New diagnostic criteria proposed for fibromyalgia

Discussion in 'Fibromyalgia Main Forum' started by richvank, Jun 3, 2010.

  1. richvank

    richvank New Member

    Hi, all.

    The American College of Rheumatology is proposing to change their diagnostic criteria for fibromyalgia.

    Looks like there will be a bigger overlap with the case definitions for CFS. I've always viewed fibromyalgia and CFS as being distinct conditions, though certainly many people have satisfied the criteria for both in the past. But I do think there are PWCs without pain, and PWFs without fatigue, aren't there?

    Best regards,


    New Criteria Proposed For Diagnosing Fibromyalgia Suggests No Longer Focusing On Tender Points
    26 May 2010

    The American College of Rheumatology (ACR) is proposing a new set of diagnostic criteria for fibromyalgia that includes common symptoms such as fatigue, sleep disturbances, and cognitive problems, as well as pain. The new criteria are published in the May issue of the ACR journalArthritis Care & Research.

    "These new criteria recognize that fibromyalgia is more than just body pain," said Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center. "This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown."

    Routine lab tests can not detect fibromyalgia, a condition that is characterized by unexplained pain from head to toe and exhaustion. Instead, the diagnosis has been made by a tender point test, a physical exam that focuses on 18 points throughout the body. When light pressure is applied to these points, clustered around the neck, shoulder, chest, hip, knee, and elbow regions, patients with fibromyalgia feel tenderness or pain.

    To meet the previous diagnostic criteria, which were established in 1990, patients must have widespread pain in all four quadrants of their body for a minimum duration of three months and experience moderate pain and tenderness at a minimum of 11 of the 18 specified tender points.

    "There are numerous shortcomings with the previous criteria, which didn't take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities," said Katz.

    According to Katz, fibromyalgia pain may fluctuate, which can affect the number of tender points, and the tender point test did not adequately measure symptom severity or the effectiveness of new treatments.

    "The tender point test also has a gender bias because men may report widespread pain, but they generally aren't as tender as women. Fibromyalgia may be under-diagnosed in both men and women because of the reliance on 11 tender points, and also due to failing to account for the other central features of the illness," said Katz.

    Additionally, due to the confusion regarding the tender point test, the authors note that most primary care doctors don't bother to check tender points or they aren't checking them correctly. Consequently, fibromyalgia diagnosis in practice has often been a symptom-based diagnosis. The new criteria will standardize a symptom-based diagnosis so that all doctors are using the same process.

    The tender point test is being replaced with a widespread pain index and a symptom severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.

    The symptom severity score is determined by rating on a scale of zero to three, three being the most pervasive, the severity of three common symptoms: fatigue, waking unrefreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.

    To meet the criteria for a diagnosis of fibromyalgia a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more.

    Some criteria will remain unchanged. The symptoms must have been present for at least three months, and the patient does not have a disorder that would otherwise explain the pain.

    To develop and test the new criteria, researchers performed a multicenter study of 829 previously diagnosed fibromyalgia patients and a control group of rheumatic patients with non-inflammatory disorders using physician physical and interview examinations. The data were processed by the National Data Bank for Rheumatic Diseases.

    The authors note the study has a number of limitations. They recommend a follow-up test in the primary care setting that includes patients with other rheumatic conditions to determine the rate of misclassification that may occur.

    The study was funded by Lilly Research Laboratories. Lilly Research Laboratories did not participate in the design of the study, see the results of the study, or review the manuscript or submitted abstracts.

    Rush University Medical Center, located in Chicago, Illinois, is an academic medical center that encompasses the 676-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

    Source: Rush University Medical Center
  2. Janalynn

    Janalynn New Member

    Great information! Thank you for sharing.
    I personally believe they are two distinct conditions. Yes, many can have both and can certainly have overlapping conditions. I've learned a lot from you and your knowledge and with me having Fibro it seems there is a lot of difference in treatment.

    I've often wondered how some people here have been diagnosed - by what criteria, what symptoms they have/had at the time etc. (with Fibro) I think there is probably a lot of difference depending on what Dr.'s they have seen etc.

    I actually met someone who has said she has "a little bit of Fibro in her knees" Fibro isn't like arthritis, where you start to develop a little bit of it! There needs to be other criteria met along with pain, even though "unexplained" to be diagnosed. We'll end up with the wastebasket diagnosis stigma that we've fought for too long. The same goes with those who can't find a diagnosis, I agree that the tender point test isn't always reliable - for me, it definitely varies on now much pain I have in those areas. A good Dr. will know what tests to perform to rule out other illnesses, a good history to take etc..

    Educating Dr. on diagnosing patients would be an important component!
  3. gapsych

    gapsych New Member

    The new criteria looks like a good start. What really jumped out at me was the fact that it will be periodically reviewed The science behind this study appears pretty solid from a quick look at the summary.

    I have always questioned the tender point test. Even though I scored 18/18 tender points and they certainly were tender, I think I could have been poked just about anywhere on my body and it would have been painful. If the tender point test is the only criteria it unfortunately gives rise to the misconception that FM is localized pain. However, if it is included with the other criteria it firms up diagnosing FM and diagnosing it as a pervasive pain condition.

    I think some doctors have started to recognize that diagnosing FM goes further than just the tender point test but this will make diagnosing FM easier for doctors who are not as informed.

    I don't even know what CFS is anymore. I think FM is separate in that the cause is known (neurological), whereas CFS is speculated and may be found to be several conditions from several causes where fatigue of unknown origin is a hallmark. Very real but not yet clearly defined which makes scientific endeavors difficult. Hopefully in the future we will know more.

    I've always admired Dr. Katz and he is well known at least in the Chicago area. My rheumatologist in Chicago trained with him and is affiliated with Rush Medical Center doing research in the downtown campus and practicing at the Skokie campus.

    gap[This Message was Edited on 06/03/2010]
  4. gapsych

    gapsych New Member

    Several years ago I tried to participate in an FM study about exercise. I finally had to quit because I could not make it to the place because of fatigue.

    When I called and told them my tiredness was hindering my getting there the woman I talked to said that her FM patients often say the fatigue is worse than the pain. For me it depends on the day and I can have both at the same time.

    Recently I have found out I have had OSA, probably for the last ten years. It is starting to improve the tiredness however the sleep doctor said I would still have the FM but it might be more controllable. (yea!!!!)

    My pcp who sees over 500 FM patients in her practice says a number one priority is to get your sleep under control as well the pain. Better sleep often equals less pain.

    It's not an easy task for researchers to sort out, let alone patients.

    I told my PCP that this would all be fascinating if it wasn't happening to me. Actually, not quite true as I find the whole thing fascinating and have learned a lot. I love to research different topics.

    But I also have a lot of time on my hands. :>)

    Take care.