Comparison of Diagnostic Criteria for Fibromyalgia Syndrome

Winfried Häuser, MD

Department of Internal Medicine I
Klinikum Saarbrücken gGmbH
Saarbrücken, Germany

The original fibromyalgia classification criteria from the American College of Rheumatology (ACR) require the presence of chronic widespread pain for at least 3 months duration and pain at ≥11 of 18 tender points in response to digital palpation. Since their introduction, these criteria have often been considered the de facto “gold standard” for the diagnosis of fibromyalgia not only for research but also in the clinic. Yet many experts have questioned the utility of the tender point criterion owing to high interexaminer variability and a bias toward the selection of females and individuals with high levels of physical and/or psychological distress. The use of a more symptom-based approach, including the presence of fatigue and nonrestorative sleep, has recently been championed by Association of the Medical Scientific Societies in Germany and newer recommendations from the ACR. Here, Dr. Häuser discusses challenges related to the tender point examination and concordance among various diagnostic approaches for fibromyalgia.

References

Häuser W, Hayo S, Biewer W, et al. Diagnosis of fibromyalgia syndrome—A comparison of Association of the Medical Scientific Societies in Germany, survey, and American College of Rheumatology criteria. Clin J Pain. 2010;26:505-511.
Häuser W, Eich W, Herrmann M, et al. Fibromyalgia syndrome: classification, diagnosis, and treatment. Dtsch Arztebl Int. 2009;106:383-391.
Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600-610.
Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160-172.

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