The American College of Rheumatology has just finished a new set of Diagnostic Criteria for Fibromyalgia diagnosis.
Posted by Rowena Case on Friday, October 29, 2010
The American College of Rheumatology has just finished a new set of Diagnostic Criteria for Fibromyalgia diagnosis.
Just using tender-point exams are no longer the only way to diagnose DoFollow fibromyalgia — the American College of Rheumatology has provisionally accepted alternate criteria for diagnosing the condition and gauging the severity of warning signs.
The diagnostic criteria medics have been using were established in 1990. Once other conceivably possible causes of warning signs were eliminated, diagnosis was based purely upon suffering. 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 of 11 of 18 specific places on the body that are called symptoms have to have been present for a minimum 3 months.
The 18 point tender-point exam has always been controversial for a lot of reasons. First, it was originally intended as a qualifier for clinical studies, not as a diagnostic tool. Second, it’s subjective the plain truth is it relies on a patient’s self-reported suffering. Third, realistically indications fluctuate so much, the number of tender points will vary greatly from one exam to another.
Until we have a diagnostic exam that’s based on blood markers or imaging, we probably won’t have a perfect diagnostic proceedure. (This is true of many diseases, especially neurological ones.) Still, researchers believe they’ve come up with something that functions healthier — 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 criteria keep the requirements that other causes be ruled out and that manifestations have to have persisted for a minimum 3 months. They also includes 2 new methods of assessment, the widespread suffering index (WPI) and the symptom severity (SS) scale score.
The WPI lists 19 aspects 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 symptoms on a scale of 0-3. These signs include:
• Fatigue
• waking up unrefreshed
• Cognitive difficulties
• Somatic (physical) symptoms 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 in truth interesting to me. Instead of looking for a hard score on each, there’s some flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that warning signs will fluctuate.
For a diagnosis you need EITHER:
1. WPI of a minimum of 7 and SS scale score of a minimum of 5, OR
2. WPI of 3-6 and SS scale score of at least 9.
What this does is allow for people with fewer aching areas but more severe symptoms to be diagnosed.
Something else I honestly like about this is that it finally includes thinking warning signs! For many of us, mental failure or Fibro fog is as debilitating or even more debilitating than agony, yet the old criteria didn’t even mention it. It also recognizes the difference between “tiredness” and “Waking unrefreshed,” which I believe is an under-recognized distinction in the medical community.
A instant note about “somatic symptoms”: strictly speaking, somatic means physical. The term has gotten a bad rap in the fibromyalgia community due to the reason that it’s been used to recommend our warning signs 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 painful areas for the WPI and a long list of somatic manifestations that could be considered.
If you’re undiagnosed or tentatively diagnosed, you can require to take that to your doctor. Be sure to let him/her know that it’s from the American College of Rheumatology and was published in Arthritis Care & Research.
Just using tender-point exams are no longer the only way to diagnose DoFollow fibromyalgia — the American College of Rheumatology has provisionally accepted alternate criteria for diagnosing the condition and gauging the severity of warning signs.
The diagnostic criteria medics have been using were established in 1990. Once other conceivably possible causes of warning signs were eliminated, diagnosis was based purely upon suffering. 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 of 11 of 18 specific places on the body that are called symptoms have to have been present for a minimum 3 months.
The 18 point tender-point exam has always been controversial for a lot of reasons. First, it was originally intended as a qualifier for clinical studies, not as a diagnostic tool. Second, it’s subjective the plain truth is it relies on a patient’s self-reported suffering. Third, realistically indications fluctuate so much, the number of tender points will vary greatly from one exam to another.
Until we have a diagnostic exam that’s based on blood markers or imaging, we probably won’t have a perfect diagnostic proceedure. (This is true of many diseases, especially neurological ones.) Still, researchers believe they’ve come up with something that functions healthier — 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 criteria keep the requirements that other causes be ruled out and that manifestations have to have persisted for a minimum 3 months. They also includes 2 new methods of assessment, the widespread suffering index (WPI) and the symptom severity (SS) scale score.
The WPI lists 19 aspects 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 symptoms on a scale of 0-3. These signs include:
• Fatigue
• waking up unrefreshed
• Cognitive difficulties
• Somatic (physical) symptoms 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 in truth interesting to me. Instead of looking for a hard score on each, there’s some flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that warning signs will fluctuate.
For a diagnosis you need EITHER:
1. WPI of a minimum of 7 and SS scale score of a minimum of 5, OR
2. WPI of 3-6 and SS scale score of at least 9.
What this does is allow for people with fewer aching areas but more severe symptoms to be diagnosed.
Something else I honestly like about this is that it finally includes thinking warning signs! For many of us, mental failure or Fibro fog is as debilitating or even more debilitating than agony, yet the old criteria didn’t even mention it. It also recognizes the difference between “tiredness” and “Waking unrefreshed,” which I believe is an under-recognized distinction in the medical community.
A instant note about “somatic symptoms”: strictly speaking, somatic means physical. The term has gotten a bad rap in the fibromyalgia community due to the reason that it’s been used to recommend our warning signs 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 painful areas for the WPI and a long list of somatic manifestations that could be considered.
If you’re undiagnosed or tentatively diagnosed, you can require to take that to your doctor. 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 treatment
