This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination.
Diagnostic Criteria of Fibromyalgia
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.
1) WPI: note the number areas in which the patient has had pain over the last week. In how many areas has the patient had pain? Score will be between 0 and 19.
- Shoulder girdle, left
- Shoulder girdle, right
- Upper arm, left
- Upper arm, right
- Lower arm, left
- Lower arm, right
- Hip (buttock, trochanter), left
- Hip (buttock, trochanter), right
- Upper leg, left
- Upper leg, right
- Lower leg, left
- Lower leg, right
- Jaw, left
- Jaw, right
- Upper back
- Lower back
2) SS scale score:
- Waking unrefreshed
- Cognitive symptoms
For the each of the 3 symptoms above, indicate the level of severity over the past week using the following scale:
0 = no problem
1 = slight or mild problems, generally mild or intermittent
2 = moderate, considerable problems, often present and/or at a moderate level
3 = severe: pervasive, continuous, life-disturbing problems
Considering somatic symptoms in general, indicate whether the patient has:*
0 = no symptoms
1 = few symptoms
2 = a moderate number of symptoms
3 = a great deal of symptoms
The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.
* Somatic symptoms that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing
difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.
- Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. [Medline]
- Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun;38(6):1113-22. [Medline]
- Wolfe F, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Jon Russell I, Walitt B. Comparison of Physician-Based and Patient-Based Criteria for the Diagnosis of Fibromyalgia. Arthritis Care Res (Hoboken). 2016 May;68(5):652-9. [Medline]
Created Apr 25, 2018.