title: Discriminative value of tender points in fibromyalgia syndrome.
abstract: OBJECTIVE
  The aim of this study is to assess the discriminative value of all tender points, alone and in combination, that are designated as criteria for fibromyalgia diagnosis by the American College of Rheumatology (ACR), by investigating the appropriate pressure magnitude that should be applied during tenderness examination.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  This study was performed on 66 patients with fibromyalgia diagnosed according to ACR classification criteria and 50 control subjects.
  
  
  METHODS
  The outpatient rheumatology clinic of a PM&R department of a university hospital. Intervention. Pressure pain threshold values were measured by a dolorimeter on nine specific point pairs in both groups and a cutoff value for discriminating positivity and negativity was calculated for each. Then the most valuable tender point pairs were assessed for discrimination of fibromyalgia syndrome using ACR criteria set as a reference standard.
  
  
  RESULTS
  All tender points with determined pressure cutoff values were found out to significantly discriminate fibromyalgia syndrome and their area under curve values ranged from 0.779 to 0.934. Univariate logistic regression analysis revealed that lateral epicondyle and supraspinatus point pairs had the most powerful discriminative ability (odds ratio = 113.6 and 45.0, respectively). Multiple logistic regression analysis with backward stepwise method showed that lateral epicondyle and second rib point pairs were most discriminative with sensitivity and specificity rates of 87.9-94.0% and 77.3-84.0%, respectively.
  
  
  CONCLUSIONS
  Fibromyalgia syndrome can have potential to be recognized simply by pressing fewer tender point areas but with various pressure cutoff levels identified for each tender point areas.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Edirne, Turkey. zentastekin@yahoo.com
authors.forename: Nurettin
authors.initials: N
authors.lastname: Tastekin
authors.forename: Kaan
authors.initials: K
authors.lastname: Uzunca
authors.forename: Necdet
authors.initials: N
authors.lastname: Sut
authors.forename: Murat
authors.initials: M
authors.lastname: Birtane
authors.forename: Oznur Berke
authors.initials: OB
authors.lastname: Mercimek
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis*; D006801:Humans; D016017:Odds Ratio; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold; D010173:Palpation; D011312:Pressure; D012372:ROC Curve; D012044:Regression Analysis