Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting
- 20 Downloads
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.
KeywordsFibromyalgia Diagnosis Stress disorders, posttraumatic
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.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
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.
Ethical approval was obtained from the Institutional Ethics Committee, SGPGIMS, Lucknow. All patients gave written informed consent before inclusion into the study.
- 1.Sumpton JE, Moulin DE (2014) Fibromyalgia. Handb Clin Neurol 119:513–527. https://doi.org/10.1016/B978-0-7020-4086-3.00033-3 CrossRefGoogle Scholar
- 5.Smythe HA (2004) Fibromyalgia among friends. J Rheumatol 31:627–630Google Scholar
- 8.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 CrossRefGoogle Scholar
- 10.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 CrossRefGoogle Scholar
- 12.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 CrossRefGoogle Scholar
- 14.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–S58Google Scholar
- 25.Treatment C for SA (2009) Appendix E: DSM-IV-TR criteria for posttraumatic stress disorder. Substance abuse and mental health services administration (US)Google Scholar
- 27.Yancey JR, Thomas SM (2012) Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician 86:741–746Google Scholar
- 32.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 CrossRefGoogle Scholar
- 34.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):39–43Google Scholar
- 36.Häuser W, Sarzi-Puttini P, Fitzcharles M-A (2019) Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol 37(Suppl 116):90–97Google Scholar