In May 2010, the American College of Rheumatology (ACR) released new criteria for the clinical diagnosis of Fibromyalgia (FM). These replace older criteria published in 1990. Using the older criteria, besides having widespread pain on both sides of the body for at least 3 months, a patient needed to have pain (not just ‘tenderness’) present in 11 out of 18 specific tender point sites in order to be diagnosed with FM.
The new criteria recommend that the tender point examination be replaced with a combination of a widespread pain index (WPI) and severity scale of symptoms (SS) as the revised standards for the diagnosis of FM.
Note: There is a new blood test for Fibromyalgia that is being developed by a private clinic. Independent validation of this test has shown mixed results so far.
The new criteria for FM diagnosis were developed during a 2010 study intended to create a simple, efficient and uniform standard that would be used in the clinical diagnosis of FM, and that would also be easy to use in primary and specialty care settings.
The new standards were designed to:
In short, the study concluded that the most significant diagnostic variables were the “widespread pain index” (WPI) and the categorical scales for cognitive symptoms, unrefreshing sleep, fatigue, and other somatic symptoms. These categorical scales were added up to create the “symptom severity score” (SS) scale.
The new criteria recommend that the tender point examination be replaced with a combination of a widespread pain index (WPI) and severity scale of symptoms (SS) as the revised standards for the diagnosis of FM.
The Widespread Pain Index is scored by asking the patient about whether pain was experienced in the last week in 19 different areas of the body. Score one point for each area (total WPI score is from 0 – 19).
The Symptom Severity Scale rates the severity in the last week of the following symptoms from 0 (no problems) to 3 (severe, life-disturbing):
In addition to these three, the severity of any/all other symptoms is rated from 0 to 3. This results in a total SS score of from 0 – 12.
For more detail, see this chart [2010_diagnostic_criteria_graphic.pdf]
Using these new criteria, a diagnosis of Fibromyalgia will be made on the following basis:
Why new diagnostic criteria were needed
This major revision of the diagnostic criteria was precipitated by numerous shortcomings of the 1990 ACR standards. Dr. Robert M. Bennett of Portland, Oregon, one of the FM specialists who helped to create the original criteria, discussed some of these problems in a recent FM publication.
Dr. Bennett stated that considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools.
Many primary care physicians have been avoiding tender point examinations, or if the exams were performed, they might often have been done incorrectly.
It is thought that a percentage of patients who likely have FM have not been diagnosed with it, either due to poor examination of their tender points or not having the minimum number of required tender points. As a result, physicians had already started to rely on symptoms commonly found in FM patients (i.e., sleep problems, decreased mental clarity, forgetfulness, and impaired function during daily activities) when making a diagnosis of FM, but with no consistent standards in place.
Other specialists mentioned in their criticisms:
One of the study authors, Dr. Robert S. Katz, a rheumatologist at Rush University Medical Center, elaborated on this discrepancy in a June 2010 issue of Science Daily, "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, rather than considering other central features of the illness.”
However, most researchers felt the old criteria had helped to bring the science and recognition of FM to where it stands today.
A new blood test for Fibromyalgia?
In 2012, Bruce Gillis, M.D. published a paper reporting “Unique immunologic patterns in fibromyalgia.” 1 On the basis of these findings, a new blood test 2 for diagnosing Fibromyalgia was developed and patented by Dr. Gillis. While there has been additional research 3 supporting these findings, there is also caution 4.
To date, the test is only available through one laboratory, Epic Genetics, a biotech startup founded by Dr. Gillis 5. The test costs approximately $775, which may or may not be covered by insurance.
The study supporting the revised criteria was published in the May 2010 issue of Arthritis Care & Research titled, "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity." The authors of the revised criteria are Frederick Wolfe, Daniel J. Clauw, Mary-Ann Fitzcharles, Don L. Goldenberg, Robert S. Katz, Philip Mease, Anthony Russell, I. Jon Russell, John B. Winfield, and Muhammad B. Yunus. Read the full text of the article.
1. Behm et al., BMC Clinical Pathology 12 (2012):25. Full text is available at http://www.biomedcentral.com/1472-6890/12/25 accessed on 8/22/2015
2. https://thefibromyalgiatest.com/ accessed on 8/22/2015
3. http://www.fmcpaware.org/second-study-on-blood-test-for-fm.html accessed on 8/22/2015
4. https://www.arthritiswa.org.au/news/view/fact-or-fiction-the-fm-test.html accessed on 8/22/2015
5. https://www.genomeweb.com/proteomics/despite-researcher-criticism-epicgenetics-fibromyalgia-test-does-750k-sales-firs accessed on 8/22/2015