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The American College of Rheumatology
Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

FREDERICK WOLFE,1 DANIEL J. CLAUW,2 MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4 ROBERT S. KATZ,5 PHILIP MEASE,6 ANTHONY S. RUSSELL,7 I. JON RUSSELL,8 JOHN B. WINFIELD,9 AND MUHAMMAD B. YUNUS10

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.
As disclosed in the manuscript, these criteria were developed with support from the study sponsor, Lilly Research Laboratories. The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participate in the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to the submission of the paper. The recipient of the grant was Arthritis Research Center Foundation, Inc. The authors received no compensation. The ACR found the criteria to be methodologically rigorous and clinically meaningful.
ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse any commercial product or service. The ACR received no compensation for its approval of these criteria.

Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.

Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.

Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3–6 AND SS >9).

Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.

If you would like to read the whole paper click the link → Diagnostic Criteria - American College of Rheumatology


 

 

"The psychiatrist confronted with a fibromyalgia patient", Siegfried Kasper. Copyright © 2009 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Siegfried Kasper

The psychiatrist confronted with a fibromyalgia patient

Human Psychopharmacology: Clinical and Experimental, 2009; 24: S25–S30

key words: fibromyalgia; recognition; symptoms; treatment

Fibromyalgia is usually treated by rheumatologists but since co-morbid depression and anxiety are frequent, psychiatrists are likely to be confronted with patients suffering from the syndrome. The symptoms associated with fibromyalgia vary from patient to patient but there is one common symptom – they ache all over. In addition to pain, patients report headaches, poor sleep, fatigue, depressed mood and irregular bowel habits, which are also all symptoms of depression. For a formal diagnosis of fibromyalgia, the American College of Rheumatology (ACR) criteria require the patient to have widespread pain for at least 3 months together with tenderness at 11 or more of 18 specific tender points. Treatment of fibromyalgia requires a comprehensive approach involving education, aerobic exercise and cognitive behavioural therapy in addition to pharmacotherapy. The most effective drugs available for the treatment for fibromyalgia, the serotonin noradrenaline reuptake inhibitors, milnacipran and duloxetine and the anti-epileptic, pregabalin, are well known to psychiatrists. Thus the psychiatrist is well placed to initiate treatment in these patients.

INTRODUCTION

Fibromyalgia syndrome exists in all ethnic groups and is not limited to affluent or industrialised nations. Current estimates suggest that between 2 and 4% of the general population suffer from the syndrome (Bannwarth et al., 2009; McLean and Clauw, 2005; White et al., 1999;Wolfe et al., 1995). Fibromyalgia sufferers are overwhelmingly women with seven times more women patients than men (White et al., 1999; Wolfe et al., 1995) although this figure may be exaggerated by a diagnostic bias (see below). Thus, in the United States alone, over 10 million women probably suffer from fibromyalgia. If these patients are treated (because many are never diagnosed and treated) it is usually by a rheumatologist or a pain specialist. Comorbid depression (20–80%) and anxiety (13–64%) are, however, common in these patients (Fietta et al., 2007) and it is not unlikely that the psychiatrist will see some of these patients either referred by a rheumatologist or coming to him directly. Although fibromyalgia is not a psychiatric disorder, it is now generally considered that dysfunctional central pain perception is the most likely basic mechanism. In addition chronic pain is being increasingly seen as, at least, a symptom frequently associated with depression and possible an integral part of depressive symptomatology (Stahl and Briley, 2004). Finally, the most effective and bestevaluated medications for the treatment of fibromyalgia are psychotropic drugs that the psychiatrist knows well.

Thus the psychiatrist should be ready to recognise fibromyalgia and to initiate treatment. Many patients will have suffered from fibromyalgia for years and visit numerous physicians before being correctly diagnosed. Even when they are finally diagnosed they often find it difficult to obtain effective therapy. This is not because the treatments are not effective; they are. Simply prescribing the right medication, however, is not enough. The management of fibromyalgia takes a lot of time and involvement on the part of the physician. The successful therapy of fibromyalgia requires a multidisciplinary approach.

Click the link if you would like to read the whole article --> The psychiatrist confronted with a fibromyalgia patient

 



 

Enrico Bellato, 1 ,* Eleonora Marini, 1 Filippo Castoldi, 1 Nicola Barbasetti, 1 Lorenzo Mattei, 1 Davide Edoardo Bonasia, 2 and Davide Blonna 1

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

Copyright © 2012 Enrico Bellato et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy.

Pain Res Treat. 2012; 2012: 426130.
Published online 2012 Nov 4. doi: 10.1155/2012/426130 PMCID: PMC3503476

1. INTRODUCTION

Fibromyalgia is a syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness, and systemic symptoms (e.g., mood disorders, fatigue, cognitive dysfunction, and insomnia) [1–4] without a well-defined underlying organic disease. Nevertheless, it can be associated with specific diseases such as rheumatic pathologies, psychiatric or neurological disorders, infections, and diabetes. What today is defined as fibromyalgia had already been described in the nineteenth century. In 1904, Gowers [5] coined the term “fibrositis” which was used until the seventies and eighties of the last century when an etiology involving the central nervous system was discovered. But it was Graham [6] in 1950 who introduced the modern.

If you would like to read the whole paper click the link → Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

 


 


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