The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity

作者：Frederick Wolfe, Daniel Joseph Clauw, Mary‐Ann Fitzcharles, Don L. Goldenberg, Robert S. Katz, Philip J. Mease, ANTHONY SCIENCE RUSSELL, Irwin Jon Russell, John B. Winfield, Muhammad B. Yunus · 发表于：Arthritis Care & Research · 年份：2010 · DOI：10.1002/acr.20140 · 被引用次数：3987 · 研究领域：Fibromyalgia and Chronic Fatigue Syndrome Research、Psychosomatic Disorders and Their Treatments、Spondyloarthritis Studies and Treatments

OBJECTIVE: To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. METHODS: We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale. RESULTS: Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9). CONCLUSION: This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia sympto...