Alternate Criteria for Fibromyalgia Diagnosis Shown Better, Easier

An alternative to 2011 ACR criteria for fibromyalgia (FM) diagnosis with more specifics about symptoms and pain proves better -- and easier -- for spotting FM in everyday clinical practice.

Bennett R, Friend R, Marcus D, et al, Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary ACR criteria and the development of alternative criteria. Arthritis Care & Research (2014) DOI: 10.1002/acr.22301 [accepted article]

The 2011 American College of Rheumatology (ACR) modified criteria for fibromyalgia (FM)* may be valid, but an alternative that adds more specific questions about symptoms and pain is better at spotting FM in everyday clinical practice and also easier to use, according to a multi-site study.

The alternative criteria, called the 2013AltCr, were based on a combination of 10 items from the Symptom Impact Questionnaire (SIQR), a 28 area pain location inventory (PLI) used in the 2011 modified ACR criteria (2011ModCr).

The study of 321 patients at six different sites around the US first tested the validity of the 2011 modified ACR fibromyalgia among eight clinicians, using a more comprehensive set of chronic pain conditions and comparing it with the earlier 1990 ACR fibromyalgia criteria.

The investigators, who developed the alternate criteria, tested them against the 2011ModCri in a cross-sectional online survey of FM patients (n=135) and those with other common pain problems (n=186) such as osteoarthritis and back pain.

The 2011ModCr proved valid, with an 83% diagnostic sensitivity, 67% specificity, correctly classifying 74% of FM patients. But the alternative criteria were just as sensitive and more specific, with an 80.7% diagnostic sensitivity and 79.6% specificity, correctly identifying more FM cases (80.1%) as well as other pain disorders. The 2011 criteria diagnosed FM more frequently, with with more false positives.

Most of the FM patients were middle-aged women; males with FM tended to be older.

The study also found 2013Alt Cr were easier to use than the 2011 modified ACR criteria. They assess three symptoms not included in the 2011 criteria: stiffness, tenderness to touch, and environmental sensitivity .

*Garg N and Deodhar A. New and Modified Fibromyalgia Diagnostic Criteria, Rheumatology Network, February 08, 2012.