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Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?

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Abstract

The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of whether they have accompanying painful disorders. Widespread pain index (WPI), symptom severity scale (SS), and fibromyalgia impact questionnaire (FIQ) scores were found to be significantly higher in the patients who satisfied the 1990 criteria than those who did not (P < 0.001). Tender point counts were found to be significantly correlated with WPI, SS, FIQ, and Beck depression inventory (BDI) scores (P < 0.001). The findings of the study support the suggestion that FMS is just a continuum of CWP, rather than a distinct diagnostic entity. As treatment of FMS is usually identical with that of CWP, strict diagnosis of FMS will provide little or no significance from the viewpoint of clinical practice. We suggest that future research should be directed toward classification of CWP to provide guidance to clinicians in selecting effective therapies.

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References

  1. Lee J, Ellis B, Price C, Baranowski AP (2014) Chronic widespread pain, including fibromyalgia: a pathway for care developed by the British pain society. Br J Anaesth 112:16–24

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  CAS  PubMed  Google Scholar 

  3. Harth M, Nielson WR (2007) The fibromyalgia tender points: use them or lose them? A brief review of the controversy. J Rheumatol 34:914–922

    PubMed  Google Scholar 

  4. Wolfe F (1997) The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic. Ann Rheum Dis 56:268–271

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Croft P, Burt J, Schollum J, Thomas E, Macfarlane G, Silman A (1996) More pain, more tender points: is fibromyalgia just one end of a continuous spectrum? Ann Rheum Dis 55:482–485

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. White KP, Nielson WR, Harth M, Ostbye T, Speechley M (2002) Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample. J Rheum 29:588–594

    PubMed  Google Scholar 

  7. McBeth J, Macfarlane GJ, Silman AJ (2002) Does chronic pain predict future psychological distress? Pain 96:239–245

    Article  PubMed  Google Scholar 

  8. Wolfe F, Clauw DJ, Fitzcharles MA et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610

    Article  Google Scholar 

  9. Wolfe F, Clauw DJ, Fitzcharles MA et al (2011) Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 38:1113–1122

    Article  PubMed  Google Scholar 

  10. Abeles M, Abeles AM (2011) The new criteria for fibromyalgia: evolution or devolution? Rheumatology 1:1

    Google Scholar 

  11. Toda K (2011) Preliminary diagnostic criteria for fibromyalgia should be partially revised: comment on the article by Wolfe, et al. Arthritis Care Res 63:308–309

    Article  Google Scholar 

  12. Toda K (2012) Purpose and significance of the 2010 criteria and modification of the 2010 criteria for fibromyalgia. J Rheumatol 39:6

    Article  Google Scholar 

  13. Sarmer S, Ergin S, Yavuzer G (2000) The validity and reliability of the Turkish version of the fibromyalgia impact questionnaire. Rheumatol Int 20:9–12

    Article  CAS  PubMed  Google Scholar 

  14. Kapci EG, Uslu R, Turkcapar H, Karaoglan A (2008) Beck depression inventory II: evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 25:E104–110

    Article  PubMed  Google Scholar 

  15. Papageorgiou AC, Silman AJ, Macfarlane GJ (2002) Chronic widespread pain in the population: a seven year follow up study. Ann Rheum Dis 61:1071–1074

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Meeus M, Nijs J (2007) Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 26:465–473

    Article  PubMed Central  PubMed  Google Scholar 

  17. Banic B, Petersen-Felix S, Andersen OK et al (2004) Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 107:7–15

    Article  PubMed  Google Scholar 

  18. Lewis GN, Rice DA (2014) Chronic pain: we should not underestimate the contribution of neural plasticity. Crit Rev Phys Rehabil Med 26:51–86

    Article  Google Scholar 

  19. Giesecke T, Gracely RH, Grant M et al (2004) Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum 50:613–623

    Article  PubMed  Google Scholar 

  20. Croft PR, Papageorgiou AC, Ferry S, Thomas E, Jayson MI, Silman AJ (1995) Psychologic distress and low back pain. Evidence from a prospective study in the general population. Spine 20:2731–2737

