Diagnosis of Fibromyalgia

FM should be considered in any person with musculoskeletal pain that is unrelated to any anatomic lesion. Since FM is a clinical diagnosis it requires only minimal screening laboratory tests to exclude other medical conditions such as rheumatoid arthritis, myositis, hypothyroidism, and lupus. Other laboratory studies (e.g., antinuclear antibodies, Lyme antibody) should be obtained only if there is compelling evidence that such a test is warranted. Because physical and laboratory abnormalities are generally absent in FM, the diagnosis is made by patient histories, self-reports, and physical examination – identification of tenderness at discrete anatomic sites called tender points under mild pressure.

The American College of Rheumatology (ACR) (Wolfe, et al. Arthritis & Rheumatism 33:160, 1990) has established general classification guidelines for FMref 8. These guidelines require that widespread aching for at least 3 months and a minimum of 11 out of 18 tender points (available on the Fibromyalgia Partners website). However, not all physicians and researchers agree with these guidelines. Some believe the criteria are too rigid and that FM can be present even if the required number of tender points is not met, while others question how reliable and valid tender points are as a diagnostic tool. Unfortunately, given the difficulties of diagnosing FM, it is estimated that it takes an average of 5 years from the time the patient first reports symptoms to the time when FM is formally diagnosedref 5.

References

  1. Wolfe, F et al. Prevalence of characteristics of fibromyalgia in the general population. Arthritis and Rheumatism 38:19-28, 1995.
  2. Guymer, E.K., & Clauw, D.J. Treatment of fatigue in fibromyalgia. Rheumatic Disease Clinics of North America28:367-378, 2002.
  3. Burckhardt, C.S. (2001). Fibromyalgia. In: Clinical Care in Rheumatic Diseases. Atlanta, GA: American College of Rheumatology.
  4. Boissevain, M.D., & McCain, G.A. Toward an integrated understanding of fibromyalgia syndrome: Psychological and phenomenological aspects. Pain45:239-248, 1991.
  5. Millea, P.J., Holloway R.L. Treating fibromyalgia. American Family Physician October 1, 2000.
  6. Burckhardt, C.S., Clark, S.R., & Bennett, R.M. Fibromyalgia and quality of life: a comparative analysis. Journal of Rheumatology20:475-479, 1993.
  7. Fitzcharles MA, DaCosta, D., & Poyhia, R. A study of standard care in fibromyalgia syndrome: A favorable outcome. Journal of Rheumatology30:154-159, 2003.
  8. Wolfe F., Smythe, H.A., Yunus, M.B. et al. The American College of Rheumatology Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis & Rheumatism33:160-172, 1990.
  9. Rao, S.G., Bennett, R.M. Pharmacological therapies in fibromyalgia. Best Practice & Research Clinical rheumatology17:611-627, 2003.
  10. Busch, A., Schachter, C.L., Peloso, P.M., & Bombardier, C. (2002). Exercise for treating fibromyalgia syndrome. The Cochrane Library, 3.
  11. Richards S.C.M., & Scott, D.L. Prescribed exercise in people with fibromyalgia: parallel group randomized trial.British Medical Journal325:185-188, 2002.

Updated: October 10, 2012

Kevin Fontaine, PhD

About Kevin Fontaine, PhD

Associate Professor of Medicine
Johns Hopkins University