Background The 2010 Fibromyalgia Diagnostic Criteria was designed for primary care1. The 2011 modification was a simplified version for self-reporting of fibromyalgia2. The 2016 revision combines both, and is supposed to be used also in tertiary setting3. This requires validation.
Objectives To validate the Proposed 2016 revision with respect to (1) expert physician diagnosis and (2) 1990 ACR Classification Criteria.
Methods Patients referred to a tertiary care centre with suspicion of Fibromyalgia were evaluated using the Proposed 2016 revision. Patients with other rheumatological diseases were excluded. Considering the expert physician opinion and American College of Rheumatology (ACR) 1990 Classification as gold standards, sensitivity, specificity, and likelihood ratios were calculated. Also, validated Hindi language versions of Brief Patient Health Questionnaire (BPHQ), Generalised Anxiety Disorder-7 (GAD7), and Toronto Alexithymia Scale-20 (TAS20) were filled up by the participants.
Results Out of 101 patients, 77 were diagnosed as Fibromyalgia by the expert. The 2016 criteria and ACR1990 criteria were met by 79 and 67 patients respectively. The 2016 had high sensitivity but much lower specificity as compared with either the expert diagnosis or ACR1990 criteria (Table 1). Visual Analogue Scale (VAS) for pain, BHPQ, GAD7, and TAS20 scores were 7.2±2.3, 14.1±5.1, 11.3±5.5 and 58.0±14.0 (Mean±SD) respectively. Patients with or without fibromyalgia as per each of the three criteria had no significant difference in these scores.
Conclusions Non-tender point based criteria have been validated in primary care. However, in tertiary care where patients are referred to as fibromyalgia, there are mimics with similar comorbidities as evident by high BPHQ, GAD7 and TAS20 scores. Even after exclusion of other rheumatological conditions, the 2016 Criteria has poor specificity. Thus, it should be used as a screening tool than a diagnostic criterion in tertiary care.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600–10.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun;38(6):1113–22.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016 Dec;46(3):319–329.
Disclosure of Interest None declared