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  • Review Article
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Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria

Nature Reviews Rheumatology volume 8, pages 108–116 (2012)Cite this article

Subjects

Abstract

Fibromyalgia is a disorder characterized by chronic widespread pain in the presence of widespread tenderness, and multiple somatic symptoms. Since the publication of the American College of Rheumatology (ACR) 1990 classification criteria for fibromyalgia, research has proliferated and, in a relatively short period, investigators have begun to unravel the etiology and long-term impact of this complex condition. Although the ACR 1990 criteria have been central to fibromyalgia research during the past two decades, a number of practical and philosophical objections have been raised in relation to them. Principally these objections have centered on the use (or lack thereof) of the tender point examination, the lack of consideration of associated symptoms, and the observation that fibromyalgia might represent the extreme end of a pain continuum. In developing the ACR 2010 criteria, experts have sought to address these issues and to simplify clinical diagnosis. An implicit aim was to facilitate more rigorous study of etiology. The purpose of this Review is to summarize research to date that has described the epidemiology, pathology and clinical course of fibromyalgia, and to assess the probable impact of the ACR 2010 criteria on future research efforts.

Key Points

  • Although the American College of Rheumatology (ACR) 1990 classification criteria for fibromyalgia have facilitated two decades of research, several practical and philosophical objections to them have been raised

  • The ACR 2010 diagnostic criteria were developed to address obstacles and concerns presented in response to the 1990 criteria

  • The ACR 2010 diagnostic criteria comprise a widespread pain index (WPI, measures pain distribution), and the symptom severity (SS) scale (assesses cognitive symptoms, sleep disturbances, fatigue and somatic symptoms)

  • The maximum WPI score is 19, the SS score range is 0–12; WPI≥7 and SS≥5, or WPI 3–6 and SS≥9, classifies individuals as having fibromyalgia

  • Use of the traditional tender-point count is not required in the ACR 2010 criteria

  • The ACR 2010 criteria should facilitate more rigorous study of the etiology of fibromyalgia

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Figure 1: Prevalence rates for CWP and fibromyalgia by age and sex across the adult lifespan.

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  1. Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, ST5 5BG, UK

    John McBeth

  2. Arthritis Research UK Epidemiology Unit, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK

    Matthew R. Mulvey

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McBeth, J., Mulvey, M. Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria. Nat Rev Rheumatol 8, 108–116 (2012). https://doi.org/10.1038/nrrheum.2011.216

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