Abstract
The American College of Rheumatology (ACR) 2016 criteria for fibromyalgia (FM) is recommended for use in primary and referral setting. However, neither the ACR 2016 nor its predecessor ACR 2010 criteria have been validated in a referral setting. We hypothesized that the presence of higher comorbidities in the referral care setting may affect the performance of the ACR 2016. All patients referred to a tertiary care hospital with widespread pain for more than 3 months were screened using (1) the ACR 2016 criteria and (2) by a blinded expert physician (using ACR 1990 criteria). Using the ACR 1990 as reference standard, the sensitivity and specificity were calculated. Also, concomitant depression (BPHQ: Brief Patient Health Questionnaire), anxiety disorder (GAD7: Generalized Anxiety Disorder-7) and alexithymia (TAS-20: Toronto Alexithymia Scale-20) were screened for using standardized instruments. Other central sensitization syndromes were also screened clinically. Of 147 patients (132 females; median age 36 [30–45] years, median symptom duration 4 [1–6] years), 112 met the ACR 1990 criteria while 93 met the ACR 2016 criteria. There was disagreement between the two criteria in 47 patients. The sensitivity and specificity of ACR 2016 were 71% and 60%, respectively. Patients diagnosed by ACR 2016 criteria alone, had higher GAD7 scores than those diagnosed by the ACR 1990 alone. However, BPHQ and TAS-20 did not differ between the groups. Patients diagnosed by the ACR 2016 criteria had a greater odds (OR 5.2 CI 1.3–21.7, p = 0.022) of having concomitant restless leg syndrome or post-traumatic stress disorder or chronic fatigue syndrome. The sensitivity/specificity of the ACR 2016 in tertiary settings matched those found in previous primary care-based studies. Thus, the ACR 2016 criteria are valid for use in the tertiary setting. However, patients diagnosed by only the ACR 2016 criteria (and not by the ACR 1990) have high probability of having another concomitant comorbidity.
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References
Sumpton JE, Moulin DE (2014) Fibromyalgia. Handb Clin Neurol 119:513–527. https://doi.org/10.1016/B978-0-7020-4086-3.00033-3
Moldofsky H, Scarisbrick P, England R, Smythe H (1975) Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med 37:341–351
Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172
Mahan MA (2015) Is fibromyalgia a real pathology? World Neurosurg 83:717–718. https://doi.org/10.1016/j.wneu.2015.03.002
Smythe HA (2004) Fibromyalgia among friends. J Rheumatol 31:627–630
Wolfe F, Clauw DJ, Fitzcharles M-A et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610. https://doi.org/10.1002/acr.20140
Wolfe F (2015) Editorial: the status of fibromyalgia criteria. Arthritis Rheumatol 67:330–333. https://doi.org/10.1002/art.38908
Pamuk ON, Yeşil Y, Cakir N (2006) Factors that affect the number of tender points in fibromyalgia and chronic widespread pain patients who did not meet the ACR 1990 criteria for fibromyalgia: are tender points a reflection of neuropathic pain? Semin Arthritis Rheum 36:130–134. https://doi.org/10.1016/j.semarthrit.2006.05.002
McBeth J, Mulvey MR (2012) Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria. Nat Rev Rheumatol 8:108–116. https://doi.org/10.1038/nrrheum.2011.216
Jones GT, Atzeni F, Beasley M et al (2015) The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol Hoboken NJ 67:568–575. https://doi.org/10.1002/art.38905
Segura-Jiménez V, Aparicio VA, Álvarez-Gallardo IC et al (2014) Validation of the modified 2010 American College of Rheumatology diagnostic criteria for fibromyalgia in a Spanish population. Rheumatol Oxf Engl 53:1803–1811. https://doi.org/10.1093/rheumatology/keu169
Bennett RM, Friend R, Marcus D et al (2014) Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. Arthritis Care res 66:1364–1373. https://doi.org/10.1002/acr.22301
Bidari A, Hassanzadeh M, Ghavidel Parsa B et al (2013) Validation of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia in an Iranian population. Rheumatol Int 33:2999–3007. https://doi.org/10.1007/s00296-013-2829-6
Casanueva B, García-Fructuoso F, Belenguer R et al (2016) The Spanish version of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia: reliability and validity assessment. Clin Exp Rheumatol 34:S55–S58
Usui C, Hatta K, Aratani S et al (2013) The Japanese version of the modified ACR preliminary diagnostic criteria for fibromyalgia and the fibromyalgia symptom scale: reliability and validity. Mod Rheumatol 23:846–850. https://doi.org/10.1007/s10165-012-0759-x