    Article  CAS  PubMed  Google Scholar 

  21. Nahit ES, Pritchard CM, Cherry NM, Silman AJ, Macfarlane GJ (2001) The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers. J Rheum 28:1378–1384

    CAS  PubMed  Google Scholar 

  22. Aaron LA, Burke MM, Buchwald D (2000) Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Int Med 160:221–227

    Article  CAS  Google Scholar 

  23. Matcham F, Rayner L, Steer S, Hotopf M (2013) The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 52:2136–2148

    Article  Google Scholar 

  24. Croft P, Schollum J, Silman A (1994) Population study of tender point counts and pain as evidence of fibromyalgia. BMJ 309:696–699

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Kim SM, Lee SH, Kim HR (2012) Applying the ACR preliminary diagnostic criteria in the diagnosis and assessment of fibromyalgia. Korean J Pain 25:173–182

    Article  PubMed Central  PubMed  Google Scholar 

  26. Aaron LA, Bradley LA, Alarcon GS, Alexander RW et al (1996) Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum 39:436–445

    Article  CAS  PubMed  Google Scholar 

  27. Andersson ML, Svensson B (2013) Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years. J Rheumatol 40:1977–1985

    Article  PubMed  Google Scholar 

  28. Andersson, Branco JC, Bannwarth B et al (2010) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39:448–533

    Article  Google Scholar 

  29. Zammurrad S, Munir W, Farooqi A, Wolfe F, Michaud K (2013) Disease activity score in rheumatoid arthritis with or without secondary fibromyalgia. J Coll Physicians Surg Pak 23:413–417

    PubMed  Google Scholar 

  30. Ranzolin A, Brenol JC, Bredemeier M et al (2009) Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis. Arthritis Rheum 15:794–800

    Article  Google Scholar 

  31. Buskila D, Press J, Abu-Shakra M (2003) Fibromyalgia in systemic lupus erythematosus: prevalence and clinical implications. Clin Rev Allergy Immunol 25:25–28

    Article  PubMed  Google Scholar 

  32. Sarzi-Puttini P, Salaffi F, Di Franco M et al (2014) Pain in rheumatoid arthritis: a critical review. Reumatismo 6:18–27

    Article  Google Scholar 

  33. Coury F, Rossat A, Tebib A et al (2009) Rheumatoid arthritis and fibromyalgia: a frequent unrelated association complicating disease management. J Rheumatol 36:58–62

    PubMed  Google Scholar 

  34. Toda K (2010) Treatment of chronic widespread pain is similar to treatment of fibromyalgia throughout the world. J Musculoskelet Pain 18:317–318

    Article  Google Scholar 

  35. Yunus MB, Aldag JC (2012) The concept of incomplete fibromyalgia syndrome: comparison of incomplete fibromyalgia syndrome with fibromyalgia syndrome by 1990 ACR classification criteria and its implications for newer criteria and clinical practice. J Clin Rheumatol 18:71–75

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Izmir, Turkey

    Arzu Yagiz On, Dilek Aykanat & Funda Calis Atamaz

  2. Department of Anesthesiology, Pain Clinic, Ege University Medical Faculty, Izmir, Turkey

    Can Eyigor

  3. Department of Internal Medicine, Division of Rheumatology, Ege University Medical Faculty, Izmir, Turkey

    Hayriye Kocanogullari & Fahrettin Oksel

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  1. Arzu Yagiz On
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  2. Dilek Aykanat
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  3. Funda Calis Atamaz
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  5. Hayriye Kocanogullari
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  6. Fahrettin Oksel
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Correspondence to Funda Calis Atamaz.

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On, A.Y., Aykanat, D., Atamaz, F.C. et al. Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?. Clin Rheumatol 34, 1473–1479 (2015). https://doi.org/10.1007/s10067-015-2975-1

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  • DOI: https://doi.org/10.1007/s10067-015-2975-1

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