990 criteria; 2010 preliminary criteria

MeSH Terms

Fibromyalgia
Follow-Up Studies
Humans
Pain Threshold
Surveys and Questionnaires
Rheumatology

Reference

1. Gran JT. The epidemiology of chronic generalized musculoskeletal pain. Best Pract Res Clin Rheumatol. 2003; 17:547–561. PMID: 12849711.

2. Nisenbaum R, Reyes M, Mawle AC, Reeves WC. Factor analysis of unexplained severe fatigue and interrelated symptoms: overlap with criteria for chronic fatigue syndrome. Am J Epidemiol. 1998; 148:72–77. PMID: 9663406.

3. Clauw DJ, Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. 2008. 4th ed. Edinburgh: Mosby;p. 703–704.

4. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33:160–172. PMID: 2306288.

5. Klippel JH, Stone JH, Crofford LJ, White PH. Primer on the rheumatic diseases. 2008. 13th ed. New York: Springer;p. 89.

6. Clauw DJ. Fibromyalgia: correcting the misconceptions. J Musculoskelet Med. 2003; 20:467–472.

7. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010; 62:600–610. PMID: 20461783.

8. Kim SH, Bae GR, Lim HS. Prevalence and risk factors of fibromyalgia syndrome and chronic widespread pain in two communities in Korea-first report in Korean. J Korean Rheum Assoc. 2006; 13:18–25.

9. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995; 38:19–28. PMID: 7818567.

10. Leveille SG, Ling S, Hochberg MC, Resnick HE, Bandeen-Roche KJ, Won A, et al. Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med. 2001; 135:1038–1046. PMID: 11747382.

11. Croft P, Rigby AS, Boswell R, Schollum J, Silman A. The prevalence of chronic widespread pain in the general population. J Rheumatol. 1993; 20:710–713. PMID: 8496870.

12. Schochat T, Raspe H. Elements of fibromyalgia in an open population. Rheumatology (Oxford). 2003; 42:829–835. PMID: 12730531.

13. Kim SH. Prevalence of chronic widespread pain and chronic fatigue syndrome in young Korean adults. J Musculoskelet Pain. 2008; 16:149–153.

14. Kim SH. Fibromyalgia syndrome. J Korean Rheum Assoc. 2009; 16:1–15.

15. Petzke F, Gracely RH, Park KM, Ambrose K, Clauw DJ. What do tender points measure? Influence of distress on 4 measures of tenderness. J Rheumatol. 2003; 30:567–574. PMID: 12610818.

16. Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum. 2006; 54:169–176. PMID: 16385512.

17. Mayou R, Farmer A. ABC of psychological medicine: Functional somatic symptoms and syndromes. BMJ. 2002; 325:265–268. PMID: 12153926.

18. Häuser W, Zimmer C, Felde E, Köllner V. What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Schmerz. 2008; 22:176–183. PMID: 18210165.

19. Häuser W, Akritidou I, Felde E, Klauenberg S, Maier C, Hoffmann A, et al. Steps towards a symptom-based diagnosis of fibromyalgia syndrome. Symptom profiles of patients from different clinical settings. Z Rheumatol. 2008; 67:511–515. PMID: 18830659.

20. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991; 18:728–733. PMID: 1865419.

21. Buskila D, Neumann L, Alhoashle A, Abu-Shakra M. Fibromyalgia syndrome in men. Semin Arthritis Rheum. 2000; 30:47–51. PMID: 10966212.

22. Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE. Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum. 2004; 51:890–898. PMID: 15593364.

23. van Alphen A, Halfens R, Hasman A, Imbos T. Likert or Rasch? Nothing is more applicable than good theory. J Adv Nurs. 1994; 20:196–201. PMID: 7930122.

24. Fortinsky RH, Garcia RI, Joseph Sheehan T, Madigan EA, Tullai-McGuinness S. Measuring disability in Medicare home care patients: application of Rasch modeling to the outcome and assessment information set. Med Care. 2003; 41:601–615. PMID: 12719685.

25. Russell IJ. Fibromyalgia syndrome: presentation, diagnosis, and differential diagnosis. Prim Psychiatry. 2006; 13:40–45.

26. Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum. 1981; 11:151–171. PMID: 6944796.

27. Turk DC, Okifuji A, Sinclair JD, Starz TW. Pain, disability, and physical functioning in subgroups of patients with fibromyalgia. J Rheumatol. 1996; 23:1255–1262. PMID: 8823701.

28. Rehm SE, Koroschetz J, Gockel U, Brosz M, Freynhagen R, Tölle TR, et al. A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology (Oxford). 2010; 49:1146–1152. PMID: 20236955.

29. Usui C, Hatta K, Aratani S, Yagishita N, Nishioka K, Kanazawa T, et al. The Japanese version of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and the Fibromyalgia Symptom Scale: reliability and validity. Mod Rheumatol. 2012; 22:40–44. PMID: 21556970.