ANAHEIM, Calif.—(11 August 2010) The American College of Rheumatology (ACR) published a new set of diagnostic criteria for fibromyalgia in the May 2010 issue of its journal Arthritis Care & Research. The most significant changes to the criteria, first established by the ACR in 1990, propose to replace the tender point test with a widespread pain index and a symptom severity scale.
Response from National Fibromyalgia Association
The National Fibromyalgia Association (NFA) is extremely pleased that the American College of Rheumatology is in the process of updating the diagnostic criteria for fibromyalgia. It is a positive initial step to a better diagnosis, especially for the doctors who are not familiar with diagnosing and treating fibromyalgia.
However, the NFA is very concerned that the new criteria propose to remove the element of tenderness from fibromyalgia. The tender point criterion is the one defining feature of fibromyalgia, along with the history of chronic widespread body pain lasting longer than three months.
To eliminate one-half of the 1990 ACR fibromyalgia diagnostic criteria seems unusually aggressive, especially when a suitable replacement for tenderness has not been included in the new preliminary diagnostic criteria. Although the manual tender point examination may be cumbersome and not easily accessible for those healthcare professionals interested in learning more about how to diagnose and treat FM, the procedure should not be looked at any differently than learning and executing a neurological examination which, unlike the FM tender point examination, is taught to all physicians during medical school.
Perhaps, instead of eliminating the tender point examination, a concerted effort should be set forth by the National Institutes of Arthritis, Musculoskeletal and Skin Diseases to establish the FM tender point examination as part of the arthritis medical school curriculum for all graduating physicians.
By taking away the relevance of tenderness and relying instead on symptoms returns fibromyalgia to its early 1980s classification as a “wastebasket diagnosis.” Putting a greater emphasis on “somatic” symptoms could also result in a more psychological designation for fibromyalgia as opposed to a neurological description in terms of diagnosis, treatment management and access to care issues. If this diagnostic approach continues, we are in jeopardy of losing fibromyalgia as an entity altogether.
NFA Scientific Article Review
A report and opinion on the preliminary guidelines for the clinical diagnostic criteria for fibromyalgia
By Robert Bennett, MD
In this article, rheumatologist Dr. Robert Bennett, a world-renowned fibromyalgia researcher, offers an overview of the updated criteria as well as his views regarding both the positive and negative attributes of this new diagnostic standard. The article is published in the inaugural issue of the National Fibromyalgia Association (NFA) Healthcare Professional Newsletter, a quarterly publication that offers HCPs up-to-date information regarding fibromyalgia (FM). To register and view Dr. Bennett’s article, visit www.FibromyalgiaHCP.org, please take a moment to fill out the form so you can continue to receive fibromyalgia e-alerts as well as the HCP quarterly newsletter.