2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria

Nociplastic pain: towards an understanding of prevalent pain conditions

Fibromyalgia is characterized by chronic widespread pain, fatigue, sleep disturbances and functional symptoms. The etiopathogenesis, diagnostic criteria and classification criteria of fibromyalgia are still debated and, consequently, so are the strategies for treating this condition. Fibromyalgia is the third most frequent musculoskeletal condition, and its prevalence increases with age. However, although diagnosis has improved with the evolution of more accurate diagnostic criteria, a considerable proportion of physicians still fail to recognize the syndrome. Many factors contribute to the development of fibromyalgia in a unique manner: genetic predisposition, personal experiences, emotional-cognitive factors, the mind-body relationship and a biopsychological ability to cope with stress. The multiple components of the pathogenesis and maintenance of the condition necessitate a multi-modal treatment approach. Individually tailored treatment is an important consideration, with the increasing recognition that different fibromyalgia subgroups exist with different clinical characteristics. Consequently, although an evidence-based approach to fibromyalgia management is always desirable, the approach of physicians is inevitably empirical, and must have the aim of creating a strong alliance with the patient and formulating shared, realistic treatment goals.

Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment

AAPT Diagnostic Criteria for Fibromyalgia.

Purpose Multiple clinical and epidemiological studies have provided estimates of fibromyalgia prevalence and sex ratio, but different criteria sets and methodology, as well as bias, have led to widely varying (04%->11%) estimates of prevalence and female predominance (>90% to <61%) In general, studies have failed to distinguish Criteria based fibromyalgia (CritFM) from Clinical fibromyalgia (ClinFM) In the current study we compare CritFM with ClinFM to investigate gender and other biases in the diagnosis of fibromyalgia Methods We used a rheumatic disease databank and 2016 fibromyalgia criteria to study prevalence and sex ratios in a selection biased sample of 1761 referred and diagnosed fibromyalgia patients and in an unbiased sample of 4342 patients with no diagnosis with respect to fibromyalgia We compared diagnostic and clinical variables according to gender, and we reanalyzed a German population study (GPS) (n = 2435) using revised 2016 criteria for fibromyalgia Results In the selection-biased sample of referred patients with fibromyalgia, more than 90% were women However, when an unselected sample of rheumatoid arthritis (RA) patients was studied for the presence of fibromyalgia, women represented 587% of fibromyalgia cases Women had slightly more symptoms than men, including generalized pain (368% vs 324%), count of 37 symptoms (47 vs 37) and mean polysymptomatic distress scores (102 vs 82) We also found a linear relation between the probability of being females and fibromyalgia and fibromyalgia severity Women in the GPS represented 592% of cases Discussion The perception of fibromyalgia as almost exclusively (≥90%) a women’s disorder is not supported by data in unbiased studies Using validated self-report criteria and unbiased selection, the female proportion of fibromyalgia cases was ≤60% in the unbiased studies, and the observed CritFM prevalence of fibromyalgia in the GPS was ~2% ClinFM is the public face of fibromyalgia, but is severely affected by selection and confirmation bias in the clinic and publications, underestimating men with fibromyalgia and overestimating women We recommend the use of 2016 fibromyalgia criteria for clinical diagnosis and epidemiology because of its updated scoring and generalized pain requirement Fibromyalgia and generalized pain positivity, widespread pain (WPI), symptom severity scale (SSS) and polysymptomatic distress (PSD) scale should always be reported

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Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias.

Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria

Objective
The American College of Rheumatology (ACR) 2010 preliminary fibromyalgia diagnostic criteria require symptom ascertainment by physicians. The 2011 survey or research modified ACR criteria use only patient self-report. We compared physician-based (MD) (2010) and patient-based (PT) (2011) criteria and criteria components to determine the degree of agreement between criteria methodology.

Methods
We studied prospectively collected, previously unreported rheumatology practice data from 514 patients and 30 physicians in the ACR 2010 study. We evaluated the widespread pain index, polysymptomatic distress (PSD) scale, tender point count (TPC), and fibromyalgia diagnosis using 2010 and 2011 rules. Bland-Altman 95% limits of agreement (LOA), kappa statistic, Lin's concordance coefficient, and the area under the receiver operating curve (ROC) were used to measure agreement and discrimination.

Results
MD and PT diagnostic agreement was substantial (83.4%, κ = 0.67). PSD scores differed slightly (12.3 MD, 12.8 PT; P = 0.213). LOA for PSD were −8.5 and 7.7, with bias of −0.42. The TPC was strongly associated with both the MD (r = 0.779) and PT PSD scales (r = 0.702).

Conclusion
There was good agreement in MD and PT fibromyalgia diagnosis and other measures among rheumatology patients. Low bias scores indicate consistent results for physician and patient measures, but large values for LOA indicate many widely discordant pairs. There is acceptable agreement in diagnosis and PSD for research, but insufficient agreement for clinical decisions and diagnosis. We suggest adjudication of symptom data by patients and physicians, as recommended by the 2010 ACR criteria.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.22742

Robert L. Katz

Papers

2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria

Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria

Comparison of Physician-Based and Patient-Based Criteria for the Diagnosis of Fibromyalgia.