diagnostic criteria for fibromyalgia
Last reviewed 01/2018
the American College of Rheumatology (ACR) criteria for the classification of fibromyalgia
The American College of Rheumatology 1990 criteria for the classification of fibromyalgia (1)
2) Pain in 11 of 18 tender point sites on digital palpation
Digital palpation should be performed with an approximate force of 4kg.
For classification purposes, patients will be said to have fibromyalgia if both criteria are satisfied.
- widespread pain involving both sides of the body, above and below the waist as well as the axial skeletal system, for at least three months
- presence of 11 tender points among the nine pairs of specified sites (18 points)
The presence of a second clinical disorder does not exclude the diagnosis of
- although quick and easy to do, 25% of patients diagnosed as having fibromyalgia did not have 11 tender points (2)
The American College of Rheumatology 2010 criteria for the classification of fibromyalgia (3)
The 31 point questionnaire was developed by ACR in 2010
- it does not require a tender-point count
- patients are assessed by
- the widespread pain index (WPI) - divides the body into 19 regions and scores how many regions are reported as painful
- a symptom severity score (SS) - assesses severity of fatigue, unrefreshing sleep, and cognitive symptoms
- provides a severity scale for associated fibromyalgia symptoms (2,3).
A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
- widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3 - 6 and SS scale score ≥9.
- symptoms have been present at a similar level for at least 3 months.
- the patient does not have a disorder that would otherwise explain the pain (3)
- (1) Wolfe F et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72
- (2) Rahman A, Underwood M, Carnes D. Fibromyalgia. BMJ. 2014;348:g1224
- (3) Wolfe F et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement ofsymptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600-10