title: Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.
abstract: OBJECTIVE
  To develop a fibromyalgia (FM) survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010). We also created a new FM symptom scale to further characterize FM severity.
  
  
  METHODS
  The ACR 2010 consists of 2 scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR 2010 criteria by eliminating the physician's estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. We also created a 0-31 FM Symptom scale (FS) by adding the WPI to the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with FM, 845 with osteoarthritis (OA) or with other noninflammatory rheumatic conditions, 439 with systemic lupus erythematosus (SLE), and 5210 with rheumatoid arthritis (RA).
  
  
  RESULTS
  The modified ACR 2010 criteria were satisfied by 60% with a prior diagnosis of FM, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups based on FM severity variables. An FS score ≥ 13 best separated criteria+ and criteria- patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population.
  
  
  CONCLUSIONS
  A modification to the ACR 2010 criteria will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies.
authors.affiliation: National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 288, Wichita, KS 67214, USA. fwolfe@arthritis-research.org
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Fitzcharles
authors.forename: Don L
authors.initials: DL
authors.lastname: Goldenberg
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
authors.forename: Robert S
authors.initials: RS
authors.lastname: Katz
authors.forename: Philip
authors.initials: P
authors.lastname: Mease
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Russell
authors.forename: I Jon
authors.initials: IJ
authors.lastname: Russell
authors.forename: John B
authors.initials: JB
authors.lastname: Winfield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006306:Health Surveys / Q000639:trends*; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology