The American College of Rheumatology has just put forth a innovative set of Diagnostic Criteria for Fibromyalgia diagnosis.
Posted by Rowena Case on Friday, October 29, 2010
Just using tender-point exams could be no longer the only way to diagnose DoFollow fibromyalgia — the American College of Rheumatology has provisionally accepted alternate criteria for diagnosing the problem and gauging the severity of warning signs.
The diagnostic criteria physicians have been using were established in 1990. Once other feasible causes of manifestations were eliminated, diagnosis was based purely upon agony. It had to be on both sides of the body, both above and below the waist, along the axial skeleton (head, throat, chest, spine), and also in a minimum 11 of 18 specific places on the body that are called manifestations have to have been present for at least 3 months.
The 18 point tender-point exam has always been controversial for many reasons. First, it was originally intended as a qualifier for clinical studies, not as a diagnostic tool. Second, it’s subjective as a result it relies on a patient’s self-reported suffering. Third, due to the fact that warning signs fluctuate so much, the number of tender points may vary greatly from one exam to another.
Until we have a diagnostic proceedure that’s based on blood markers or imaging, we probably won’t have a perfect diagnostic test. (This is true of many diseases, especially neurological ones.) Still, researchers believe they’ve come up with something that does it's magic good — they believe when looking at the data from a group previously diagnosed with fibromyalgia sufferers, the tender-point exam was about 75% accurate, while the new criteria found it 88% of the time.
The new way for diagnosing Fibromyalgia
The new set of symptoms keep the requirements that other causes be ruled out and that signs have to have persisted for at least 3 months. They also includes 2 new methods of assessment, the widespread pain index (WPI) and the symptom severity (SS) scale score.
The WPI lists 19 areas of the body and you say where you’ve had suffering in the last week. You get 1 point for each area, so the score is 0-19.
For the SS scale score, the patient ranks specific indications on a scale of 0-3. These warning signs include:
• Fatigue
• Waking unrefreshed
• thinking difficulties
• Somatic (physical) manifestations in general (such as headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss)
The numbers assigned to each were added up, for a total of 0-12.
This next part is certainly interesting to me. Instead of looking for a hard score on each, there’s a number of flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that symptoms can fluctuate.
For a diagnosis you need EITHER:
1. WPI of a minimum of 7 and SS scale score of a minimum 5, OR
2. WPI of 3-6 and SS scale score of a minimum 9.
What this does is allow for people with fewer aching areas but more severe manifestations to be diagnosed.
Something else I actually like about this is that it finally includes Cognitive signs! For many of us, Cognitive failure or Fibro fog is as debilitating or even more debilitating than anguish, yet the old criteria didn’t even mention it. It also recognizes the difference between “tiredness” and “awakening unrefreshed,” which I believe is an under-recognized distinction in the medical community.
A instant note about “somatic warning signs”: strictly speaking, somatic means physical. The term has gotten a bad rap in the fibromyalgia community due to the fact that it’s been used to advise our manifestations could be the result of somatization, which means “physical manifestations of a psychological illness.” On its own, however, the word somatic does not imply a psychological basis.
The full article on the new criteria isn’t yet available for free online, but a PDF of an appendix including these criteria is. It has the list of excruciating areas for the WPI and a long list of somatic warning signs that could be considered.
If you’re undiagnosed or tentatively diagnosed, you may long to take that to your physician. Be sure to let him/her know that it’s from the American College of Rheumatology and was published in Arthritis Care & Research.
The diagnostic criteria physicians have been using were established in 1990. Once other feasible causes of manifestations were eliminated, diagnosis was based purely upon agony. It had to be on both sides of the body, both above and below the waist, along the axial skeleton (head, throat, chest, spine), and also in a minimum 11 of 18 specific places on the body that are called manifestations have to have been present for at least 3 months.
The 18 point tender-point exam has always been controversial for many reasons. First, it was originally intended as a qualifier for clinical studies, not as a diagnostic tool. Second, it’s subjective as a result it relies on a patient’s self-reported suffering. Third, due to the fact that warning signs fluctuate so much, the number of tender points may vary greatly from one exam to another.
Until we have a diagnostic proceedure that’s based on blood markers or imaging, we probably won’t have a perfect diagnostic test. (This is true of many diseases, especially neurological ones.) Still, researchers believe they’ve come up with something that does it's magic good — they believe when looking at the data from a group previously diagnosed with fibromyalgia sufferers, the tender-point exam was about 75% accurate, while the new criteria found it 88% of the time.
The new way for diagnosing Fibromyalgia
The new set of symptoms keep the requirements that other causes be ruled out and that signs have to have persisted for at least 3 months. They also includes 2 new methods of assessment, the widespread pain index (WPI) and the symptom severity (SS) scale score.
The WPI lists 19 areas of the body and you say where you’ve had suffering in the last week. You get 1 point for each area, so the score is 0-19.
For the SS scale score, the patient ranks specific indications on a scale of 0-3. These warning signs include:
• Fatigue
• Waking unrefreshed
• thinking difficulties
• Somatic (physical) manifestations in general (such as headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss)
The numbers assigned to each were added up, for a total of 0-12.
This next part is certainly interesting to me. Instead of looking for a hard score on each, there’s a number of flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that symptoms can fluctuate.
For a diagnosis you need EITHER:
1. WPI of a minimum of 7 and SS scale score of a minimum 5, OR
2. WPI of 3-6 and SS scale score of a minimum 9.
What this does is allow for people with fewer aching areas but more severe manifestations to be diagnosed.
Something else I actually like about this is that it finally includes Cognitive signs! For many of us, Cognitive failure or Fibro fog is as debilitating or even more debilitating than anguish, yet the old criteria didn’t even mention it. It also recognizes the difference between “tiredness” and “awakening unrefreshed,” which I believe is an under-recognized distinction in the medical community.
A instant note about “somatic warning signs”: strictly speaking, somatic means physical. The term has gotten a bad rap in the fibromyalgia community due to the fact that it’s been used to advise our manifestations could be the result of somatization, which means “physical manifestations of a psychological illness.” On its own, however, the word somatic does not imply a psychological basis.
The full article on the new criteria isn’t yet available for free online, but a PDF of an appendix including these criteria is. It has the list of excruciating areas for the WPI and a long list of somatic warning signs that could be considered.
If you’re undiagnosed or tentatively diagnosed, you may long to take that to your physician. Be sure to let him/her know that it’s from the American College of Rheumatology and was published in Arthritis Care & Research.
Tags: fibromyalgia diagnosis fibromyalgia symptoms american college of rheumatology
