Elsevier

Autoimmunity Reviews

Volume 17, Issue 1, January 2018, Pages 33-35
Autoimmunity Reviews

Review
Are the ACR 2010 diagnostic criteria for fibromyalgia better than the 1990 criteria?

https://doi.org/10.1016/j.autrev.2017.11.007Get rights and content

Abstract

Fibromyalgia (FM) is difficult to diagnose and manage chronic pain condition whose symptoms have no clear pathophysiological cause, although it is thought that patient hypersensitivity to a range of stimuli may give rise to mechanical hyperalgesia as a result of altered central nociceptive processing. The 1990 American College of Rheumatology (ACR) classification criteria, which have been widely used in clinical practice, require the existence of chronic widespread pain (CWP) for > 3 months, and the presence of at least 11 out of 18 specified tender points upon digital palpation, although this latter criterion has long been criticised. The newer 2010 ACR diagnostic criteria state that FM can be defined as CWP associated with somatic symptoms, and recommend the use of a widespread pain index and a scale to rate symptom severity. A modified version of the 2010 criteria removed the physician assessment of the extent of somatic symptoms and replaced it by a summary score of three self-reported symptoms, thus making it easier to use while maintaining its sensitivity. This review discusses the advantages and limitations of all of these criteria.

Introduction

Fibromyalgia (FM) is characterised by chronic widespread pain (CWP) and a range of other symptoms [1]. It is difficult to diagnose because FM has no specific diagnostic marker and, although CWP predominates, its symptoms are non-specific and may be due to various causes; furthermore, it can frequently overlap with central sensitivity syndrome [1], [2]. It has now become clear that psychological factors are less important than was originally thought: some patients may have concomitant psychiatric disorders but many do not, and the simultaneous presence of other pain and somatic syndromes is more frequently found in twin and epidemiological studies [2].

The 1990 American College of Rheumatology (ACR) classification criteria have been extensively used in clinical practice [3]. These require a 3-month history of CWP on both sides of the body, above and below the waist, that also involves the upper and/or lower spine; they also require the presence of > 11 out of 18 secified sites that are tender upon digital palpation. The newer 2010 ACR criteria state that FM is characterised by CWP associated with fatigue, sleep and cognitive disturbances, and a range of somatic symptoms [4], and use a widespread pain index and a scale for rating the severity of fatigue, sleep disorders, dyscognition, and 41 possible somatic symptoms. A modified version of the 2010 criteria removed the physician estimate of the extent of somatic symptoms and replaced it with a summary score of three self-reported symptoms, thus making it easier to use while maintaining its sensitivity [5]. In comparison with their predecessors, these modified criteria indicate a greater prevalence of FM with a higher proportion of male patients [6], [7].

This review discusses the advantages and limitations of the three sets of criteria with the aim of identifying the criteria that are more likely to lead the correct diagnosis of FM.

Section snippets

Are the 2010 ACR criteria better than the 1990 ACR criteria? YES of course

The 1990 ACR criteria [4] have contributed greatly to harmonising study populations in order to facilitate research and, although initially developed as “classification” criteria, have been widely used to diagnose FM in clinical practice. However, there were criticisms of their inclusion of tender points because there is no specific pathology at the given sites, reduced pressure pain thresholds are not limited to these points and, in any case, are lower in females then males, the tenderness

Are the 2010 ACR criteria better than the 1990 ACR criteria? NO of course not

The 2010 criteria [4] replaced the tender point physical examination with a widespread pain index (WPI, a 0–19 count of the number of reportedly painful body regions), and introduced a 0–3 severity scale for the characteristic symptoms of fatigue, unrefreshing sleep and cognitive problems, and the extent of somatic symptom reporting, which were combined to give a 0–12 symptom severity (SS) score, and led to a new definition of FM as a WPI of > 7 and an SS > 5, or a WPI of 3–6 and an SS of > 9. The

Conclusions

FM is frequently encountered and represents a considerable burden on healthcare resources. Although experts are still seeking the best diagnostic criteria, particularly for early-onset disease, the costs of a delayed diagnosis mean that primary care physicians should be trained to recognise and manage it promptly. The new 2010, modified 2011 or, even better the 2016 diagnostic criteria [24] which are further step forward, include a symptom severity scale and CWP index that more appropriately

Take-home messages

  • The 1990 ACR classification criteria define FM as chronic widespread pain with pressure pain allodynia or hyperalgesia.

  • The new 2010 and modified 2011 ACR diagnostic criteria also include a symptom severity scale that better reflects the multifaceted mature of the syndrome.

  • The 1990, 2010 and 2011 ACR criteria have advantages and limitations

  • There is still a lack of a specific biomarker in the direction of identifying this multi-symptom syndrome.

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