Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Performance of American College of Rheumatology 2010 Diagnostic Criteria for Fibromyalgia Among Fibromyalgia Patients Seen in a Rheumatology Clinic and Diagnosed by 1990 Classification Criteria.
Aldag, Muhammad B. Yunus and Jean C.
The 2010 American College of Rheumatology (ACR) Diagnostic Criteria for Fibromyalgia (FM) were developed to diagnose FM in the clinic without the need for performing tender point (TP) examination. The predominant purpose of our study was to assess the performance of the above 2010 criteria among FMS patients seen in our clinic. Further, we wished to assess correlations among important variables.
We selected 473 patients in our data base who fulfilled the 1990 ACR criteria for classification of fibromyalgia (widespread pain plus at least 11 TPs among 18). These patients did not have another condition that would explain the pain. According to the 2010 criteria, widespread pain index (WPI) was calculated by counting sites of pain symptom among 19 sites (possible WPI score 019). Symptom severity (SS) scale score was calculated by adding the severity (03 categories) of the following symptoms: fatigue, waking unrefreshed and cognitive symptoms, as well as number of total symptoms (0=none, 1= few, 2=moderate and 3= large number). Thus, possible score for SS scale was 012. To fulfill the 2010 diagnostic criteria a patient needed to have WPI score of 7 or greater and SS score of 5 or greater, OR WPI score of 36 and SS score of 9 or greater.
The mean (SD) age in years was 46.7 (13.2), 95.7% Caucasian, 87.7% female. Mean (SD) duration of symptoms was 9.2 (9.7) years. Mean (SD) number of TPs among 18 sites was 15.7 (2.4). Of the 473 FM patients by 1990 ACR criteria, 408 (86.2%) fulfilled the new 2010 diagnostic criteria. Spearman correlations showed significant correlation of TPs with 19 pain sites (p=.0001), no. of symptoms (p=.0001), no. of subjective swollen sites (p=.0001), no. of subjective numbness sites (p=.003), and AM fatigue (p=.021). No correlation was found between TPs and self-assessed depression or anxiety. Anxiety correlated with depression (p=.0001). Sleep difficulties correlated with AM fatigue (p=.0001), depression (p=.0001), anxiety (p=.001) and AM stiffness (p=.001).
86.2% of our FM patients diagnosed by 1990 ACR criteria fulfilled the 2010 FM diagnostic criteria. This figure is similar to 88.1% found in the multicenter 2010 criteria study. Since 76% of FM patients diagnosed by a physician in a clinic fulfilled the 1990 ACR criteria in the 2010 study, as many as 3335% of physician diagnosed FM will be missed by the new 2010 criteria. Given the strong correlation between TPs and number of subjective swollen sites and no. of subjective numbness sites, these symptoms are likely to be part of central sensitization that characterizes FM. Further, TP was not correlated with self-assessed anxiety or depression in our study. However, poor sleep was correlated with both depression and anxiety.
To cite this abstract, please use the following information:
Aldag, Muhammad B. Yunus and Jean C.; The Performance of American College of Rheumatology 2010 Diagnostic Criteria for Fibromyalgia Among Fibromyalgia Patients Seen in a Rheumatology Clinic and Diagnosed by 1990 Classification Criteria. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :740