Revising Fibromyalgia: One Year Later

What do rheumatologists consider to be fibromyalgia when they diagnose it in practice? Answering this question was the basis for the “ACR preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity,” published in May 2010.¹

The 2010 criteria build upon—but do not replace—the “ACR 1990 criteria for the classification of fibromyalgia: Report of the Multicenter Criteria Committee,” which were written as classification criteria and not clinical diagnostic criteria.² Advances in the understanding of fibromyalgia and concerns about how the 1990 criteria functioned for fibromyalgia diagnosis prompted the investigators to revisit the issue and create the 2010 criteria, which the ACR endorsed.

In addition to developing diagnostic criteria for fibromyalgia that are in line with the way the disease was being identified by rheumatologists, the authors of the 2010 criteria hope that the guide will facilitate diagnosis and management of fibromyalgia by primary care physicians.

The Rheumatologist recently spoke with several fibromyalgia experts about the process of developing the 2010 criteria and how the new criteria are being received and implemented, both within and outside of the rheumatology community.

Another Look at Fibromyalgia

In 2008, several members of the 1990 fibromyalgia criteria committee began discussing efforts to revise the criteria. Two years after those conversations, the project was complete with participation from 113 ACR members and 893 patients in the key study.

Regarding the speed of the effort, “that’s all Fred Wolfe,” jokes Don Goldenberg, MD, chief rheumatologist at Newton Wellesley Hospital in Newton, Mass., and professor of medicine at Tufts University School of Medicine in Boston. A member of the 1990 and 2010 fibromyalgia criteria committees, Dr. Goldenberg was key in engaging Dr. Wolfe in the revision effort, because Dr. Wolfe had distanced himself professionally from fibromyalgia.

This consensus-based approach, with the study performed in community rheumatology clinics, was a departure and reflects lessons learned from the 1990 fibromyalgia criteria. “Unfortunately, the 1990 committee, myself included, had a singular idea about fibromyalgia, which may be have been incorrect,” concedes Frederick Wolfe, MD, leader of the National Data Bank for Rheumatic Diseases in Wichita, Kan., and lead author for both the 1990 and 2010 fibromyalgia criteria sets. “The 1990 ACR fibromyalgia committee believed in the Smythe and Modolfsky definition for fibromyalgia with widespread pain, lots of tender points, fatigue, and unrefreshed sleep.” The study testing the 1990 criteria was designed to support the expert opinion; hence the tender point criteria and widespread pain became the most specific factors and defined the criteria. “The 1990 criteria was the most circular thing we have done,” says Dr. Wolfe.