New American College of Rheumatology Criteria for Fibromyalgia
Twenty years have passed since the first diagnostic criteria were presented for the
condition of Fibromyalgia.
The new criteria:
- removes tender point from the diagnostic criteria as the central element in its definition
- recognizes the importance of a quantitative measure of widespread pain, the widespread pain index (WPI)
- incorporate key Fibromyalgia symptoms into the criteria
- provide severity scales to measure the extent of widespread pain and symptom severity; the symptom severity scale (SS)
Fibromyalgia Diagnostic Criteria
Criteria
A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
- Widespread pain indes (WPI) > 7 and symptom severity (SS) scale score > 5 or WPI 3-6 and SS scale score > 9.
- Symptoms have been present at a similar level for at least 3 months.
- The patient does not have a disorder that would otherwise explain the pain.
Ascertainment
- WPI (widespread pain index): note the number of areas 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 (buttoci, 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 (symptom severity) scale score:
- Fatigue
- Walking unrefreshed
- Cognitive symptoms
For each of the 3 symptoms above, indicate the level of severity over the past week using the following scale:
- no problem
- slight or mild problems, generally mild or intermittent
- moderate, considerable problems, often present and/or at a moderate level
- severe: pervasive, continuous, life-disturbing problems
Considering somatic symptoms in general, indicate whether the patient has:
- no symptoms
- few symptoms
- a moderate number of symptoms
- a great deal of symptoms
The SS scale score is the sum of the severity of the 3 symptoms (fatigue, walking 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/crambe in the abdomen, numbness/tingling, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, dry eyes, ringing in the ears, heartburn, oral ulcers, loss of/change in taste, seizures, shortness of breath, loss of appetite, rash, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.
Reference: Arthritis Care & Research: Vol.62, No.5, May 2010, pp. 600-610
