title: The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity.
abstract: OBJECTIVE
  The polysymptomatic distress (PSD) scale is derived from variables used in the 2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for survey and clinical research. The scale is useful in measuring the effect of PSD over the full range of pain-related clinical symptoms, not just in those who are FM criteria-positive. However, no PSD scale categories have been defined to distinguish severity of illness in FM or in those who do not satisfy the FM criteria. We analyzed the scale and multiple covariates to develop clinical categories and to further validate the scale.
  
  
  METHODS
  FM was diagnosed according to the research criteria modification of the 2010 ACR FM criteria. We investigated categories in a large database of patients with pain (2732 with rheumatoid arthritis) and developed categories by using germane clinic variables that had been previously studied for severity groupings. By definition, FM cannot be diagnosed unless PSD is at least 12.
  
  
  RESULTS
  Based on population categories, regression analysis, and inspections of curvilinear relationships, we established PSD severity categories of none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). Categories were statistically distinct, and a generally linear relationship between PSD categories and covariate severity was noted.
  
  
  CONCLUSIONS
  PSD categories are clinically relevant and demonstrate FM type symptoms over the full range of clinical illness. Although FM criteria can be clinically useful, there is no clear-cut symptom distinction between FM (+) and FM (-), and PSD categories can aid in more effectively classifying patients.
authors.affiliation: From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München. fwolfe@arthritis-research.org.
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.affiliation: From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Walitt
authors.affiliation: From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Rasker
authors.affiliation: From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Katz
authors.affiliation: From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012219:Rheumatology; D012720:Severity of Illness Index; D063189:Symptom Assessment
keywords: CATEGORIES; FIBROMYALGIA; POLYSYMPTOMATIC DISTRESS; SCALE