Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.

Wolfe2,  Frederick, Clauw7,  Daniel J., Fitzcharles1,  Mary Ann, Goldenberg3,  Don L., Hauser6,  Winfried, Katz4,  Robert S., Mease5,  Philip J.

Montreal West, QC, Canada
University of Texas HSC, San Antonio, TX
National Data Bank for Rheumatic Diseases, Wichita, KS
Newton-Wellesley Hosp, Newton, MA
Rheumatology Associates, Chicago, IL
Seattle Rheumatology Associate, Seattle, WA
Technische Universität München, Munich, Germany
UM/Chronic Pain & Fatigue Res, Ann Arbor, MI
University of Alberta, Edmonton, AB, Canada
University of North Carolina, Chapel Hill, NC

Purpose:

To develop a FM survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 ACR Preliminary Diagnostic Criteria for Fibromyalgia (ACR2010). We also created a new FM symptom scale to further characterize fibromyalgia [FM] severity.

Methods:

The ACR2010 consists of two scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR2010 criteria by eliminating the physician's estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. The 3 specific symptoms score was sum of the number of the following symptoms occurring during the previous 6 months: headaches, abdominal pain, and depression. We made this change because the physician's estimate of the extent of somatic symptoms was an evaluative measure that could be not performed in a survey. The 3 new symptoms tapped into the same domain of symptom reporting. We also created a 0–31 FM Symptom scale (FS), also known as the Fibromyalgianess scale, by summing the WPI and the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with fibromyalgia, 845 with osteoarthritis or with other non-inflammatory rheumatic conditions (OA), 439 with lupus, and 5,210 with RA.

Results:

The modified ACR2010 criteria were satisfied by 60% with a prior diagnosis of fibromyalgia, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups according to FM severity variables. An FS score >=13 best separated criteria (+) and criteria (-) patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population, as shown in Figure 1.

Characteristics of patients according to entry and criteria status demonstrated appropriate classification.

Fibromyalgia-related Characteristics According Entry and Diagnostic Criteria

VariableFM (+) Criteria +FM (+) Criteria -FM (-) Criteria +FM (+) Criteria -
 Mean or %Mean or %Mean or %Mean or %
Widespread pain index (0–19)12.95.611.73.6
4-item Modified SS score (0–12)8.04.07.42.8
Fibromyalgia symptom scale (0–31)20.99.619.06.5
Fatigue (0–10)7.24.27.13.1
Sleep disturbance (0–10)6.53.86.13.0
VAS Pain (0–10)6.33.85.92.7
Mood (0–10)4.02.63.82.0
Muscle tenderness (%)89.763.065.718.6
Symptom count (0–37)16.18.814.55.7
FM (+) and FM (-) refer to clinical diagnosis at time of data bank entry. Criteria + and Criteria - refer to results of the modified ACR 2010 diagnostic criteria.

Conclusions:

A slight modification to the ACR2010 will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The modified criteria can also be used to determine widespread pain according to the 1990 ACR classification criteria. The modified criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies and measurement of FM severity.

To cite this abstract, please use the following information:
Wolfe, Frederick, Clauw, Daniel J., Fitzcharles, Mary Ann, Goldenberg, Don L., Hauser, Winfried, Katz, Robert S., et al; Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :100
DOI: 10.1002/art.27869

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