Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician‐Based Fibromyalgia Diagnosis in a University Clinic

Wolfe, Frederick; Schmukler, Juan; Jamal, Shakeel; Castrejón, Isabel; Gibson, Kathryn A.; Srinivasan, Sachin; Haüser, Winfried; Pincus, Theodore

doi:10.1002/acr.23731

Cited by 53 publications

(52 citation statements)

References 40 publications

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“…Some other studies have also looked at the concordance issue. In a university rheumatology clinic, 50.4% of 104 consecutive patients with a fibromyalgia clinical diagnosis also satisfied fibromyalgia criteria, and 24.3% of 121 criteria-positive patients received a clinical diagnosis of fibromyalgia (22). Agreement beyond chance was only fair: kappa 0.41.…”

Section: Discussionmentioning

confidence: 99%

The Problematic Nature of Fibromyalgia Diagnosis in the Community

Srinivasan¹,

Maloney²,

Wright³

et al. 2019

ACR Open Rheumatology

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BackgroundRecently, some studies suggested that clinical diagnosis of fibromyalgia is inaccurate and does not reflect current definitions. However, this hypothesis has not been tested. We examined whether fibromyalgia was accurately diagnosed in the community.MethodsWe surveyed 3276 primary care patients to determine current fibromyalgia status by criteria (CritFM). We also determined whether the patients had a physician's diagnosis of fibromyalgia (MDFM) and the level of symptom severity as measured by the polysymptomatic distress scale (PSD).ResultsThe prevalence of MDFM and CritFM was 6.1% (95% confidence interval [CI] 5.3%, 6.9%) and 5.5% (95% CI 4.8%, 6.3%), respectively. However, only 32.2% with MDFM met 2016 criteria (CritFM), and only 35.4% with CritFM also had MDFM. The kappa statistic for diagnostic agreement was 0.296 (minimal agreement). The mean PSD score was 12.4 and 18.4 in MDFM and CritFM, respectively. The odds ratio for being a woman compared with being a man was 3.2 for MDFM versus 1.9 for CritFM, P = 0.023. Of the patients with MDFM, 68.3% received specific fibromyalgia pharmacotherapy.ConclusionsThere is little agreement between MDFM and CritFM. Only one‐third of MDFM satisfy fibromyalgia criteria, and only one‐third of patients who meet the criteria have a clinical diagnosis of fibromyalgia. Physician diagnosis is biased and more likely in women. Fibromyalgia treatment is common in MDFM (70.7%). Overall, MDFM appears subjective and unrelated to fibromyalgia criteria. There appears to be no common definition of fibromyalgia in the community.

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Section: Discussionmentioning

confidence: 99%

The Problematic Nature of Fibromyalgia Diagnosis in the Community

Srinivasan¹,

Maloney²,

Wright³

et al. 2019

ACR Open Rheumatology

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“…There are no clear boundaries between what is and what is not FM (32). A number of studies have found substantial discordance between patient-reported diagnosis of FM and assessment using FM criteria (33)(34)(35). While there are many potential reasons for such discordance, uncertainty related to criteria may be one contributing factor.…”

Section: Discussionmentioning

confidence: 99%

Modified 2016 American College of Rheumatology Fibromyalgia Criteria, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks–American Pain Society Pain Taxonomy, and the Prevalence of Fibromyalgia

Haüser

Brähler

Ablin

et al. 2021

Arthritis Care & Research

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Objective To study the prevalence of fibromyalgia (FM) in the general population according to a 2016 modification of the American College of Rheumatology criteria (FM 2016) and the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks–American Pain Society pain taxonomy criteria (AAPT), and to compare diagnostic and clinical variables between the criteria sets. Methods We studied 2,531 randomly selected subjects from the German general population in 2019. Pain regions from the Michigan Body Map were fitted to the FM 2016 and the AAPT criteria, and criteria symptom items were derived from validated questionnaires assessing somatic and psychological symptom burden and disability. We determined FM criteria prevalence and criteria‐related scales including widespread and multisite pain (MSP) and symptom scales, and measured symptom burden and disability. Results According to the FM 2016 criteria, the prevalence of FM was 3.4% (n = 75 subjects; 95% confidence interval [95% CI] 2.7, 4.3) compared with 5.7% (n = 130 subjects; 95% CI 4.8, 6.8) for the AAPT criteria; κ = 0.65. Compared with AAPT‐positive subjects, FM 2016–positive subjects had higher MSP, Widespread Pain Index score, Polysymptomatic Distress Scale scores, Symptom Severity Scores, and psychological symptom burden. Physician‐diagnosed FM was reported by 1.1% of the subjects. Of these, 44.0% met the FM 2016 criteria, and 47.5% met the AAPT criteria. Conclusion The prevalence of FM in the German general population is 73% greater using the AAPT criteria than the FM 2016 criteria. The AAPT criteria select individuals with less symptom severity and fewer pain sites. The FM 2016 criteria, but not the AAPT criteria, provide a general severity measure for FM.

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“…More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [ 24 ].…”

Section: Diagnosismentioning

confidence: 99%

Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies

Maffei

2020

IJMS

105

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Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules.

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Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician‐Based Fibromyalgia Diagnosis in a University Clinic

Cited by 53 publications

References 40 publications

The Problematic Nature of Fibromyalgia Diagnosis in the Community

The Problematic Nature of Fibromyalgia Diagnosis in the Community

Modified 2016 American College of Rheumatology Fibromyalgia Criteria, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks–American Pain Society Pain Taxonomy, and the Prevalence of Fibromyalgia

Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies

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