Wolfe F, Clauw DJ, Fitzcharles M-A et al (2016) 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 46:319–329. https://doi.org/10.1016/j.semarthrit.2016.08.012
Egloff N, von Känel R, Müller V et al (2015) Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 44:416–424. https://doi.org/10.3109/03009742.2015.1010103
Sarzi-Puttini P, Atzeni F, Masala IF et al (2018) Are the ACR 2010 diagnostic criteria for fibromyalgia better than the 1990 criteria? Autoimmun Rev 17:33–35. https://doi.org/10.1016/j.autrev.2017.11.007
Kawamura A, Shimodera S, Furukawa TA et al (2013) Effect of depression-related somatic pain on treatment satisfaction and daily living functions. Int J Psychiatry Med 46:27–38. https://doi.org/10.2190/PM.46.1.c
Curtin KB, Norris D (2017) The relationship between chronic musculoskeletal pain, anxiety and mindfulness: adjustments to the fear-avoidance model of chronic pain. Scand J Pain 17:156–166. https://doi.org/10.1016/j.sjpain.2017.08.006
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613
Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Lumley MA, Neely LC, Burger AJ (2007) The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess 89:230–246. https://doi.org/10.1080/00223890701629698
Bourke JH, Langford RM, White PD (2015) The common link between functional somatic syndromes may be central sensitisation. J Psychosom Res 78:228–236. https://doi.org/10.1016/j.jpsychores.2015.01.003
Treatment C for SA (2009) Appendix E: DSM-IV-TR criteria for posttraumatic stress disorder. Substance abuse and mental health services administration (US)
Wijemanne S, Ondo W (2017) Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management. Pract Neurol 17:444–452. https://doi.org/10.1136/practneurol-2017-001762
Yancey JR, Thomas SM (2012) Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician 86:741–746
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012
Yunus MB (2012) The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat 2012:584573. https://doi.org/10.1155/2012/584573
Lawson VH, Grewal J, Hackshaw KV et al (2018) Fibromyalgia syndrome and small fiber, early or mild sensory polyneuropathy. Muscle Nerve. https://doi.org/10.1002/mus.26131
Littlejohn G (2015) Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome. Nat Rev Rheumatol 11:639–648. https://doi.org/10.1038/nrrheum.2015.100
Albrecht PJ, Hou Q, Argoff CE et al (2013) Excessive peptidergic sensory innervation of cutaneous arteriole-venule shunts (AVS) in the palmar glabrous skin of fibromyalgia patients: implications for widespread deep tissue pain and fatigue. Pain Med Malden Mass 14:895–915. https://doi.org/10.1111/pme.12139
Yunus MB (2007) Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 36:339–356. https://doi.org/10.1016/j.semarthrit.2006.12.009
Conversano C, Carmassi C, Bertelloni CA et al (2019) Potentially traumatic events, post-traumatic stress disorder and post-traumatic stress spectrum in patients with fibromyalgia. Clin Exp Rheumatol 37(Suppl 116):39–43
Wolfe F, Schmukler J, Jamal S et al (2019) Diagnosis of fibromyalgia: disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a University Clinic. Arthritis Care Res 71:343–351. https://doi.org/10.1002/acr.23731
Häuser W, Sarzi-Puttini P, Fitzcharles M-A (2019) Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol 37(Suppl 116):90–97
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The conception and design of the study, acquisition of data, analysis and interpretation of data—SA, AA, AL. Drafting the article—SA. Revising it critically for important intellectual content—AA, AL. Final approval of the version to be submitted—SA, AA, AL. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—SA, AA, AL.
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Sakir Ahmed declares that he has no conflict of interest, including no relationship with pharmaceutical companies. Amita Aggarwal declares that she has no conflict of interest, including no relationship with pharmaceutical companies. Able Lawrence declares that he has no conflict of interest, including no relationship with pharmaceutical companies.
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Ethical approval was obtained from the Institutional Ethics Committee, SGPGIMS, Lucknow. All patients gave written informed consent before inclusion into the study.
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Ahmed, S., Aggarwal, A. & Lawrence, A. Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int 39, 1397–1403 (2019). https://doi.org/10.1007/s00296-019-04323-7
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DOI: https://doi.org/10.1007/s00296-019-04323-7