Rheumatologists Outline New Ways to Diagnose Fibromyalgia

New criteria for diagnosing fibromyalgia was proposed by the American College of Rheumatology. The criteria were published in the journal Arthritis Care & Research.

"These new criteria recognize that fibromyalgia is more than just body pain," said Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center, in a news release. "This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown."

Currently, the diagnosis of fibromyalgia is made by the tender point test, which focuses on 18 points throughout the body. Additionally, a patient must have widespread pain in all four quadrants of their body for at least three months and experience moderate pain and tenderness at a minimum of 11 of the 18 points to be diagnosed with the disease. These diagnostic criteria were established in 1990.

"There are numerous shortcomings with the previous criteria, which didn't take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities," said Katz, in a release.

Katz said, in the release, fibromyalgia can fluctuate, which affects the number of tender points, and the tender point test doesn’t adequately measure symptom severity or the effectiveness of new treatments.

"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, and also due to failing to account for the other central features of the illness," said Katz, in a release.

According to group, the new criteria will standardize a symptom-based diagnosis so that all doctors are using the same process. Instead of the tender point test, physicians can use a widespread pain index, which will be determined by counting the number of areas on the body where the patient has felt pain in the last week (19 specified areas), and a symptom severity scale (0 to 3) rating fatigue, waking unrefreshed, and cognitive symptoms.

For a patient to be diagnosed with fibromyalgis, he or she would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more. Also, the symptoms must have been present for at least three months

The criteria was developed after researchers performed a multicenter study of 829 previously diagnosed fibromyalgia patients and a control group of rheumatic patients with non-inflammatory disorders using physician physical and interview examinations.